Breast fetishism is a fetishistic sexual interest in the female breasts, especially their size, shape, display and movement. Particularly in American and Japanese culture, this fixation has increased cultural acceptance of female breasts implants. The roots of this phenomenon date back to ancient history, are culturally driven, and reflect differences in each society.
A bountiful bust is seen by some as a symbol of sexuality and attractiveness, especially in large portions of the Western world, although historically the "preferred" breast size has changed many times. Anthropologists and sociologists have often tried to explain this in terms of natural selection and biology but conflicts exist over what is the conclusive reason for many men's attraction to big breasts. It is worth noting that breasts are not completely sexually irrelevant organs, since the nipples are an erogenous zone.
Not all breasts fetishism concerns size. Some fetishists prefer puffy areolae or unusually long or thick nipples. The "puffy" fetish, in particular, can be somewhat controversial because this characteristic is most common in pubescent girls (though it is not unknown in older women). There are also fetishes concerned with lactation in general, and with nursing ("milk fetishism"). Finally, some prefer small rather than large breasts (estimates of men's preferences range as high as 1/3).
Some individuals have a fetishistic preference for large "natural" breasts without breast implants. Natural breasts are required to become a Page Three girl in the UK tabloid The Sun. Another magazine featuring the "natural" look is Perfect 10.
Like any other sexual fetishes or paraphilias, this preference might become psychologically problematic when it develops into a strong fixation and becomes the only means of sexual arousal.
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. In the 60 countries where silicone implants are available, they are used in approximately 90-95% of implant operations.
In the United States the implantation of silicone gel-filled breast implants is currently restricted to clinical trials. In many other countries they are in regular use. The General and Plastic Surgery advisory panel recommended FDA approval of Mentor and against Inamed silicone gel breast implants. Despite the panel's recommendation that Inamed's implants not be approved, the FDA sent Inamed a letter stating that the companies implants would be approvable if certain conditions could be met. The FDA has not announced a final decision regarding approval for either manufacturer.
History of breasts
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 breasts. 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. Women sometimes seek medical treatment up to 30 years after receiving this type of injection.
Silicone Gel breasts 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.
These "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. Polyurethane coating was believed to diminish capsular contracture by causing an inflammatory reaction that discouraged formation of fibrous tissue around the capsule. However, these Meme and Replicon implants were placed on the Canadian and U.S. market without a safety review. The Congressional report, which had access to internal industry and FDA documents, describes the foam as similar to the foam used in carpets and upholstery, and states that it was used under nonsterile conditions. The manufacturer later withdrew the product after FDA scientists determined that the foam broke down to TDA, a known animal carcinogen. FDA scientists advised that the implants presented an "unacceptable" risk, but after the implants were removed from the market FDA officials advised women that the relatively low risk of cancer from one set of implants would not justify removing these implants solely over concerns about TDA. Plastic surgeons have found that removing polyurethane-coated implants "can be disfiguring and lead to chronic infection, drainage from thebreasts and skin ulceration." While still manufactured in Europe and South America, these implants are not FDA approved for sale in the United States.
Around 1985, "third generation" gel implants were introduced using thicker shells, a barrier-coat elastomer to decrease gel-bleed, and a more cohesive gel fillers. These 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.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.
Silicone gel-filled breast implants (3rd generation). Data presented to the FDA from the core and adjunct studies is limited to 3 and 4 year data at this point. 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 breasts.
Research on complications and rupture for silicone-gel implants indicates:
First generation from 1963-1972 - Low rupture, higher complications like contracture
Second generation from 1972 - to mid 1980’s –50-95% rupture after 10 years,
Third generation from mid-1980’s to present — 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. 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.
4th generation Cohesive Gel Implant (form-stable)
Evaluation of high-cohesive, form-stable implants ("fourth generation" devices) 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. Implant companies and plastic surgeons believe that the high degree of gel cohesion in these implants is likely to eliminate or significantly reduce potential silicone oil 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.
Saline breasts Implants
Saline implants were originally designed by plastic surgeon Henry Jenny because of his concerns about the safety of silicone breast gel. In addition, they can be implanted through a smaller incision (2.5-3 cm) than that required for a silicone implant. After the FDA silicone gel moratorium in the early 1990's, saline implants became the dominant type placed in the United States.
The complications for saline breast implants are similar to those for silicone gel implants, including infection, malposition, rupture, and capsular contracture. 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.
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-glandular implant
There 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.
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 breasts 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 breasts (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 breasts.
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