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From Wikipedia, the free encyclopedia
Surgery

A typical modern surgical operationFor other uses, see Surgery (disambiguation).
Surgery (from the Greek cheirourgia meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment. Surgeons may be physicians, dentists, or veterinarians who specialize in surgery.
A surgery can also refer to the place where surgery is performed, or simply the office of a physician, dentist, or veterinarian.

Contents
1 History of surgery
2 Development of modern surgery
3 Diseases that can be treated by surgery
4 Common surgical procedures
5 Noted surgeons
6 See also (surgeries)

History of surgery
The earliest known surgical procedure is trepanation, also known as trephinning or trepanning, in which a hole is drilled or scraped into the skull, leaving the membrane around the brain intact. A trepanned cranium found near Kiev, Ukraine, is the oldest yet found, dating back to 7300-6220 BC. Trepanation attempts to address health problems that relate to abnormal intracranial pressure, and has been found in cultures around the world. Modern surgery has largely abandoned this practice, although it is still used in cases of acute subdural hematomas and acute epidural hematomas.
Researchers have also uncovered an Ancient Egyptian mandible, dated to approximately 2750 BC, having two perforations just below the root of the first molar, indicating the draining of an abscessed tooth. Recent excavations of the construction workers of the Egyptian pyramids also led to the discovery of evidence of brain surgery on a labourer, who continued living for two years afterwards.
Indian physician Sushrutha(600 BC) is an important figure in the history of surgery. He lived, taught and practiced his art of surgery on the banks of the Ganges in the area that corresponds to the present day city of Benares in North-West India. Because of his seminal and numerous contributions to the science and art of surgery he is also known by the title "Father of Surgery". Much of what is known about this inventive surgeon is contained in a series of volumes he authored, which are collectively known as the Susrutha Samhita. It is the oldest known surgical text and it describes in exquisite detail the examination, diagnosis, treatment, and prognosis of numerous ailments.
Surgeons are now considered to be specialised physicians, the profession of surgeon and that of physician have different historical roots and surgeons have now even subspecialised as have physicians. For Example, Greek tradition was against opening the body and the Hippocratic Oath warns physicians against the practice of surgery, specifically that cutting persons laboring under the stone, i.e. lithotomy, an operation to relieve kidney stones, was to be left to such persons as practice [it]. Of course, most knowledge of surgery comes from dissecting bodies, a science which was repulsive to many healers.
By the thirteenth century, many European towns were demanding that physicians have several years of study or training before they could practice. Montpellier, Padua and Bologna Universities were particularly interested in the academic side to Surgery, and by the fifteenth century at the latest, Surgery was a separate university subject to Physic. Surgery had a lower status than pure medicine, beginning as a craft tradition until Rogerius Salernitanus composed his Chirurgia, which laid the foundation for the species of the occidental surgical manuals, influencing them up to modern times.
Among the first modern surgeons were battlefield doctors in the Napoleonic Wars who were primarily concerned with amputation. Naval surgeons were often barber-surgeons, who combined surgery with their main jobs as barbers.
In London, an operating theatre or operating room from the day before modern anaesthesia or antiseptic surgery still exists, and is open to the public. It is found in the roof space of St Thomas Church, Southwark, London and is called the Old Operating Theatre.

Development of modern surgery
Before the advent of anaesthesia, surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering. This also meant that operations were largely restricted to amputations and external growth removals. In addition, the need for strict hygiene during procedures was little understood, which often resulted in life threatening post-operative infections in patients.
Beginning in the 1840s, surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform. In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. In addition, the discovery of muscle relaxants such as curare allowed for safer applications.
However, the move to longer operations increased the danger of dangerous complications since the prolonged exposure of surgical wounds to the open air heightened the chance of infections. It was only in the late 19th century with the rise of microbiology with scientists like Louis Pasteur and innovative doctors who applied their findings like Joseph Lister did the idea of strict cleanliness and sterile settings during surgery arise. In the United Kingdom, surgeons are distinguished from physicians by being referred to as "Mister." This tradition has its origins in the 18th century, when surgeons were barber-surgeons and did not have a degree (or indeed any formal qualification), unlike physicians, who were doctors with a university medical degree.
By the beginning of the 19th century, surgeons had obtained high status, and in 1800, the Royal College of Surgeons (RCS) in London began to offer surgeons a formal status via RCS membership. The title Mister became a badge of honour, and today only surgeons who hold the Membership or Fellowship of one of the Royal Surgical Colleges are entitled to call themselves Mister, Miss, Mrs or Ms.
In contrast, North American physicians and surgeons are always addressed as "Doctor."

Diseases that can be treated by surgery
Intraoperative X-Ray of a Humerus fixated by Kirschner wiresTrauma
Anatomical Abnormalities
Disorders of function
Inflammation
Ischaemia and infarction
Metabolic disorders
Neoplasia
Other abnormalities of tissue growth, e.g. cysts, hyperplasia or hypertrophy
Common surgical procedures
Of the eight most common surgical procedures in the US, four are obstetric:
episiotomy,
repair of obstetric laceration,
cesarean section, and
artificial rupture of the amniotic membrane.
The most common non-obstetric surgeries include:
dental extraction
circumcision
According to 1996 data from the US National Center for Health Statistics, 40.3 million inpatient surgical procedures were performed in the United States in 1996, followed closely by 31.5 million outpatient surgeries.

For more information on Surgery, please visit Wikipedia

From Wikipedia, the free encyclopedia
Plastic Surgery
"Facial reconstruction" redirects here. For the identification of skeletal remains, see Forensic facial reconstruction.
Plastic surgery is a general term for operative manual and instrumental treatment which is performed for functional or aesthetic reasons. The word "plastic" derives from the Greek plastikos meaning to mold or to shape; its use here is not connected with modern plastics.
The principal areas of plastic surgery include two broad fields.
Reconstructive surgery, including microsurgery, focuses on undoing or masking the destructive effects of trauma, surgery or disease. Reconstructive surgery may include closing defects with flaps�that is, by moving tissue from other parts of the body.
Cosmetic (or aesthetic) surgery is most often performed in order to change features the patient finds unflattering. In many cases, however, there are medical reasons (for example, breast reduction when orthopedic problems are present).
Contents
1 History
2 Reconstructive surgery
3 Cosmetic surgery
4 Related disciplines
5 Addiction to cosmetic surgery

History
The history of cosmetic surgery reaches back to the ancient world. Physicians in ancient India including the great Indian surgeon Susrutha were utilizing skin grafts for reconstructive work as early as the 8th century BC and performed nose reconstruction, using a portion of the forehead, during periods where amputation of the nose was a punishment for certain crimes. The Romans were able to perform simple techniques such as repairing damaged ears from around the 1st century BC. In mid-15th century Europe, Heinrich von Pfolspeundt described a process "to make a new nose for one who lacks it entirely, and the dogs have devoured it" by removing skin from the back of the arm and suturing it in place. However, because of the dangers associated with surgery in any form, especially that involving the head or face, it was not until the 19th and 20th centuries that such surgeries became commonplace.
The U.S.'s first plastic surgeon was Dr. John Peter Mettauer. He performed the first cleft palate operation in 1827 with instruments that he designed himself. Sir Harold Gillies developed many of the techniques of modern plastic surgery in caring for those who suffered facial injuries in World War I; he is considered to be the father of modern plastic surgery. His work was expanded upon during World War II by one of his former students and cousin, Archibald McIndoe, who pioneered treatments for RAF aircrew suffering from severe burns. McIndoe's radical, experimental treatments, lead to the formation of the Guinea Pig Club.

Reconstructive surgery
Common reconstructive surgeries are: breast reconstruction for women who have had a mastectomy, cleft lip and palate surgery, contracture surgery for burn survivors, and closing skin and mucosa defects after removal of tumors in the head and neck region. Sex reassignment surgery for transsexual people is another example of reconstructive surgery.
Plastic surgeons have developed the use of microsurgery to transfer tissue for coverage of a soft tissue defect when no local tissue is available. Tissue, such as a muscle, may be removed from the body, moved to another site on the body and reconnected to a blood supply by suturing blood vessels as small as 1-2 mm in diameter.
There is a definite gray area between reconstructive and cosmetic surgery. Many of the techniques of cosmetic surgery are utilized in reconstructive surgery to improve cosmesis.

Cosmetic surgery
Cosmetic surgery is a very popular avenue for personal enhancement, as demonstrated by the 11.9 million cosmetic procedures performed in the U.S. alone in 2004. As for any operation, cosmetic procedures involve risk, and should therefore not be undertaken lightly. Within the US, critics of plastic surgery note that it is legal for any doctor, regardless of speciality, to perform "cosmetic surgery", but not "plastic surgery". It is thus important to distinguish the terms "plastic surgery" and "cosmetic surgery": Plastic Surgery is recognized by the American Board of Medical Specialties (the only official entity overseeing physician certification in the United States) as the subspecialty dedicated to the surgical repair of defects of form or function -- this includes cosmetic (or aesthetic) surgery, as well as reconstructive surgery. The term "cosmetic surgery" however, simply refers to surgery that is designed to improve cosmetics, or appearance. (One could argue that reconstructive surgery always has some cosmetic aspect to it, because form and function are often both important in plastic surgery repairs.) Thus there is no real art of "cosmetic surgery": it is a catch-all commercial phrase that laypeople understand easily and non-plastic surgeons eagerly use because they are not allowed to use the term "plastic surgery".
It is vital to check a physician's credentials, looking for those MDs who are actually board-certified by the American Board of Plastic Surgery. Plastic Surgery training takes 5 to 7 years of surgical residency training after medical school, and even more depending on the residency program. Because cosmetic surgery is seen as lucrative, non-plastic surgeons who receive fewer years of training for their specialty, advertise that they perform "cosmetic surgery" which is not a true specialty, only a commercial term. Thus to gain cerdibility, these non-plastic surgeons have gotten together to draft fake "medical boards" that are NOT recognized by the American Board of Medical Specialties, such as "American Board of Cosmetic Surgery" and "American Board of Facial Plastic and Reconstructive Surgery," both of which have been created and easily fool the layperson into thinking these physicians have actually been trained in Plastic Surgery. Remember, the American Board of Medical Specialties only recognizes the American Board of Plastic Surgery for certification of Plastic Surgeons in the United States, and require rigorous training standards in order to provide safe medical and surgical care.
The most prevalent aesthetic/cosmetic procedures are listed below. Most of these types of surgery are more commonly known by their "common names." These are also listed when pertinent.
Abdominoplasty (or "tummy tuck"): reshaping and firming of the abdomen
Blepharoplasty (or "eyelid surgery"): Reshaping of the eyelids or the application of permanent eyeliner, including Asian blepharoplasty
Augmentation Mammaplasty (or "breast enlargement" or "boob job"): Augmentation of the breasts. This can involve either saline or silicone gel prosthetics.
Buttock Augmentation (or "butt augmentation" or "butt implants"): Enhancement of the buttocks. This procedure can be performed by using silicone implants or fat grafting and transfer from other areas of the body.
Chemical peel: Removal of acne scars and sagging skin�not technically surgery and can be performed by a cosmetologist. Chemical peels commonly involve Phenol, TCA, or Glycolic acid as the active agent. Phenol peels, while the most effective, require cardiac monitoring and require longer recovery periods, thus diminishing their current popularity.
Mastopexy (or "breast lift"): Raising of sagging breasts
Labiaplasty: Surgical reduction and reshaping of the labia
Rhinoplasty (or "nose job"): Reshaping of the nose
Otoplasty (or ear surgery): Reshaping of the ear
Rhytidectomy (or "face lift"): Removal of wrinkles and signs of aging from the face
Suction-Assisted Lipectomy (or liposuction): Removal of fat from the body
Chin augmentation: Augmentation of the chin with an implant (e.g. silicone) or by sliding genioplasty of the jawbone.
Cheek augmentation
Collagen, fat, and other tissue filler injections
Mesotherapy : An alternative to liposuction where fluids are injected to break down and dissolve the fat. This area is still under investigation for both efficacy and safety. There have been many episodes of dangerous and deceptive practices involved with mesotherapy as practiced. Currently the American Society of Plastic Surgery does not endorse this procedure outside of controlled trials with IRB oversite.

Related disciplines
Plastic surgery is a broad field, and may be subdivided further. Plastic surgery training and approval by the American Board of Plastic Surgery includes mastery of the following as well:
Craniofacial surgery mostly revolves around the treatment of pediatric congenital anomalies, such as cleft lip and palate, craniosynostosis, and other disturbances in facial growth and development. Because these children have multiple issues, they are often taken care of in an interdisciplinary approach which include oral surgeons, otolaryngologists, speech therapists, occupational therapists, geneticists.
Hand surgery is a field that has some overlap with general surgeons and orthopedic surgeons (see Hand surgeon). Plastic surgeons receive full training in hand surgery, with some trainees deciding even to do an additional full-year hand fellowship afterwards (this fellowship can also be pursued by general surgeons and orthopedic surgeons). In particular, plastic surgeons receive training in microvascular surgery, which is needed to replant and amputated hand or digit. Many hand operations (such as reconstruction of injuries, replantations, rheumatoid surgery and surgery of congenital defects) are performed by plastic surgeons.
Maxillofacial surgery is surgery of the "maxilla" (which means jaw) and face, and is an important aspect of plastic surgery. This field grew from contributions by both the plastic surgeons and oral surgeons. Examples of repairs here would be traumatic fractures of the jaw and face (such as from fights or vehicle accidents), tumors of the jaw and face.

Addiction to cosmetic surgery
Some people appear to become addicted to cosmetic surgery, possibly because of body dysmorphic disorder. Sufficient amounts of repeated cosmetic surgery can lead to irreversible damage to the normal body structure. However, due to the high cost of repeated cosmetic surgery, this disorder is generally one limited to the wealthy. However, others have been known to take out loans for repeat procedures.

For more information on Plastic Surgery, please visit Wikipedia

From Wikipedia, the free encyclopedia
Liposuction
Liposuction, also known as lipoplasty ("fat modeling") or suction lipectomy ("suction-assisted fat removal") is a cosmetic surgery operation which removes fat from many different sites on the human body. Areas affected can range from the abdomen, thighs, buttocks, neck, arms and elsewhere. The fat is usually removed via a cannula and aspirator.
While exercise and dieting may be useful for losing unwanted weight and fat, some fat deposits may not respond to efforts at weight loss. Applying liposuction techniques may be an option in these situations. Liposuction is not a low-effort alternative to exercise and diet. It is a form of body contouring and not a weight loss method. The amount of fat removed varies by doctor, method, and patient, but the average amount is typically less than 10 pounds (5 kg).
There are several factors that limit the amount of fat that can be safely removed in one session. Ultimately, the operating physician and the patient make the decision. There are negative aspects to removing too much fat. Unusual "lumpiness" and/or "dents" in the skin can be seen in those patients "over suctioned."
Reports of people removing 50 pounds (25 kg) of fat are exaggerated. However, the contouring possible with liposuction may cause the appearance of weight loss to be greater than the actual amount of fat removed. The procedure may be performed under general or local ("tumescent") anesthesia. The safety of the technique relates to the amount of tissue removed, the choice of anesthetic, and the patient's overall health.

Contents
1 History
2 Popularity
3 Candidacy
4 Approaches
5 Techniques
5.1 Basic liposuction with fluid injection
5.2 Tumescent liposuction
5.3 Stitches
5.4 Super-wet liposuction
5.5 Ultrasound-assisted liposuction (UAL)
5.6 Power-assisted liposuction (PAL)
5.7 External ultrasound-assisted liposuction (XUAL or EUAL)
6 Candidate preparation
7 The procedure
8 Recovery
8.1 Expediting recovery
9 Side effects
10 Possible complications
11 Combined with other procedures
11.1 Liposuction with a tummy tuck (abdominoplasty)
11.2 Liposuction with a hip, thigh or buttock lift
11.3 Liposuction and wrinkle removal
12 Choosing a surgeon

History
Before liposuction, if one desired to have extra fat removed, it had to be done with a surgical knife. Apart from knowing that a great deal of blood would be lost, results were uncertain.
Traditional liposuction was first done in 1974, by Dr. Fischer, a gynecologist in Italy. During the 1980s, many U.S. surgeons experimented with liposuction, developing some variations, and achieving mixed results.
In 1985, two U.S. dermatologists developed the tumescent technique, which enhances effectiveness and safety, partly by avoiding the use of general anesthesia.
In the 1990s, ultrasound was introduced to facilitate the fat removal by first liquefying it. This approach causes less trauma to the body.
The Vaser System refined the use of ultrasound by using a low energy ultrasound which causes even less trauma to the body and allows the treated areas to be contoured more precisely. It also brings better controlled fluid management, new cannula designs and a grooved probe that more effectively emulsifies the fat, even fibrous fat. All of this enhances the liposuction procedure and leaves neighboring nerves, blood vessels and connective tissue more safely intact.
Since 2000, more variations have been tried.
Overall, the advantages of 30 years of improvements have been that more fat cells can more easily be removed, with less blood loss, less discomfort, and less risk. A great deal has been written about it as practitioners and advocates wrestle with the alternatives and controversies.

Popularity
In the U.S., more than 50% of the population is overweight. So it shouldn't be surprising that liposuction is now the most often performed surgery in the country. Usually it's done to remove about 10 to 15 pounds of fat.
Removal of very large volumes of fat is a complex and potentially life-threatening procedure. The American Society of Plastic Surgeons defines "large" in this context as being more than 5 liters.
Most often, liposuction is performed on:
The abdomen and thighs in women
The abdomen and flanks in males

Candidacy
Not everybody is a good candidate for liposuction. As stated earlier, it isn't a good alternative to dieting or exercising. To be a good candidate, one must be:
Over 18
In good general health
Have tried a diet and exercise regime, and find that the last 10 or 15 pounds insists on remaining in certain pockets on the body
Diabetes, any infection, or heart or circulation problems usually nullify ones eligibility for the procedure.
In older people, the skin is usually less elastic, so it doesn�t tighten so readily around the new shape. In this case, other procedures can be added to the liposuction, such as a tummy tuck.

Approaches
The basic surgical challenge of any liposuction procedure is:
To remove the right amount of fat
Cause the least disturbance of neighboring tissue, such as blood vessels and connective tissue
No disturbance to the person�s fluid balance
The least discomfort to both patient and surgeon
As techniques have been refined, many ideas have emerged that have brought liposuction closer to being safe, easy, painless, and effective.

Techniques
In the basic approach, a small cannula (like a straw) is inserted through a small incision. It's attached to a vacuum device. The surgeon pushes and pulls it carefully through the fat layer, breaking up the fat cells and drawing them out of the body by suction.
This method is seldom used today. Instead, the surgeon will incorporate some of the various improvements that have been made since liposuction's inception.

Basic liposuction with fluid injection
A small amount of fluid, less in volume than the amount of fat to be removed, is injected into the area. It contains:
Lidocaine: as a local anesthetic
Epinephrine: to contract the blood vessels and thus minimize bleeding
A salt solution: to make it saline, like our body fluids
This fluid helps to loosen the fat cells and reduce bruising. The fat cells are then suctioned out as in the basic procedure.

Tumescent liposuction
This is a major improvement on basic liposuction. Not just a small amount, but a large amount of fluid is injected into the area, perhaps as much as 3 or 4 times the volume of fat to be removed. "Tumescent" means swollen.
It's the same saline fluid as used in basic liposuction, but its increased quantity creates space between the muscle and the fatty tissue, which creates more room for the suction tube (cannula) that the surgeon uses to remove the fat cells. It�s easier for the surgeon to make the back and forth movements that break up the fat cells and allow them to be suctioned out.
Depending on the size of the area(s) being worked, this procedure takes perhaps four hours or so, longer than basic liposuction. This is because the fluid must be introduced carefully and about an hour must be allowed for it to percolate and enlarge the area before any work is started.

Stitches
To stitch or not to stitch is the surgeons decision. Since the incisions are small, and since the amount of fluid which must drain out is large:
Some surgeons opt to leave the incisions open, the better to clear your body of excess fluid. They find that the unimpeded departure of that fluid allows the incisions to heal more quickly by themselves.
Others stitch them only partially, leaving space for the fluid to drain out
Others delay stitching until most of the fluid has drained out, about 1 or 2 days
In either case, while the fluid is draining, dressings need to be changed often. After one to three days, small self-adhesive bandages are sufficient.

Super-wet liposuction
In this method, a smaller amount of the fluid is injected, perhaps about the same amount as the volume of fat to be removed. It takes one to three hours, depending on the size of the treated area(s). It may require either:
IV sedation as well as the local lidocaine, or
Complete anesthesia

Ultrasound-assisted liposuction (UAL)
Also referred to as ultrasonic liposuction, this is a type of tumescent liposuction. A specialized cannula is used which transmits ultrasound vibrations within the body. This vibration bursts the walls of the fat cells, emulsifying the fat, i.e., liquefying it, and making it easier to suction out.

UAL is a good choice for working on more fibrous areas, like the upper back, or male breast area
It takes longer to do than traditional liposuction, but not longer than tumescent liposuction
There�s slightly less blood loss
So far, there appears to be slightly more risk of seromas forming (pockets of fluid) which may have to be drained with a needle

Power-assisted liposuction (PAL)
Another variation of UAL, PAL uses a specialized cannula with mechanized movement, so that the surgeon doesn�t need to make manual movements.
The cannula movement is more subtle, which creates less discomfort for the patient
So far, there appears to be less risk of puncturing internal organs, because of the more controlled cannula movement

External ultrasound-assisted liposuction (XUAL or EUAL)
XUAL is a type of UAL where the ultrasonic energy is applied from outside the body, through the skin, making the specialized cannula of the UAL procedure unnecessary.
It was developed because surgeons found that in some cases, the UAL method caused skin necrosis (death) and seromas, which are pockets of a pale yellowish fluid from the body, analogous to hematomas (pockets of red blood cells).
XUAL is a possible way to avoid such complications by having the ultrasound applied externally. It can also potentially:
Cause less discomfort for the patient, both during the procedure and afterwards
Decrease blood loss
Allow better access through scar tissue
Treat larger areas
At this time however, it's not widely used and studies are not conclusive as to its effectiveness.

Candidate preparation
Before receiving any of the procedures described above:

No anticoagulants should be taken for two weeks before the surgery.
If receiving general anesthesia, and the surgery will be in the morning, fasting from midnight the night before is required. If only local anesthesia will be used, fasting is not required.
Smoking must be avoided for about two months prior to surgery. Smoking interferes with circulation and in the context of surgery, may increase the risk of blood clots.

The procedure
In all liposuction methods, there are certain things that should be done when having the procedure.
The candidate and the surgeon will agree ahead of time on exactly which area(s) will be treated and both will discuss what outcome to expect
A consent form is signed on the day of surgery
An antibiotic will be given either about an hour beforehand, or afterwards
The targeted areas are marked on the body while the candidate is in a standing position
Sometimes photos will be taken of the area to be treated, so the patient will have before and after photos
In the operating room, a sterilizing solution such as Betadine, is applied to the relevant areas
Local anesthetic is injected and the patient may be given a sedative, either orally, or through an IV injection
Incisions are small, about a quarter to a third of an inch
The patient will probably have an IV fluid line, since they�ll be losing fluid with the fat, and the fluid balance must be kept intact
There�ll be some monitoring devices attached to the body to keep track of the blood pressure, heart rate, and blood oxygen level
The patient will feel only a scraping or rasping sensation from the cannula movement
Usually the patient can get up, walk around, and go home the same day if they did not receive general anesthesia, although they�ll need someone else to drive

Recovery
Afterwards, a compression garment or Ace bandage will be worn until drainage has stopped, perhaps days, or perhaps for two to four weeks, depending on the specific case
Bandages will be changed after one or two days
Drains and sutures will be removed after five to ten days, or whenever the drainage is finished
Any pain is controlled by a prescription or over-the-counter medication, and may last as long as two weeks, depending on the particular procedure
Swelling will subside in anywhere from two weeks to two months
Bruising will fade after a few days or maybe as long as two weeks later
Numbness may last for several weeks
Normal activity can be resumed anywhere from several days to several weeks afterwards, depending on the procedure
The final result will be evident anywhere from one to six months after surgery, although the patient will see noticeable difference within days or weeks, as swelling subsides

Expediting recovery
The patient should:
Drink enough water to prevent dehydration
Avoid alcohol for a couple of days, both before and after surgery
Avoid using ice packs or heating pads on the treated areas
Postpone any submersion in water for at least a week (bathtub, swimming pool, river, etc.)
If any dizziness is experienced, the patient should take it easy. They should stand up slowly, get some help for the shower, remove the compression garment slowly.
The suctioned fat cells are permanently gone. However, if the patient doesn't diet and exercise properly, the remaining fat cell neighbors could still enlarge, creating assorted bulges.

Side effects
A side effect, as opposed to a complication, is medically minor, although it can be uncomfortable, annoying, and even painful.
Bruising: can be painful in the short term, and should fade after a few weeks.
Swelling: should subside gradually over a month or two.
Scars: will vary in size depending on the particular procedure, and should fade over the weeks. Scarring is an individual thing, partly dependent on heredity. For some, scar healing may take as long as a year.
Pain: should be temporary and controlled by either over-the-counter medication, or by a prescription.
Numbness: sometimes persists for a few weeks.
Limited mobility: will depend on the exact procedure.
There could be various factors limiting movement for a short while, such as:
Wearing a compression garment
Keeping the head elevated
Temporary swelling or pain
The surgeon should advise on how soon the patient can resume normal activity.

Possible complications
As with any surgery, there are certain risks, beyond the temporary and minor side effects. The surgeon may mention them during a consultation. Careful patient selection minimizes their occurrence. Their likelihood is somewhat increased when treated areas are very large or numerous and a large amount of fat is removed.
During the 1990s there were some deaths as a result of liposuction, as well as alarmingly high rates of complication. By studying more and educating themselves further, surgeons have reduced complication rates.
A study published in Dermatologic Surgery (July 2004, pp. 967-978), found that:
�The overall clinical complication rate.[for liposuction] ... was 0.7% (5 of 702)�
The minor complication rate was 0.57%
The major complication rate was 0.14% with one patient requiring hospitalization
The more serious possible complications include:
Allergic reaction to anesthetic: most liposuction is done with local anesthetic, so the risks of general anesthesia are avoided.
Infection: any time the body is incised or punctured, bacteria can get in and cause an infection. During liposuction, multiple small puncture wounds are made for inserting the cannula, typically about 1/3 inch wide.
Damage to the skin: most surgeons work on the deeper levels of fat, so as to avoid wounding the skin any more than they must for the insertion of the cannula.
Sometimes the cannula can damage tissue beneath the skin, which may show up as a spotted appearance on the skin surface.
Skin necrosis (death) is a rare complication, in which the skin falls off in the necrotic area. Bacteria can then invade.
Puncture of an internal organ: since the surgeon can�t see the cannula, sometimes it damages an internal organ, such as the intestines during abdominal liposuction. Such damage can be corrected surgically, although in rare cases it can be fatal. An experienced cosmetic surgeon is unlikely to puncture any internal organ.
Contour irregularities: sometimes the skin may look bumpy and/or withered, because of uneven fat removal, or poor skin elasticity. We all heal differently, and with the older, the healing may be slower and a bit imperfect. Sometimes a small touch-up procedure can help.
Blood clots or fat clots: if clots form in the treated area, they can get into the circulation system and travel to the lungs (pulmonary embolism). This can interfere seriously with breathing and even sometimes cause death. Or they can travel to the brain, also a serious situation. This is a grave complication, but very rare.
Burns: sometimes the cannula movement can cause friction burns to skin or nerves. Also, in UAL, the heat from the ultrasound device can cause injury to the skin or deeper tissue.
Lidocaine toxicity: when the super-wet or tumescent methods are used, too much saline fluid may be injected, or the fluid may contain too high a concentration of lidocaine. Then the lidocaine may become too much for that particular person�s system. Lidocaine poisoning at first causes tingling and numbness and eventually, seizures followed by unconsciousness and respiratory or cardiac arrest.
Fluid imbalance: since fat contains a lot of fluid and is removed in liposuction, and since the surgeon injects fluid for the procedure, even a very large amount of it for tumescent liposuction, there�s a danger of the body�s fluid balance being disturbed. This could happen afterwards, after the patient is at home. If too much fluid remains in the body, the heart, lungs and kidneys could be badly affected.
The cosmetic surgeon should give the participant a written list of symptoms to watch for, along with instructions for post-op self-care.

Combined with other procedures
In general, it's regarded as less than optimally safe to have other procedures done at the same time as liposuction. But it can be done, and some combinations are:

Liposuction with a tummy tuck (abdominoplasty)
The removal of quantities of fat from under the skin leaves the skin loose. If the person�s skin is less elastic than it used to be, it might remain loose and never quite tighten up around the new, slimmer contour. In older people, the muscle can also be somewhat lax and need tightening. So a tummy tuck is a way of addressing this situation.

Liposuction with a hip, thigh or buttock lift
For some people, excess fat stubbornly remains in the buttocks, hips and thighs. When the skin is not loose, liposuction alone can remedy the problem.

But if the skin is loose and hanging in folds, then the liposuction can be combined with a hip, thigh or buttock lift. The skin will be tightened, the excess removed, and the remainder re-positioned over the newly liposuctioned areas.

Liposuction and wrinkle removal
Tumescent liposuction is often used to slim down the jaw and neck area. In younger people, this produces very good results. In older people, a facelift can often do the job nicely.

But if the skin there is becoming too wrinkled or sagging, the best alternative is sometimes a combination of liposuction and laser resurfacing or chemical peel.

Choosing a surgeon
There is no standardized training specifically required for a surgeon to perform liposuction. Any surgeon can do it, and in view of the increasing demand, many do.

Therefore:
One should choose a surgeon who belongs to the Association of Plastic Surgeons (AAPS), at the very least, and preferably some of the other national associations as well such as:
The Association of Aesthetic Plastic Surgery (ASAPS)
The American Society for Dermatologic Surgery (ASDS) (in the U.S.)
One should choose a surgeon who's experienced in doing liposuction in the way that he/she proposes it for the candidate.
The facility where it will be done should be certified and accredited by a nationally recognized surgery accreditation body. It should have the ability to handle complications.
The surgeon should have privileges in at least one local hospital. This is a back-up in case of any emergency that turns out to be more than the surgeon�s facility can handle.
The anesthesiologist should be equally as qualified and experienced as the performing surgeon.
The surgeon�s support staff in the operating and recovery rooms should be experienced with the procedure.
With a list of possible surgeons, the candidate should set up initial consultations with them.
The candidate should have a list of questions and should be sure that they understand the answers. If the surgeon seems impatient or unwilling to take time to answer the questions, move on.
The surgeon should be one with whom the candidate feels personally comfortable, as well as confident in their professional qualifications.

For more information on Liposuction, please visit Wikipedia

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Breast Implant
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This article is very long. It has been suggested that it be split into more manageable, smaller articles. Following a recent editing dispute, the split pages are currently being worked upon 'off-line' as subpages: Breast implant/Revised and Breast implant/Risks and debate. To help us with this process, please see (Discussion)
The examples and perspective in this article or section may not represent a worldwide view.
Please improve the article or discuss the issue on the talk page.
Breast implant diagramA breast implant is a prosthesis used in cosmetic surgery to enlarge the size of a woman's breasts (known as breast augmentation), or to reconstruct the breast (e.g., to correct genetic deformities or after a mastectomy, or during male-to-female sex reassignment surgery).
According to the American Society of Plastic Surgeons, breast augmentation is the third most commonly performed cosmetic surgical procedure in the United States. In 2005, 291,000 breast augmentation procedures were performed.[1]

Contents
1 Types of implants
2 History
3 Silicone Gel Implants
3.1 First and Second Generation
3.2 Third Generation
3.3 Fourth Generation
4 Saline Implants
5 Techniques
6 Risks and controversy
6.1 Rupture
6.2 Other Local Complications
6.3 Mammography
6.4 Systemic Illness
6.4.1 Rheumatological
6.4.2 Oncological
6.4.3 Neurological
6.4.4 Additional Surgeries

Types of implants
There are two contemporary types of breast implant filler materials with many different shapes and textures available:
Saline, which have a silicone rubber shell filled with sterile saline liquid. These implants are currently the only type available outside of clinical trials in the United States, but future regulation may make more filler types available.
Silicone gel, which have a silicone shell filled with a viscous silicone gel.
[edit]
History
Implants have been used at least since 1865 to augment the size of women's breasts. The earliest known implant occurred in Germany, in which fat from a lipoma (benign fatty lump) was removed from a woman's back and implanted in her breast. In the following years, the medical community experimented with implants of various materials, most commonly paraffin.

The first use of silicone for breast augmentation was immediately following World War II, when doctors in Japan and Las Vegas began injecting it to enlarge women's breasts. Initially they used the industrial kind of silicone that goes into making furniture polish and transformer fluid. Complications like cysts, sores and painful hardening of the breasts were in some cases so severe that women needed mastectomies. According to the New York Times, at least three women died when silicone obstructed their blood vessels and lungs.[2] Women sometimes sought medical treatment up to 30 years after receiving this type of injection.

Silicone Gel Implants
Houston, Texas plastic surgeons Thomas Cronin and Frank Gerow developed the first silicone breast prosthesis with the Dow Corning Corporation in 1961, and the first woman was implanted in 1962. The implant was made of a silicone rubber envelope (or sac), and was filled with a thick, viscous silicone gel.
When originally introduced by Cronin, medical devices were not regulated in the United States. After the law was changed in 1976 to give the Food and Drug Administration (FDA) the authority to regulate all medical devices, the FDA "grandfathered" many devices that were already on the market, including breast implants. As a result, the long-term safety of the devices had never been documented. In 1992, the FDA restricted the implantation of silicone gel-filled breast implants because of questions about their safety. Silicone implants may be used only under certain controlled conditions. The FDA has not yet lifted the ban for widespread use.[3]
In Canada, silicone gel-filled prostheses were banned by Health Canada on 6th January 1992 in response to concerns raised in the scientific literature regarding possible illnesses associated with the implants. In 1999, Health Canada's Medical Devices Bureau began to make silicone implants available to plastic surgeons again under a Special Access Program. Under the program, surgeons must submit requests to use silicone implants to the Bureau on a case-by-case basis.[4]

First and Second Generation
The first generation Cronin-Gerow implants were redesigned in the 1970's in response to surgeons asking for softer and more life-like devices. The original cohesive gel and thick-shell models were replaced in the 1970�s by implants with thinner gel and thinner shells. These more flexible gels were introduced by various companies from 1972-1975, and thinner elastomer shells were introduced in 1972. These "second generation" implants had a greater tendency to rupture and leak, or "bleed" silicone through the porous shell, and complications such as capsular contracture were also quite common.
Another development in the 1970�s was a polyurethane foam coating on the implant shell. According to a Congressional report an estimated 200,000 women received this type of implant before it was discontinued in the early 1990's because of health concerns.[5] Polyurethane coating was believed to diminish capsular contracture by causing an inflammatory reaction that discouraged formation of fibrous tissue around the capsule. The manufacturer later withdrew the product after FDA scientists determined that the foam broke down to TDA, a known animal carcinogen.[6] FDA scientists advised the low theoretic risk of cancer would not justify removing these implants solely over concerns about TDA.[7] Plastic surgeons have found that removing polyurethane-coated implants "can be disfiguring and lead to chronic infection, drainage from the breast and skin ulceration."[8] While still manufactured in Europe and South America, these implants are not FDA approved for sale in the United States.[9]
Second-generation implants also included various �double lumen� designs. These implants had two cavities and two shells, which were either �patched� together or had one shell floating freely inside the other. The double lumen was an attempt to provide the cosmetic benefits of gel in the inside cavity, while the outside lumen contained saline and could be used for an expander or even for injection of antibiotics or steroids. The failure rate of these implants is higher than for single lumen implants. The contemporary versions of these devices ("Becker Implants") are used primarily for breast reconstruction. The adjustability of the saline chamber allows tissue expansion and subtle volume corrections to be performed after placement.
Around 1985, gel implants were introduced that used thicker shells, a barrier-coat elastomer to decrease gel-bleed, and a more cohesive gel filler.

Third Generation

Silicone gel-filled breast implants (3rd generation)Third-generation implants, developed in the 1990s, are made of cohesive gel that better maintains its form. These implants are used in other countries, and are the implants currently being considered for FDA approval. However, these implants can rupture, and the rate of rupture of contemporary devices is still being determined. Data presented to the FDA from the core and adjunct studies is limited to 3 and 4 year data. The increased cohesion of the gel filler has decreased silicone bleed and is believed to reduce leakage of the gel as compared to earlier devices, although leakage of silicone oil has still been reported in these newer implants. FDA studies indicate that most women with these implants will have at least one ruptured implant within 11-15 years. Research by Holmich and his colleagues, estimated rupture rates of "at least 15%" of implants within the first 10 years.[10] Two companies, Inamed Corp and Mentor Corp, provided two to three year rupture data based on Magnetic Resonance Imaging (MRI), which indicated low rupture rates during those first few years, but projecting an accurate device failure rate is not possible based on those data.

Cohesive Gel Implant[edit]
Fourth Generation
Evaluation of "gummy bear" or high-cohesive, form-stable implants is in preliminary stages in the United States. Although these implants are used more widely in other countries, their long-term safety record is still being evaluated. It is speculated that the high degree of gel cohesion in these implants is likely to eliminate or significantly reduce potential silicone migration. Short-term safety and efficacy reports have been favorable, but 10 to 20 year rupture and leakage data are needed to determine whether the silicone leakage problem has been solved.[11][12][13]

Saline-filled breast implants[edit]
Saline Implants
There is some dispute as to who originally invented saline implants. Early saline implants were reported in France in 1965 and in the United States that same year, in New York City. [1]. The early models frequently deflated. [2]. In 1967, Dr. Henry Jenny, a California plastic surgeon, found that gel implants leaked so much silicone that they were covered with a greasy film and left large spots of grease when laid down. [3]. Moreover, he found, the implants ruptured in about 16 percent of cases. Dr. Jenny and Dr. Jeri Smahel of Switzerland followed up their observations with experiments on tissue taken from a woman who had gel implants removed. They found that the silicone leaking from her intact implants had gotten into not only body tissues, but into the bloodstream and, as Dr. Jenny put it, "once in the blood, silicone would undoubtedly be distributed throughout the body." It was later proved that even implants that had not ruptured 'bled' silicone into many organs, including the spleen, liver and bone marrow. [4]. As a result of these concerns, Dr. Jenny designed a saline implant that was sturdier than the earliest models and had a diaphragm valve, known as the "Jenny valve." [5].
Original saline implants had a high failure rate and were discontinued in the early 1970s. The current design has thicker, room temperature vulcanized (RTV) shells. After the FDA silicone gel moratorium in the early 1990's, saline implants became the dominant type placed in the United States. Saline implants lacked the problems of gel fluid diffusion through the shell into the tissues; axillary adenopathy secondary to silicone; release of gel on implant rupture, which can be removed only incompletely by surgery and includes the possibility of gel migration and granuloma formation; higher incidences of contracture; and greater radiopacity of gel. [6]
Local complications for saline breast implants are similar to those for silicone gel implants. Case reports of bacteria and fungal contamination have been reported. Advantages of saline implants include intraoperative adjustability, ease of removal, decreased capsular contracture rates, and cost (several hundred dollars less per implant than silicone). As compared to silicone gel however, saline implants are more likely to cause rippling, wrinkling, and be noticeably palpable. Many surgeons also feel that they are more likely to cause an attenuated "bottoming out" appearance of the lower breast pole tissue from the dependent weight of the saline filler. Some of these characteristics can be improved with newer designs, submuscular or partial submuscular placement (the "dual-plane" technique) of the implant and proper implant sizing. CITATION In patients with more breast tissue, it can be difficult to discern an advantage in feel or appearance to silicone. However, with thin breast tissue coverage, and particularly in the setting of post-mastectomy reconstruction, silicone is felt to be the superior device by most plastic surgeons.

Techniques
A sub-muscular implant
A sub-glandular implantThere are several techniques employed in the insertion of breast implants. The choice of technique may depend on the surgeon's personal preferences as much as the patient's relevant anatomy, but there are certain considerations that the surgeon can use to help select the implant and method appropriate to the patient.[14]
Sub-Glandular - sub-glandular implants are placed in a pocket between the pectoralis major muscle posteriorly and the breast tissue and subcutaneous fat anteriorly. A surgeon may select this technique in a patient with a moderate amount of pre-existing breast tissue (e.g. if one is able to "pinch an inch" or more of skin and subcutaneous tissue 3-5 cm about the nipple).
Advantages of this technique are that the implant will not move with contraction of pec major, and thus is appropriate for physically active women; some argue that this is the natural location of breast tissue (as opposed to under the mucle) and so looks more natural; also a sub-glandular implant may create a better result (and lift) in a ptotic breast (where the nipple lies below the level of the infra-mammary fold).
Disadvantages include an unpleasant cosmetic effect in patients with very little covering tissue - the outline of the implant may be more visible, "rippling" may be apparent, capsular contractures (leading to hard, uneven breasts) may be more common.
Sub-Fascial - in this technique the implant is placed into a pocket between the pectoralis major and its covering fascia.
Sub-Muscular - here the implant is placed entirely or partially beneath the pectoralis major muscle, lying on the ribcage. A surgeon may select this technique in a patient with very little pre-existing breast tissue (e.g. one is unable to "pinch an inch").
Advantages: mammograms may be more accurate than with subglandular implants, the implant may be less visible in very small-breasted women.
Disadvantages: the implant may move noticeably with contraction of pec major, producing a very bizarre visual effect that will probably be considered undesirable by the patient. This effect may be especially noticeable in physically active females with well defined pectoral muscles.
There are also several choices for incision:
Peri-Areolar - a semicircular incision around the lower half of the areola.
Infra-Mammary - a transverse incision following the line of the infra-mammary fold.
Axillary - an incision in the axilla (armpit) with a tunnel made through to the breast.

It has been suggested that this section be split into a new article entitled Breast implant controversy. (Discuss)[edit]
Risks and controversy

Rupture
Intracapsular rupture - with capsule created by the body to wall off (silicone implant) foreign object
Extracapsular rupture - Single lumen silicone implants ruptured a few years before their removal in 2004The FDA states that "implants should not be expected to last a lifetime." When saline breast implants break, they often deflate quickly and can usually be easily removed. The FDA is more concerned about silicone gel breast implants, because when they break they rarely deflate, and the silicone from the implant can leak and migrate outside of the scar tissue that the body creates around the implant. This is known as "extracapsular silicone."
The specific risk and treatment of extracapsular silicone gel is still controversial. In response to these concerns, FDA scientists completed a study on the health effects of ruptured silicone gel breast implants, which was published in the May 2001 Journal of Rheumatology.[15] The authors reported a significant increase in fibromyalgia and connective tissue disease among women with extracapsular leakage, compared to women whose implants were not broken or whose rupture was intracapsular.
The FDA stated that rupture is a concern because:
Rupture of silicone gel-filled implants may allow silicone to migrate through the tissues.
The relationship of free silicone to development or progression of disease is unknown.
Implant rupture is a device failure - the implant is no longer performing as intended.
A 2003 article by FDA scientists published in The Journal of Rheumatology stated that women with silicone breast implants report more severe pain and chronic fatigue.[16] Notably, more women with ruptured implants than those with intact implants had debilitating chronic fatigue (75% vs 51%), postexertional malaise > 24 h (77% vs 51%), impaired short term memory (58% vs 38%), and multi-joint pain (77% vs 60%).
Pathology reports of ruptured implants often show giant cell formation indicating an immune response, as well as chronic inflammation. In a 2004 article in Journal of Autoimmunity, scientists reported patients with implants demonstrated statistically significant elevation in anti-silicone antibodies compared with the unimplanted control groups.[17] The highest anti-silicone antibody levels were measured in implanted women with either frank implant ruptures or leakage of their silicone gel implants.

The age of the implant is an important factor in rupture. The FDA rupture study was superior to previous rupture studies because it was limited to women who had silicone gel implants for at least 6 years and had not removed their implants or reported problems with them. Based on magnetic resonance imaging (MRI) they found that 77% of the women had at least one ruptured implant, even though most had no symptoms and were unaware of the leakage.[18]
Neither of the US implant manufacturers have collected MRI data on rupture or leakage for women implants for more than 3-4 years. Therefore, it is impossible to determine if the implants that those companies currently sell have a different rupture rate or likelihood of leakage compared to the implants in the FDA study, which included Mentor and Inamed implants as well as implants made by other companies.
Since the research indicates that most ruptures of silicone gel implants are "silent," with no symptoms, the FDA recommends MRIs as the gold standard for detecting rupture. The FDA General and Plastic Surgery Advisory Panel has considered recommending annual MRIs, but determined that the cost would be prohibitive for screening purposes. However, the data from Inamed and Mentor clearly indicate that clinical exams are inadequate to rule out suspected rupture.[19]

Other Local Complications
Other documented complications specific to breast implants include the following:[7][8][9][[10]
Capsular Contracture
Capsules of tightly-woven collagen fibers naturally form around a foreign body (eg. breast implants, pacemakers, orthopedic joint prosthetics, etc..), tending to wall it off. Most of the time, these tissue capsules are soft-to-firm, and unnoticeable. Capsular contracture occurs when the capsule tightens and squeezes the implant. This contracture is a complication that can be painful and distort the appearance of the implanted breast. Bacterial contamination, gel implant rupture or leakage, and hematoma are the main identified factors in these complications. However, the exact mechanism of capsular contracture in most cases is never identified. Correction of capsular contracture ranges from surgical removal of the implant capsule tissue to removal (and possible replacement) of the implant itself. Capsular contracture may happen again after this additional surgery.
There are four grades of capsular contracture:
Grade I - breast normally soft and looks natural
Grade II - breast little firm and looks normal
Grade III - breast firm and looks abnormal (visible distortion)
Grade IV - breast hard, painful and looks abnormal (greater distortion)
Hematoma/Seroma
Hematoma is a collection of blood inside a body cavity and a seroma is a collection of the watery portion of the blood around the implant or around healing. A small scar can form or a rupture may occur if the implant is damaged during draining the incision. Post-operative hematoma and seroma may contribute to infection or capsular contracture.
Changes in Nipple and Breast Sensation
Feeling in the nipple and breast can increase or decrease after implant surgery. The range of changes varies from intense to no feeling in the nipple or breast after surgery. Changes in feeling can be temporary or permanent and may affect sexual response or the ability to nurse a baby.
Extrusion
Unstable or weakened tissue covering and/or interruption of wound healing may result in extrusion, (when the breast implant comes through the skin). Surgery needed to correct this can result in unacceptable scarring or breast tissue loss.
Necrosis
Necrosis, the death of tissue around the implant, may prevent wound healing and require surgical correction and/or implant removal. A permanent scar may form.
Tissue Atrophy/Chest Wall Deformity
Pressure of the breast implant may cause the breast tissue to thin and shrink. This can occur while implants are still in place or following implant removal without replacement.

Mammography
Pressure on the breast (compression) during mammography can cause implant rupture. Breast implants also can interfere with finding breast cancer during mammography, because the implant shows up as a solid white shape, obscuring tumors above or below. In addition to making tumors more difficult to detect, implants cause "false positive" results as well when extensive scarring and calcium deposits mimic the appearance of cancer, making the deposits difficult to distinguish from tumors on a mammogram.[20] Biopsy may be necessary to determine whether these are cancerous.
Specific mammogram techniques have been developed to ensure that as much breast tissue as possible is examined in the woman with implants. This requires taking extra images, called displacement views, which expose the woman to more radiation. In 2004, Miglioretti and her colleagues published a study in the Journal of the American Medical Association indicating that 55% of breast tumors were not initially detected on mammograms for women with implants, although the extra images were used.[21]
This compares to about 30% of tumors that were not initially detected for women who did not have breast implants. These tumors were subsequently detected in later mammograms. Another problem is that calcium deposits can be seen on mammograms and can be mistaken for possible cancer, resulting in additional surgery to biopsy or remove the implant to distinguish these deposits from cancer. Calcium deposits may be felt as modules or bumps under the skin around the implant.
The displacement views do not protect against rupture, which becomes a greater problem as implants age. Dr. Lori Brown, an FDA scientist, published an article in 2004 in the Journal of Women's Health, indicating that the FDA has received dozens of reports of implants rupturing or leaking during mammography.[22] Sonograms and MRIs can be used to detect breast cancer instead of mammograms, but this adds to the cost of screening and may not be covered by health insurance.

Systemic Illness
Conflicting studies make the issue of systemic illness an ongoing concern for women considering breast implants. Thousands of women have reported that they became ill from their implants, particularly when silicone implants ruptured. Complaints include systemic fungus, neurological and rheumtological problems. Although that information is considered anecdotal, peer reviewed studies indicate that symptoms of many women with implants improve when their implants are removed, as rheumatologist Professor Frank Vasey stated in 2003:
"Epidemiologic studies on silicone implants focused on defined connective tissue diseases as well as undefined symptom complexes. Studies of defined diseases were either negative or showed only a small but statistically significant relative risk. Studies of systemic lupus erythematosus (SLE) and systemic sclerosis did not show an association with silicone breast implants, but studies of symptoms did.. Because of a lack of consistency in methodology of symptom searches and in study findings some reviewers do not believe implants cause systemic problems. Since then, a Dow Corning-funded study (2496 reduction mammoplasty patients versus 1546 silicone breast implanted women, 1/6 of whom had saline-filled silicone envelope implants) has documented that all 28 symptoms were increased in silicone patients (16 of 28 were statistically increased). In a comparison study, there was a statistical correlation between local problems and systemic problems."[23]

Rheumatological
A number of existing studies internationally, funded in part by manufacturers, has reported that there is no evidence of increased mortality or defined autoimmune diseases from silicone breast implants. However, the FDA points out that previous studies have not been large enough to answer the question of whether or not breast implants increase the risk of connective tissue disease or related disorders. Several autoimmune conditions, such as scleroderma and Sjogren's, are rare and require large numbers of study participants in order to ensure that increases risks can be detected. Researchers must study a large group of women without breast implants who are of similar age, health, and social status and who are followed for a long time (such as 10-20 years) before a relationship between breast implants and these diseases can conclusively be made. In addition, autoimmune diseases like lupus typically present with relatively subjective complaints such as joint pain, fatigue, muscle aches, and sleep disturbances. Since many of the symptoms characteristic of autoimmune diseases do not require surgery or inpatient care, it is unlikely that women will be hospitalized for them. The outcome measure for many of the previous European studies was women who were hospitalized for connective tissue diseases, and did not include women who were treated on an outpatient basis. Future study designs should consider these factors.
Studies reported by the FDA have shown that some women with silicone gel-filled breast implants produced antibodies to their own collagen. The researchers initially suspected that women with implants and symptoms actually had fibromyalgia. However, they found that 42 percent of symptomatic women with implants formed antibodies against their own B cells. Only 2 percent of healthy women formed autoantibodies, compared with 14 percent of asymptomatic women with implants and 19 percent of fibromyalgia patients. A recent report detailed HLA differences among women in whom inflammatory myopathy develops after they received silicone implants.[24][25] We do not know as yet if these antibodies cause CTDs and related disorders.
In September of 2005, a Canadian Expert Advisory panel on Breast Implants reviewed available data, heard public concerns and asked questions of manufacturers.[26] The review echoed the FDA's concerns including recommending further outcome studies on device failure, rupture rates, and long term effects of silicone. The panel found that both companies provided appropriate information to show that silicones are not immunosuppressive materials. However, the panel did note that peer-reviewed literature raises questions about the potential of silicones and/or implant devices to induce autoimmune or hypersensitivity reactions. The Panel recommended to Health Canada that the manufacturers must demonstrate that migrated silicone provides acceptable risks of hypersensitivity and autoimmunity by a critical review of company and literature data and, if necessary, by undertaking studies in animal models.

Oncological
Scientists from the National Cancer Institute found an increased risk of lung cancer deaths in comparisons with other plastic surgery patients, although the women in the two groups had no difference in smoking habits. However, scientists did not find evidence that implant patients had a higher risk of death from breast cancer or brain cancer as compared with either the general population or other plastic surgery patients.[27] They had previously reported preliminary data in 2001 indicating that women with breast implants for at least seven years were twice as likely to die of brain cancer and three times as likely to die of lung cancer. [28]

Neurological
In 2006, researchers reported in the Chemistry Analytic Journal that "women exposed to silicone breast implants have platinum levels that exceed that of the general population, and the first report, to date, to document the various platinium oxidation states present in samples from women exposed to silicone breast implants" that may be more toxic. The study found that platinum migrates from silicone implants via the lymphatic and blood systems and may accumulate in bone tissue persisting years after the silicone gel breast implants have been removed. The study also reported that women with silicone breast implants had approximately 100 times higher platinum levels in their breast milk than women with no known platinum exposure. Platinum levels were as much as 1,700 times higher in urine.[29][30] The article also pointed out that the study was "quickly and aggressively attacked by other chemists, especially those with connections to breast implant makers." Former Inamed consultant, Brook, expressed skepticism of "finding platinum in a highly unstable form never before known to exist in the presence of air or water, as existing in the human body". Similarly, Lane, a Dow Corning scientist, stated that he was "personally disappointed that [the journal] chose to feature this article because the facts are just not right". The study was funded in part by a nonprofit group that has argued to keep silicone implants off the market. The women in the study had their breast implants in the 1980s, and had had them for an average of 14 years. Many of these women had had them removed, generally because of health problems.

Additional Surgeries
Regardless of the type of implant, it is likely that women with implants will need to have one or more additional surgeries (reoperations) over the course of their lives. Common reasons for reoperations include cosmetic concerns, capsular contracture, and rupture.[20] Reoperation rates are less frequent in breast reconstruction cases. The major implant manufacturers, Mentor and Inamed, both reported that almost half their reconstruction patients underwent additional surgeries within three years to fix implant problems, whether their implants were silicone or saline. The exact statistics are available on the FDA website.
More than 50,000 implant removal procedures were also reported in 2004. In fact, the American Society of Plastic Surgeons reports that in 2000, about 26% of augmentation and 16% of reconstruction surgeries were for replacement of implants � due to capsular contracture, rupture, implant shift, chronic infection, or other causes.[31]

For more information on Breast Implants, please visit Wikipedia