Surgery of the Breast
In 1894, William Halstead described his radical mastectomy as a treatment for breast cancer. As the understanding of breast cancer progressed, so did the interest in the reconstruction of the breast. The first attempt at a true breast reconstruction occurred in 1895. Vincent Czerny published a mastectomy case for a benign disease that was “reconstructed” by the transplantation of a fist-sized lipoma from the patient’s flank. More reconstructive breast surgery followed the surgical procedure of a mastectomy or breast removal. Various flap techniques were then utilized with local and regional tissues. The early 20th century saw surgeons using the pectoral (chest wall) muscle for mound reconstruction, and abdominal wall tissue was also implemented into this approach. The only drawback for this means of reconstruction was an available supply of “donor” tissue. When breast implants were introduced in the 1960s as a means of cosmetically improving the breast, it soon became apparent that these breast implants could be used for reconstructive purposes as well.
Practical Observations on Cancerous Complaints.
John Pearson. London: J. Johnson, 1793.
John Pearson was a British surgeon in the late 18th and early 19th centuries. He started his surgical apprenticeship at the age of sixteen and later on studied under John Hunter. In this book he first discusses general observations and characteristics of cancer that were known at that time. He then proceeds to discuss the ravages of cancer on various anatomic regions of the human body. Cancer of the breast, as much of it as was known at that time, is included in the discussion.
On the Anatomy of the Breast.
Astley Cooper. London: Longman, Orme, Green, Brown and Longmans, 1840.
Sir Astley Cooper was an early 19th-century British surgeon and anatomist. Because of these dual specialties, he was able to have a more “hands-on” approach to the teaching of anatomy rather than the previous lecture-based model. He is credited with numerous works in both those disciplines. As a student of John Hunter, he learned a great deal from him. He also took part in the formation of the Medical and Chirurgical Society of London. He was appointed surgeon to King George IV after performing surgery on him. In this anatomical textbook, Cooper writes about diseases of the breast, including exquisite, detailed illustrations. One such example is one of the earlier descriptions of hyperplastic cystic disease of the breast, which he refers to as “hydatid disease.”
“Drei plastischen Operationen” [Three plastic surgeries].
Vincenz Czerny. Verhandlungen der Deutschen Gesellschaft für Chirurgie 24 (1895).
Vincenz Czerny was a 19th-century German Bohemian surgeon whose main contributions were in the fields of oncology and gynecologic surgery. He founded the Institut für experimentelle Krebsforschung [Institute for Experimental Cancer Research]. His work in cancer surgery is very well known, particularly after performing the first open partial nephrectomy for kidney cancer. In the field of gynecology, he was the first to perform a vaginal hysterectomy. His contributions to plastic surgery are also well known. He has been called the “Father of Plastic Surgery” for performing the first breast reconstruction. In this work, Czerny discusses the removal of a lipoma (benign fat cell tumor) and transferring it to a woman who had previously undergone a mastectomy. Czerny realized that personal appearance, not just organ reconstruction, was important in motivating a surgeon to operate upon a patient. This is a basic tenet still held and practiced today.
“Harte und weiche Paraffin Prothesen” (Hard and soft paraffin prostheses].
Robert Gersuny. Zentralblatt für Chirurgie 30, no.1 (1903).
Robert Gersuny was a 19th-century German surgeon who learned from the esteemed Theodor Billroth. He operated all over the world with Billroth and made significant contributions to both general surgery and plastic surgery. He is credited with the discovery of both paraffin and Vaseline and using them for injection into the human body. In this work he describes their use for tissue augmentation. He also describes the use of paraffin for breast augmentation, a technique that unfortunately led to disastrous results such as local reactions and tissue loss. The consequences of that procedure did great harm to the reputation of plastic surgery, which was just beginning to be recognized as a separate and distinct surgical specialty.
“Die Operation der atrophischen und hypertrophischen Hängenbrust” [The operation for atrophic and hypertrophic breasts].
Hans Kraske. Muenchener medizinische Wochenschrift, vol. 70, no. 21 (1923).
Hans Kraske was an early 20th-century German surgeon. His father was also a surgeon and held the Freiburg chair in surgery in the late 19th century. The younger Kraske spent many years studying both anatomy and plastic surgery. He learned under the pioneering plastic surgeon Erich Lexer. In addition to plastic surgery, Kraske was known for his orthopedic work. In this article, Kraske discusses his technique for breast reduction, the procedure to surgically reduce a large breast while also maintaining the form and function of the female breast. The areola was not touched, and the breast was sutured to the pectoralis chest muscle fascia to prevent post-operative ptosis (drooping). Up until that time, there were no safe, long-lasting procedures for breast reduction.
“La correction esthétique du prolapses mammaire par le procédé de la transposition du mamelon” [The aesthetic correction of a prolapsed breast by the process of transposition of the nipple].
Raymond Passot. La presse médicale 20 (1925).
Raymond Passot was a French plastic surgeon of the early 20th century. During this period women were becoming increasingly interested in enhancing the appearance of their breasts by reduction and lifting. Because of this trend, there was a desire to minimize the scarring on the breasts while still achieving all of the same surgical goals. In this publication, Passot discusses his procedure with a design that involves no vertical scarring. The evolution of the procedure is discussed, as are details of the surgery, including the blood supply to the breast.
La chirurgie esthétique, réparatrice et plastique du sein [Aesthetic breast reconstruction and aesthetic surgery].
André Galand. Paris: Private health home, 1928.
André Galand was a French cosmetic surgeon in the early 20th century. In this work, Galand describes aesthetic and reconstructive breast surgery. The techniques of breast lifting and breast reduction are discussed. Aesthetic surgery was becoming more popular and accepted all over the world, and it was not limited just to the face. Breast surgery was also becoming safer as techniques involved.
Plastic Surgery of the Breast and Abdominal Wall.
Max Thorek. Springfield, Ill.: Charles C. Thomas, 1942.
Max Thorek was a Hungarian plastic surgeon in the early 20th century and founder of the International College of Surgeons. At first an obstetrician, he later focused on general surgery and then, after World War I, his interests led him to reconstructive surgery. In this book, Thorek discusses anatomy of the chest, breast, and abdomen; he then goes on to discuss techniques related to their reconstruction following conditions caused by birth defect, illness, or disease. The publication served as a textbook meant for both student and practitioner.
“Augmentation Mammaplasty: A New ‘Natural Feel’ Prosthesis.”
Thomas Cronin and Frank Gerow. Excerpta Medica International Congress 66 (1963).
Thomas Cronin and Frank Gerow were two 20th-century American plastic surgeons. In the 1960s they collaborated with the Dow Corning Corporation to create a silicone gel breast implant product. At that time, Dow Corning specialized in silicone products. They worked to create the first breast implant that would not only augment a woman’s breasts but correct for asymmetry, while also correcting for drooping to create a more uplifting profile. Surgeons began using the breast implant widely almost immediately after it reached the U.S. market in 1964, and breast augmentation quickly became one of the more popular cosmetic surgeries in the country.
The creation of a silicone breast implant not only established a new branch of cosmetic surgery but also enabled women with breast cancer to undergo reconstructions to improve their aesthetic appearance after cancer treatment and removal of the cancerous breast tissues. Prior to this, augmentation of the breasts had been performed with a variety of materials, often with poor results and severe health problems. This Cronin-Gerow implant had a silicone shell or envelope filled with the viscous silicone gel. In this work, which was presented at the International Society of Plastic Surgeons meeting in 1963, they discuss their initial findings on the twelve women they studied who had received the implant. There was huge interest in and acceptance of this novel procedure, and demand soon grew. Over the past fifty years, numerous changes and modifications have been made to the silicone gel breast implant, and it still remains poplar today.
“Breast Reconstruction with a Transverse Abdominal Island Flap.”
Carl Hartrampf. Plastic and Reconstructive Surgery 69 (1982).
Carl Hartrampf was a 20th-century plastic surgeon. Breast reconstruction following mastectomy had limited options. Implants were an option, but there was no predictable, long-lasting method utilizing the patient’s own tissue. With the development of the TRAM (transverse rectus abdominus muscle) flap, the skin, fat, and muscle of the abdominal wall were relocated to the chest to recreate a breast mound. The tissue was transferred with its own blood supply to nourish it. The donor area from the abdomen was closed similarly to an abdominoplasty, or tummy tuck closure.