Breast Augmentation (Breast Implants)
Breast enlargement is one of the most commonly requested aesthetic operations, with more than one-and-a-half
million procedures performed in the United States to date. Most women undergo this type of surgery because they
want to feel better about their appearance, both in and out of clothes.
Women choose to have breast augmentation surgery to improve their self image. Some feel dissatisfied because
their breasts never developed to a size that meets their expectations. Others want to bring balance to a breast
that is somewhat smaller than the other. Often women want the procedure to restore their natural breast volume,
which may have decreased as a result of pregnancy, weight loss, aging or even breast cancer surgery.
In modern times, it is important to have your personal habits in mind when considering surgery on your
breasts. Dr. Sayah realizes many women enjoy sunbathing in European settings. He therefore prefers to use the
endoscopic technique with breast augmentation which leaves no scars whatsoever on the breasts. He uses the same
minimally invasive techniques on the face for facelift or browlift procedures to accomplish plastic surgery
with no visible scars.
During your initial consultation, you will be encouraged to discuss your desires, fears, expectations, and
goals. The first and foremost objective is the creation of breasts that you envision yourself with. In addition
to increasing breast size, Dr. Sayah will strive to create a more aesthetically pleasing breast by improving
shape, balance, and proportion.
Additional cosmetic procedures may be necessary to improve your results. If your breasts are sagging
(ptotic), Dr. Sayah may suggest that a breast lift procedure ( mastopexy ) be performed in conjunction with
your breast augmentation surgery. In this manner, your breasts are lifted to the correct youthful position and
made fuller at the same time.
It is important to stress that breast surgery does not cause cancer.
The surgery lasts from one to two hours and is usually performed in a surgical facility under a light,
general anesthetic administered by an anesthesiologist. A long acting, local anesthetic is also added to help
eliminate discomfort following surgery. While the procedure is carried out, you will be on a specially designed
table that can be placed in a sitting position. This allows Dr. Sayah to try different implants and ensure that
the proper size is used with you in an upright position.
The breasts are enlarged by placing soft implants through a small incision, using one of three different
approaches: axillary (armpit), around the nipple, or under the breast. Dr Sayah will discuss your preferences
and his recommendations. Various types of implants are now available including saline (sterile saltwater) and
One of the following techniques is used, depending on your body structure, and preference:
- Endoscopic: This is the most modern technique for breast enlargement surgery. A small incision is made in
the axilla (underarm) and a small endoscope is used to introduce the implant either under the pectoralis muscle or
the breast tissue. Absorbable sutures are used through the procedure to assure your comfort. The unique features of
this technique are the small incisions necessary to perform the procedure, and the location of the incisions in the
axilla or armpit. Therefore, no scars are visible on the breast or at the breast crease leading to excellent
aesthetic results. It is ideal for those patients with smaller breasts where the scars on the breast would be
visible, and for those who have a predisposition to abnormal scarring.
- Axillary (Underarm): This approach is utilized when a patient's breasts are small, in good position, and
relatively symmetrical. The implant is introduced through a 1 to 1 1/2" incision in the center of the axilla, and is
generally placed under the muscle mass. In patients who are extremely muscular, this placement may show movement of
the implant; in such cases, the implant is placed over the muscle tissue. Absorbable stitches are placed in the
underarm area, and a small tubular drain may be used to collect fluid for a day or two in order to decrease
- Nipple: This commonly used approach involves a 1 to 1 1/2" incision on the lower border of the pigmented areola
and allows not only enlargement but some correction of shape and position discrepancies. The incision generally heals
well with minimal scarring. Although blockage of nipple ducts is a theoretical problem, it rarely occurs. Most women
are able to breast feed after this procedure.
- Inframammary incision: In a small number of cases where the areola is very small, an incision is made at the
crease below the breast. This approach may be suitable in women with prior breast surgery or with the most
complicated breast augmentations.
After the Procedure
For the first two days after surgery, you should rest at home. You are encouraged to walk around your home, but
give your body a chance to take a break from your daily routines. You may experience much less discomfort than you
expected, but will probably want a mild pain medication such as Tylenol. Stronger medication will be available if you
By the third day you will be up and walking around. When you get up out of bed, try rolling on your side toward
the edge of the bed and bring your knees up to your waist. Move your legs over the side of the bed and gently help
yourself up by pushing up with your elbows. The idea is to let your legs do most of the work so your arms can rest.
When you shower, gently wash your stitch line with mild soap, and then apply a thin layer of a mild antibiotic
ointment such as Bacitracin or Polysporin.
Most patients are driving by the fifth to seventh day, and return to work or school in one to two weeks, depending
on the level of activity required and the rate of recovery. You should be reminded that driving should be avoided
while taking strong pain medications containing morphine derivatives such as Vicodin.
Half of the swelling is resolved in two weeks, three-quarters by one month, and the remainder in one to three
months. Avoid reaching above your head to grasp objects for 4 weeks or until instructed otherwise by Dr. Sayah. Any
change in sensation following surgery is typically temporary; resolution can occur over several weeks to several
months. Although breast-feeding is desirable for infants, it can have an effect on the operated breast, sometimes
resulting in size reduction, and discomfort. This should be considered before a decision is made about breast
surgery and subsequent pregnancy and nursing.