Technique is commonly referred to in Europe as “The Boob Jab”

Macrolane is a gel compound made up of nonanimal hyaluronic acid. It’s similar to Restylane and Juvederm. It is made by a company called Q-Med. The substance has been on the market in the UK since early 2008. It is touted as an alternative to surgical breast enhancement. The proponents state that it only requires a local anesthetic and will not leave a scar. Bruising, swelling, and discomfort for a few days are expected.

The results are quite modest, (usually one cup size). The injection needles are on the large side. The effect reportedly lasts for 12 months, after which further injections are required. The cost of this procedure is close to the price of a standard augmentation with an implant. The procedure has drawn criticism since its long term effects are unknown. It is not FDA approved for use in the United States, nor is it approved for use in Canada.

The idea of injecting substances into the breast is not new. Silicone, (out of the drum), was injected into women in Korea during the war as they desired larger breasts to attract the American G.I.’s. The result was crippling scarring and contracture that often needed formal mastectomy and reconstructive surgery to correct.

Fat for breast augmentation has also been tried decades ago and was a failure. Cysts, seromas, necrosis, and scarring occurred. Arguably worse, fat can calcify in the breast. Calcifications on mammogram are cancer until proven otherwise. Many women had biopsies or even mastectomies because of this. Some plastic surgeons with extensive experience in fat transplantation have a renewed interest in a limited fashion, and so there are some ongoing studies.

“The American Society for Aesthetic Plastic Surgery, (ASAPS), and the American Society of Plastic Surgeons, (ASPS), in the interest of patient safety, do not recommend fat grafting for breast enhancement at this time. Because there is little clinical evidence available to document safety and efficacy, we urge patients to consider the procedure as one undergoing continued evaluation.”

In light of the fact that 1 in 8 women will have breast cancer, the idea of injecting material, (although safe in other areas), into the breast tissue is not recommended. If breast volume is what is desired, the best option as of this writing remains a standard breast augmentation.

References:
McCleave MJ. Is Breast Augmentation Using Hyaluronic Acid Safe? Aesthetic Plast Surg. 2009 Dec 5.

American Society for Aesthetic Plastic Surgery.
http://www.surgery.org/media/news-releases/fat-grafting-for-breast-augmentation-%E2%80%93-what-women-should-know–

This is one of my favorite questions.  The word “plastic” derives from the Greek plastikos, meaning, to mold or to form.  Carl Ferdinand Von Graefe coined the term Plastic Surgery in Germany in 1818.  Plastic Surgeons reform or reshape tissue, and have done so for thousands of years before the moldable plastic material that we see all around us was invented.

Plastic Surgery is defined as the surgical specialty or procedure concerned with the restoration, construction, reconstruction, or improvement in the form, function, and appearance of body structures that are missing, defective, damaged, or misshapen. It encompasses both reconstructive and aesthetic surgery.

A Brief History:

Plastic Surgery has been around for 2000 years before Christ, where surgeons in India were doing reconstructive surgeries.  This was for a variety of reasons.  Commonly, when one was caught stealing in ancient India, they cut off the offenders nose and put him in prison.  Once released, people wanted a nose back.  The ancient Indian Surgeons rotated tissue and filled in the defect.  In this case, Sushruta is considered to be the Father of Surgery, and was performing Plastic Surgery in 6^th century B.C.   His works mentioned many plastic surgical procedures.

Ancient Egyptians and Romans also performed Plastic Surgical procedures.

The first American Plastic Surgeon was John Peter Mettauer, who in 1827 performed the first cleft palate operation with instruments that he designed himself.

The specialty advanced rapidly in the 20^th century.  Anesthesia techniques became better.  Two World Wars provided unfortunate opportunity for the creation and refinement of reconstructive techniques.  Joseph Murray, a plastic surgeon, performed the first successful transplant, (a kidney transplant between identical twins), in 1954.  It was successful because no immunosuppression was necessary in genetically identical twins.

There are many aspects of Plastic Surgery.

Reconstructive Surgery is performed to correct functional impairments caused by; burns, trauma, (i.e. facial bone fractures), congenital abnormalities, developmental abnormalities, tumor, infection or other disease.  Microsurgery, Craniofacial Surgery, Hand Surgery, Pediatric Surgery are all disciplines of Reconstructive Plastic Surgery.  Surgery is usually performed to improve function, but it can also be done to approximate a normal appearance.

Cosmetic and Aesthetic Surgery involves techniques intended for enhancement of appearance.  It is also involved with maintaining normal appearance, restoring it, or enhancing it.

Knowledge of Reconstructive and Aesthetic techniques cross applies.  For example, when confronted with a traumatic nose injury, the first priority is function, but if given the opportunity, aesthetic form can be taken into consideration as well, for the best long term result for the patient.

Plastic Surgery It is a never ending quest for the best technique, materials, and support for the patient.  I had a Professor once tell me, “If you get bored in Plastic Surgery, you are not reading enough.”  There is always something new, even if the specialty’s history is long…

References:

American Society of Plastic Surgeons. 
http://www.plasticsurgery.org/Patients_and_Consumers/The_Story_of_Plastic_Surgery.html

American Board of Plastic Surgery.

https://www.abplsurg.org/ModDefault.aspx?section=AboutDPS

Stedman’s Medical Dictionary.  Stedman’s Medical Dictionary 28th Edition, Copyright© 2006_Lippincott Williams & Wilkins.