Dr. Kusai Awni Ibrahim El Musa Clinic
Dr. Kusai Awni Ibrahim El Musa is a plastic and reconstructive surgeon. He studied medicine at the University of Jordan, trained at the American University of B…
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Breast augmentation is surgery that increases breast volume and improves fullness, performed either with an implant placed behind the gland or behind the pectoral muscle, or with transfer of the patient's own fat from elsewhere in the body for a more modest increase. The approach is chosen according to breast tissue, skin thickness, chest shape, and the patient's goal, not according to what is fashionable or requested. Before discussing size, the limits must be stated clearly. **Augmentation adds volume; it does not lift a sagging breast.** A woman with genuine ptosis needs a lift with the augmentation or instead of it, otherwise the result is a larger breast that still sags. Augmentation does not make a marked difference between the two sides identical, and **complete symmetry cannot be guaranteed,** because the two breasts already differ in volume, nipple position, and chest wall slope. It also does not prevent later change with pregnancy, weight, or ageing, and it does not improve skin damaged by major weight loss. **Implants are not permanent.** They are manufactured devices placed inside the body and they have a working lifespan; replacement, removal, or further surgery may become necessary for reasons such as a tightening fibrous capsule around the implant that distorts the breast and causes pain, leakage or rupture, malposition, visible rippling or edges under the skin, or simply a change in the patient's own wishes over time. The operation should therefore be understood as a long-term commitment to follow-up, not a procedure forgotten after a month. **The scar is permanent** at the agreed incision site, whether in the fold under the breast, around the areola, or in the armpit. **The effect of the procedure on breastfeeding and on breast imaging (mammography) is discussed before the decision is made.** Many women breastfeed after augmentation, but the likelihood is influenced by incision site and by how much glandular tissue is disturbed, and a peri-areolar incision is more often associated with breastfeeding difficulty than the alternatives. For imaging, an implant hides part of the breast tissue and requires special positioning and additional views, so the radiologist must be told about the implant every time, and it is wise to keep documentation of the implant type and the date of surgery. Candidacy is decided by clinical examination, not by reading online or by looking at other people's photographs, because what suits one body may not suit another. The consultation should also cover the rare implant-associated conditions that your surgeon knows about, and the principle that any new symptom is evaluated rather than ignored. **Any new breast lump that is not explained by the cosmetic procedure must be assessed to rule out cancer, no matter how long ago the surgery was performed;** having an implant does not protect against breast cancer and does not remove the need for age-appropriate screening.
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Procedure steps
- 1
Consultation, examination, and defining the real goal
The surgeon examines breast volume, degree of sagging, skin thickness, tissue quantity, nipple position, side-to-side difference, and chest wall slope. Questions cover future pregnancy and breastfeeding, family history, chronic illness, and smoking, and it is determined whether your case is augmentation alone or augmentation with a lift, with breast imaging requested according to age and findings.
- 2
Choosing the plane and incision, and explaining what surgery cannot do
Options for placing the implant behind the gland or behind the muscle are explained, with the effect of each on feel, shape, and imaging, along with incision choices and their scars, and the difference between an implant and autologous fat transfer in the amount of increase and how well it lasts. It is stated explicitly that augmentation does not lift ptosis, symmetry is not guaranteed, and an implant is not permanent.
- 3
General anaesthesia and theatre preparation
Surgery is performed under general anaesthesia in a fully equipped theatre, with vital sign monitoring, venous clot prevention where indicated, and prophylactic antibiotics according to protocol. Markings are drawn on the skin with the patient standing before anaesthesia, and a safety checklist is completed before the first incision.
- 4
Creating the pocket and placing the implant or fat
The incision is made at the agreed site and a precisely sized pocket is created under the gland or under the muscle with minimal trauma and careful control of bleeding. The implant is inserted using a low-contamination technique, or processed fat is injected in layers when autologous transfer is used, then both sides are compared in a semi-sitting position before closure.
- 5
Closure, support, and long-term follow-up
Layers are closed with fine sutures, a dressing and supportive bra are applied, and instructions on movement, sleeping, and showering are explained. The patient is given a card or report documenting the implant type and date of surgery, with early wound reviews and ongoing long-term visits to assess the implant and shape and to plan appropriate imaging.
Before the procedure
Come to the consultation with what bothers you in mind rather than a size you want, and let the examination determine what is achievable; do not compare yourself with online photographs, because every body produces a different result. Tell your surgeon about all chronic illnesses and previous operations, any lump, nipple discharge, or skin change, your family history of breast cancer, and bring reports of previous imaging. Give a full list of medicines, supplements, herbal products, and contraceptive pills, and ask about blood thinners and aspirin instead of stopping anything yourself. If you are planning pregnancy or breastfeeding soon, raise it explicitly, because timing and incision choice change. Stopping smoking before and after surgery is an important condition, since smoking increases healing problems and infection. Stabilise your weight if it has been fluctuating, fast for the period the anaesthetist specifies, arrange a driver and help at home for several days, and prepare a wireless supportive bra, front-buttoning tops, and somewhere to sleep propped up.
After the procedure
Wear the supportive bra as instructed and do not swap it for a tight underwired one, sleep on your back propped up for the first weeks, and avoid heavy lifting, pushing heavy doors, chest-loading exercise, and forceful overhead movements until your surgeon allows them. Expect swelling, tightness, muscular aching, and bruising, and expect the shape to look high or uneven at first before it settles over weeks to months, with temporary changes in nipple sensation. Care for the wound as taught, avoid pools and soaking baths until cleared, and begin sun protection for the scar. Walk around the house early and drink enough fluids to reduce clot risk, and keep your implant documentation with your records. **Seek immediate review if you develop sudden swelling on one side, severe and increasing pain unrelieved by painkillers, fever with purulent wound discharge, a sudden change in breast shape or the breast becoming hard and tight, darkening of the nipple skin, or shortness of breath or calf pain.** **Any new breast lump not explained by the cosmetic procedure must be assessed to rule out cancer regardless of how long ago the surgery was,** and tell the radiologist about the implant at every imaging appointment.
Expected duration
Usually one to two and a half hours under general anaesthesia, as a day case or with one overnight stay, with a return to desk work commonly after one to two weeks and full exercise after four to six weeks, depending on your surgeon's assessment.
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