Why Humans Like Bigger Breasts - And a New Way to Augment Them

0:00When you need to build up your team to handle the growing chaos at work, use Indeed Sponsored Jobs. It gives your job post the boost it needs to be seen and helps reach people with the right skills, certifications and more. Spend less time searching and more time actually interviewing candidates who check all your boxes. Listeners of this show will get a$75 sponsored job credit at Indeed.com slash podcast. That's Indeed.com slash podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed Sponsored Jobs. A woman in Australia has become the first participant in a clinical trial to have her breasts augmented using her own fat cells via a new technique that aims to use a person's own tissue to give them their desired breast shape.

0:43So today we're going to be talking about the evolutionary uniqueness of the human breast, the history of breast augmentation and reconstruction surgeries and the promise of this new technique. This is the world, the universe and us and I'm Dr Penny Sarche. Today I'm joined by Alice Klein who's been reporting on this new surgical technique for us. Alice, breast augmentation is sometimes seen almost as a something of a frivolous surgery, you know purely cosmetic. Could you just talk us through first off what it's actually used for? Hi Penny, so breast augmentation is the most common kind of cosmetic surgery and as well as being used to simply increase breast size for those who want it, breast implants are also used for breast reconstructions following mastectomies, to restore volume loss after pregnancy and breastfeeding, and in gender-affirming surgeries too.

1:35And actually, I recently learned that the first documented breast augmentation surgery ever performed, which was way back in 1893, was done in a mastectomy context. That's so long ago, I wouldn't have guessed. Yeah, it's actually a bit of a crazy story because this Czech surgeon removed part of a 41-year-old woman's left breast that had this painful lipoma in it, which is like a benign tumor made of fat cells. And then he actually found another one of these fatty tumors in her back and he chopped that out and then put that into her left breast to reconstruct its volume. So he swapped one for the other?

2:14Exactly, yes. Wow. So the idea then of using a person's own fat cells to augment someone's breasts, as this new technique does actually goes back quite a long way then. But before we get into that, could you just talk me through how the standard silicone breast implants came about? It was around the middle of last century, which was a time when everyone wanted a Marilyn Monroe figure. And silicone was chosen as an implant material because it's relatively non-reactive and it's got a nice kind of squishy breast-like feel. And it had already been used in some other medical implants like for repairing bile ducts.

2:51And at first these silicone breast implants worked really well but over the years the number of potential complications associated with them have been steadily stacking up. So what kind of thing are we talking there? Sometimes they rupture and then that causes the silicone gel to leak out and that can make the breasts quite sore and misshapen. Another thing that can happen is that scar tissue can form around the implant and form these kind of hard lumps. There's also this thing called breast implant illness, which isn't very well understood, but it's this collection of symptoms like fatigue and muscle aches that some people seem to get after they get breast implants.

3:29And in rare cases, there's this type of cancer called breast implant associated anaplastic large cell lymphoma, which can also form around the implants. And I should say that research shows that the majority of people tolerate silicone breast implants pretty well, but they still usually need to get them removed or replace usually somewhere between 10 or 20 years of the initial surgery. So they just, they don't last forever. And there's this alternative as well, the saline implants? Yes. They also have a silicone casing to hold the saline solution in. And the problem with them is that the casing can eventually tear and then spill out all the saline.

4:08And that causes the breasts to rapidly deflate and the silicon casing has to be surgically removed. So this new technique then uses a person's own fat to fill out their breasts. So where are they taking this fat from? It can be taken from any other part of the body that's got a bit of excess fat, like say your thighs or your abdomen, and it's taken out using liposuction. And then what do they do with it? I imagine they're not just sucking it out there and sticking it in elsewhere. They basically are. They just, Yes, it's not a hugely sophisticated process. But first, so a surgeon has to insert a scaffold into the breast first.

4:48And this scaffold, it looks a bit like a bra cup, but it's very lightweight. It's made out of this thin crisscross white lattice. So they put the scaffold into the breast and then they just leave a little pocket and then they inject the fat that's come out from the liposuction through this pocket into the scaffold and then they basically just sew the breast back up. And so then is the idea that this sort of lattice, this cup-shaped lattice, holds that fat in place and that sort of organises the tissue? Yeah, so the scaffold holds the fat in place and then because it's got this lattice structure, cells from the introduced fat and the existing breast tissue can multiply and grow along the lattice to fill it out.

5:32So you get this integrated mix of fat blood vessels and connective tissue, which is just like in natural breast tissue. So clever, isn't it? What did they make the scaffold out of? It's made of 3D printed polycaprolactone, which is this biodegradable polymer that's already been used for decades in absorbable surgical sutures. So the idea is that once the introduced fat has grafted and integrated with that existing breast tissue, then the scaffold will gradually dissolve and get absorbed by the body, leaving just the person's own tissue in this new larger shape. So you don't have this permanent lump of foreign material in there, like with a silicone implant.

6:12So it's almost like plastic surgery without the plastic? Sort of, but the word plastic in plastic surgery is actually from the Greek word plasticos, meaning to mould or give form. It's not in reference to the materials that are used. I can't believe I never knew that. Thanks, Alice. Before we continue, a message from a sponsor. Almost every day we hear about AI flooding the pharmaceutical pipeline with amazing new drug candidates. But all this innovation is creating a massive problem because our ability to discover new drugs is outpacing our technology to manufacture them. Designing a miracle molecule is one thing, but purifying at a commercial scale for the global market is an entirely different challenge.

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7:35That's Indeed.com slash podcast. Terms and conditions apply. Need a hiring hero? This is a job for Indeed sponsored jobs. So Alice, where were the scaffolds then that are used in this new kind of breast augmentation? Where were they developed? They were the brainchild of a researcher called Mohit Cheya at Queensland University of Technology in Australia. who joined a research team in 2010 that was developing scaffold implants for actually orthopedic applications. And he wondered if they could also be used for breast augmentation. He says that the inspiration came from his grandmother who had a lumpectomy for breast cancer in the 1990s in India, when there were no options available for restoring the loss volume.

8:16So now we have this clinical trial of the new technique and one woman has had the procedure so far? Yes. So she had the surgery on the 10th of August and it all went well and she apparently hasn't had any complications so far. And actually, although she's the first person to have the dissolvable scaffolds and fat put in for a first time breast augmentation, there has been another clinical trial already that's tested this technique to actually reconstruct the breasts of 19 individuals after they had silicone implants removed due to various complications. And was that trial successful then? Yeah, there were no safety concerns.

8:52And it found that it took about a year for the scaffolds to fill with new tissue and then about another year or two for the scaffolds to fully dissolve and disappear. And so because you're using your own fat tissue and the sort of skeleton structure that shapes it then dissolves over time, does that mean that the sort of regenerated tissue looks and feels more like a normal breast? Yes, I mean, I haven't felt it, but apparently the people who have had it, they say that at first their breasts feel quite unusually firm because of the scaffold structure. But once they break down, they say it feels quite soft and natural.

9:32And also the researchers who've been looking at this study, they said that actually after a while, if you do MRI scans, you can't tell the difference between that new tissue that's formed and the existing breast tissue that was already there. And so the aim now is to trial the procedure on 53 participants and follow them for several years to see whether it's safe and effective. And there are some plastic surgeons who are sceptical about this new technology because they think that there might be a risk that the scaffolds will fill up with scar tissue rather than regenerated fat tissue. So we do need more long-term clinical data before we could offer this more widely.

10:11And could there be other possible uses for these kinds of scaffolds in the body? Well, there's actually this other group in Australia that's developing a similar kind of scaffold implant, and it's made of a different dissolving polymer. And the idea is that it could potentially be inserted when someone has a broken bone or osteoporosis or something, and cells could then grow along that framework and heal the bone. So it's possible that we'll see all sorts of these kinds of scaffold implants finding different applications around the body. And you mentioned earlier that breast augmentation is the most common type of cosmetic surgery.

10:48Why do humans seem to prefer bigger breasts? Is there an evolutionary reason to that? Yeah, this is a bit of a puzzle because humans are a bit weird because we're the only mammal with breasts that become permanently enlarged from sexual maturity onwards. So not just during pregnancy and lactation, but from when you go through puberty. Right. So in other mammals, the breasts are only prominent during that sort of reproductive and feeding phase, and then they sort of deflate again. Yeah. But in humans, there seems to be some kind of evolutionary benefit or preference for fuller breasts. And do we have any idea why?

11:26It seems that no one can really agree on that exactly. But one hypothesis is that maybe permanent fat deposits originally involved in our breasts as an energy storage thing. and then these kind of fat mounds were eventually co-opted as a sexual ornament for attracting mates. Because when you look at studies of many different cultures, there does seem to be a fairly universal preference for medium and large-sized boobs over small ones, which is a bit sad for those of us who are not very well endowed and it explains the popularity of padded bras and boob jobs. Thanks, Alice. That's all for this episode.

12:01Thanks for listening. Do subscribe and follow wherever you get your podcasts. Goodbye for now.

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