History of breast implants. Back to the future

Modern breast implants are a staple of plastic surgery, finding uses in esthetic and reconstructive procedures. Their history began in the 1960s, with the first generation of smooth devices with thick silicone elastomer, thick silicone gel, and Dacron patches on the back. They presented hard consistency, high capsular contracture rates and the patches increased the risk of rupture. In the same decade, polyurethane coating of implants was implemented. A sec- ond generation was introduced in the 1970s with a thinner shell, less viscous gel filler and no patches, but increased silicone bleed- through and rupture rates. The third generation, in the early 1980s, featured implants with a thicker multilayered elastomer shell rein- forced with silica to reduce rupture risk and prevent silicone bleed- through. A fourth generation from the late 1980s combined thick outer elastomer shells, more cohesive gel filler, and implemented for the first-time outer shell texturing. In the early 1990s, the fifth generation of devices pioneered an anatomical shape with highly cohesive form-stable gel filler and a rough outer shell surface. Sur- face texturing was hampered by the discovery of Breast Implant Associated-Anaplastic Large Cell Lymphoma and its link with tex- tured devices. From the 2010s, we have the era of the sixth gen- eration of implants, featuring innovations regarding the surface, with biomimetic surfaces, more resistant shells and variations in gel consistency. The road to innovation comprises setbacks such as the FDA moratorium in 1992, the PIP scandal, the Silimed CE mark temporary suspension and the FDA-requested voluntary recall of the Allergan BIOCELL implants.