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Czerny from Heidelberg is generally accepted to have performed the first augmentation mammaplasty in 1895. Since then, a variety of nonsilicone materials have been injected or implanted to augment or to reconstruct the hypoplastic female breast, including autologous tissues, intramammary- or submammary-injected alloplastic materials, and preformed alloplastic materials other than silicone. For various reasons outlined in this review, none was fully acceptable. The introduction of the medical-grade silicone bag prosthesis in the early 1960s improved the results of mammary augmentation dramatically and reduced the incidence of fibrous contracture and implant extrusion. Other methods of breast augmentation became obsolete.

The usual reaction of the human body to implantation of a silicone prosthesis is formation of a fibrous capsule. Local reactions to silicone outside this fibrous capsule and distant migration of silicone particles have been described. So far, transcapsular migration of silicone particles from the mammary implant through the fibrous capsule of mammary prostheses has not been studied. In this prospective study 71 capsules found in 40 patients were histologically studied. The chi-squared test was applied to evaluate a possible correlation between silicone migration on the one hand and implant age and integrity of the prostheses on the other. The degree of silicone migration was discerned in four stages. Stage 1 represents no silicone particles in the capsule, stage 2 represents migration up to less than half of the capsule thickness, stage 3 shows migration confined to the outer half of the capsule thickness, and stage 4 means transcapsular silicone migration. In only 4 of 71 capsules no migration into or through the capsule was observed. The degree of silicone migration was significantly less in patients in whom the capsule was calcified and was significantly more in patients in whom implantation exceeded 12 years. There was no significant correlation between the status of the prosthesis (intact, bleeding, or ruptured) and the degree of silicone migration.

Silicone breast implants have been used since 1962. Reliable methods to detect rupture and silicone gel bleed are needed, even more so because of increasing concern about the possible hazards of silicone. In cases in which clinical examination is not conclusive, additional radiodiagnostic evaluation may be useful in diagnosing intracapsular and extracapsular rupture of mammary prostheses. In the series presented, combined ultrasound and mammography shows a sensitivity for prosthesis rupture of 64% and a specificity of 81%. Silicone gel bleed cannot be detected by means of clinical examination or by combined mammography and ultrasound.

Prolonged spasm in small vessels is a major problem after microsurgical procedures. Topical agents applied to resolve these spasms have been the subject of many experimental studies. In this model we studied the effectiveness of various concentrations of lidocaine in resolving microvascular spasms induced by anastomosing the ventral rat tail artery.

Various lidocaine hydrocholoride concentrations were used to measure the degree of resolution of ergotamine-induced vasospasm of the rat tail artery. Also further studies are indicated; 12% lidocaine seems to be as effective as 20% lidocaine. The widely used 2% lidocaine had little effect on the experimentally induced vasospasm.