Breast Augmentation is a surgical procedure undertaken to improve the aesthetic appearance of the female breast, usually by enhancing the size and occasionally to improve the shape. Each patient has individual needs and certain techniques may be appropriate for some patients and not for others depending on the existing chest wall anatomy, breast size and shape. At all times, expectations must be realistic to avoid disappointment and these should be carefully discussed with your surgeon. The aim is to increase the size of the breast using an implant placed in a pocket behind the breast tissue.
Breasts may be small (mammary hypoplasia) due to:
1) Failure to develop desired fullness and size
2) Involution: Loss of fullness e.g. following pregnancy or significant weight loss
3) Asymmetrical development: One breast is smaller than the other (A minor degree of difference is normal)
The most commonly used implant is a silicone envelope filled with a soft silicone gel. Saline (salt water) filled implants are available but seldom used. The breast tissue itself is not altered and nothing is injected into the breast tissue.
The goal is to produce breasts of normal proportion to the patient’s body habitus, whilst maintaining function, softness and sensitivity.
Augmentation using a breast implant increases the bra cup size usually with no change in the chest circumference measurement. There must be a realistic assessment of what breast size may be anticipated after surgery with the patient and surgeon reaching agreement. Surgery cannot create younger skin or eliminate stretch marks. It does not address personal or psychological issues and should not be used as a solution to them.
Minor degrees of drooping (ptosis) of the breast may be improved, however significant drooping will require additional lifting surgery with or without augmentation which can be more complex.
Modern breast implants are certified medical grade devices which are perfectly safe and have demonstrated no body harm over many investigative studies.
The possible approaches for breast augmentation are inframammary (lower breast crease) periaeolar, transaxillary and transumbilical. The inframammary approach is the commonest used.
The placement of the implant itself can be:
Subglandular: The implant is placed behind the breast tissue but in front of the muscle. This is suitable for patients with adequate skin thickness and breast tissue.
Subpectoral: The implant is placed behind the pectoralis (chest) muscle which covers the upper part of the implant. This gives more coverage or padding to the implant and is the usual choice for thin patients with little breast tissue.
Patients usually stay in hospital for one night following surgery although some can go home on the same day.
Supportive undergarment is to be worn for about 2 weeks after surgery to keep implants in place and to attain the desired breast shape. For the first week women should avoid lifting weights or children. Exercises and gym work involving arm movement, chest or abdominal strain should only be commenced after 6 weeks and built gradually as comfort allows.
 Dr. Salil Bharadwaj
Consultant Plastic Surgeon
Bahrain Specialist Hospital
Email: salil.bharadwaj@bsh.com.bh