The first successful breast augmentation was performed in 1895, when a German surgeon named Vincenz Czerny transplanted a fatty tumor from a patient’s trunk into her breast after a partial mastectomy. That procedure kicked off more than a century of experimentation, but the modern “boob job” as most people think of it, using silicone implants, arrived in 1962.
The Earliest Attempts: 1895 to the 1950s
Czerny’s 1895 operation used the patient’s own tissue, a benign fatty lump called a lipoma, to restore the shape of a breast after cancer surgery. It worked well enough to inspire decades of increasingly creative (and often dangerous) experimentation. Over the next 50 years, surgeons tried implanting ivory, glass balls, rubber, cartilage, wool, and polyethylene chips into breasts. None of these produced reliable or safe results.
Alongside solid materials, doctors also injected substances directly into breast tissue, including paraffin, petroleum jelly, beeswax, shellac, and epoxy resin. These injections frequently caused severe inflammation, hardening, and disfigurement. By the mid-20th century, many of these approaches had been abandoned, but the demand for breast augmentation hadn’t gone anywhere.
In 1954, surgeons began using local tissue flaps, rearranging a patient’s own skin and fat to add volume. Around the same time, solid synthetic materials like Teflon and polyurethane sponges entered the picture. These were an improvement over glass and ivory, but they still came with high complication rates and unpredictable results.
The Silicone Implant Era Begins: 1962
The modern breast implant was born in 1962, when Houston-based plastic surgeons Thomas Cronin and Frank Gerow developed a silicone gel-filled implant. Their first patient, Timmie Jean Lindsey, received the implants at Jefferson Davis Hospital in Houston, Texas. The device was simple: a silicone rubber shell filled with silicone gel, designed to mimic the feel of natural breast tissue.
This was a turning point. Unlike earlier materials, silicone implants were soft, could be manufactured in consistent sizes, and produced results that looked and felt far more natural than anything before. Breast augmentation quickly became one of the most popular cosmetic procedures in the country.
Saline Implants and the FDA Moratorium
Saline-filled implants, which use a silicone shell filled with sterile saltwater, were introduced in the mid-1960s as an alternative to silicone gel. They gained a much larger share of the market in the 1990s, but not because surgeons preferred them. In January 1992, FDA Commissioner David Kessler called for a voluntary moratorium on silicone gel implants after concerns emerged about potential links to autoimmune disease and the consequences of implant ruptures.
By April 1992, the FDA restricted silicone gel implants to women undergoing breast reconstruction after surgery, and only as part of a scientific study. Cosmetic patients were limited to saline implants for over a decade. Silicone gel implants remained off the general market through the late 1990s and weren’t fully re-approved for cosmetic use until 2006, after large-scale safety studies found no confirmed link to the autoimmune conditions that had prompted the ban.
How Implant Placement Changed Over Time
Early implants were placed directly behind the breast tissue, on top of the chest muscle. This is called subglandular placement. It produced a natural look in patients who had enough tissue to cover the implant, but it came with higher rates of visible rippling and a hardening complication called capsular contracture, where scar tissue tightens around the implant.
Surgeons later began placing implants underneath the chest muscle, known as subpectoral or submuscular placement. This approach does a better job hiding the edges of the implant, especially along the upper part of the breast. The tradeoff is that chest muscle contractions can sometimes shift or distort the implant over time. A study comparing the two approaches over a decade found that submuscular placement reduced upper-pole rippling but led to higher rates of implant displacement. Today, surgeons choose placement based on a patient’s body type, tissue thickness, and goals.
Modern Implant Options
Today’s implants have come a long way from the first silicone shells of the 1960s. The most significant recent development is the cohesive silicone gel implant, often called “gummy bear” implants. These use a thicker, more structured gel that holds its shape even if the outer shell is damaged. Unlike older silicone gel, which could migrate if an implant ruptured, cohesive gel stays in place. These implants are classified as “form stable” and are available in both round and teardrop (anatomical) shapes.
Compared to traditional silicone implants, gummy bear versions feel slightly firmer but offer less rippling and more long-term shape retention. Saline implants remain available and are preferred by some patients because they require a smaller incision (the shell is inserted empty and filled after placement) and any rupture is immediately obvious since the saltwater is harmlessly absorbed by the body.
Fat Grafting as an Alternative
Using a patient’s own fat for breast augmentation has a surprisingly long history. The concept dates back to the late 1800s, and in 1941, surgeons documented a case of bilateral breast reconstruction using transplanted fat. But early fat grafting had a major problem: about 50% of transplanted fat cells died after the procedure, and the results were unpredictable. The tissue often hardened, formed cysts, or simply shrank away as the body reabsorbed it.
Fat transfer largely fell out of favor until the 1990s, when a surgeon named Sydney Coleman developed a standardized technique for harvesting, processing, and reinjecting fat in a way that was gentler on the cells and dramatically improved survival rates. His method, published in 1992, made fat grafting a viable option again. Today, fat transfer is used both as a standalone augmentation (typically for patients wanting a modest size increase) and as a complement to implants, smoothing out edges or adding volume in specific areas. It also plays a growing role in reconstructive surgery after mastectomy.