Breast Implant Surgery in Bangladesh

S.A. Siddikya
F. Quaderb, M. H. Rahmanc


Augmentation mammoplasty is one of the common plastic surgical operations in the western countries. The procedure has received particular attention among patients with hypo-plastic breasts. The first silicone breast implant was performed in 1963 by Cronin and Gerow, and at present more than 250,000 breast implants are done every year in the USA alone. Due to skepticism and ignorance this surgery took a very long time to become popular in Bangladesh.

We started breast implant surgery in Bangladesh in September 2001. Since then it gradually became popular and is
now a rather common procedure in our centre. In spite of our conservative culture and religious taboos, women in
Bangladesh are no longer lagging behind in deriving the benefit of this wonderful procedure.
The study was done at a private hospital from September 2001 to September 2008. A total of 126 cases were done,
125 being females and 1 male. Complications were minimal and the overall results very encouraging. The result of
the present work evidenced that silicone breast implants can boost confidence by alleviating depression in women
of different age groups with hypoplastic breasts. Research studies have further revealed that silicone implant does
not impair lactation.

Key words: Silicone implant, augmentation mammoplasty

Introduction Materials and method

The history of breast augmentation dates back to A total of 126 cases were done. All cases were
hundreds of years and over the centuries various performed as day cases.
materials like ivory, cartilage, wool, fat etc were Two different approaches were used for breast
used to enhance breast volume1. Since the past implants – inframammary and axillary. We used
few decades this procedure has received particular inframammary approach in 120 cases, and axillary
attention and appreciation among patients with approach in 6 cases. The pocket dissected for
hypoplastic breasts. Research studies have implant placement can either be subglandular (in
evidenced that silicone implant does not cause between the breast and pectoralis major muscle)
breast cancer or cause impairment of lactation2,3. or submuscular (behind the pectoralis major
It is also not linked with collagen disease2,3. muscle). In this study most of the implants were
Breast feeding is also allowed in patients who placed in submuscular plane especially in those
have undergone breast implant surgery. Breast patients with thin glandular element. The surgical
implant surgery can alleviate the agony of social procedure of augmentation encompassed three
humiliation and embarrassment.

Keeping this in steps:
view we undertook a study to find out the efficacy

(1) Dissection of pockets of mammoplasty using silicone implant.

(2) Insertion of appropriate implants

(3) Closure of incisions

a. Prof. S.A. Siddiky : Consultant Plastic Surgeon, Dissection of pockets:
Cosmetic Surgery Centre Limited, Dhanmondi, The inframammary folds and the proposed lines of Dhaka. incision were marked out with the patient in sitting

b. Dr. Firdous Quader : Consultant, Cosmetic Surgery position. Under general anesthesia submuscular Centre Limited, Dhanmondi, Dhaka. pockets were dissected behind the pectoralis

c. Dr. M. Hasibur Rahman : Associate Professor and major muscle. Small incisions (2.5 to 3.5 inches) Head, Department of Dermatology and Venereology,

Community-Based Medical College, Mymensingh were utilized for access. Absolute hemostasis was
ensured with diathermy. Particular attention to the

Address of Correspondence: Professor Dr. Sayeed perforators was given to avoid undue bleeding from
Ahmed Siddiky, Consultant Plastic Surgeon, Cosmetic retraction of the cut ends of these vessels. In only Surgery Centre Limited, Dhanmondi, Dhaka. 11 cases subglandular pockets were dissected. E-mail:

Breast Implant Surgery in Bangladesh: An Experience of 126 cases

Insertion of implants:
After careful inspection of the pockets, 150 to 500
ml (depending on the desired size of the breasts)
round, high profile, textured silicone implants
were inserted into the pockets. Synchronized
movement of the index fingers helps the implant
to be inserted through an incision almost half its

Closure of incisions:
After assessing the implant position and external
symmetry, closure of the incisions were done
in two layers. The deeper layer took care of the
inframammary fold with a view to preventing
subsequent downward displacement of the
implant. The skin was then closed by a continuous
subcuticular 5/0 vicryl. Special care was taken to
avoid pricking the implant during placement of
sutures. Drains were not employed and the use of
local steroids was avoided.

Results and discussion
The photographs presented exhibit the merit of
breast augmentation. Figure 1 shows a round
textured high profile implant ready for insertion.
Figure 2 and 3 shows a patient before and
after breast implant surgery. Figure 4 show a
preoperative picture of a patient with small breasts
and fatty abdomen. Figure 5 show the same patient
Fig -1: Silicone breast implant
as in figure 5 after breast implant and abdominal
liposuction. This type of combo surgeries where 2
or more procedures (liposuction, abdominoplasty,
Fig -2: Preoperative picture before breast implant
Fig – 3:Postoperative picture after breast implant
rhinoplasty or vaginoplasty along with breast
implant) are done in the same sitting has now
become very common. The reason behind is
that the patient gets more aesthetic result from a
single sitting; and the total time as well as the cost
required for total transformation is significantly
reduced . Patients went home after 5 to 9 hours of
the surgery where breast implant was done alone.
But for patients undergoing combo procedures
overnight hospitalization was advised. Table
1 shows the age distribution of breast implant

Table I
Below 20 years 20
20 to 29 years 64
30 to 39 years 36
40 years and above

Bangladesh Journal of Plastic Surgery (2010) Vol. 1 (1)
© 2010 Society of Plastic Surgeons of Bangladesh
Fig – 4: Preoperative picture
Table II shows the two surgical approaches for
breast implant surgery
Table II
Inframammary 120
Axillary 06
Total 126
Table III shows the type of complications
Table III
Implant displacement 4
Infection 3
Capsular contracture 3
Hematoma 1
Excessive bleeding 0
Implant disruption 0

Regular follow-up of the patients were done
during the first month for early detection of any
complications facilitating immediate correction.
Infection after breast implant surgery can result
in collection of thick fluid around the implant.
Usually implant removal should be done followed
by replacement after a number of months. This
can become very depressing for the patient and
can cause disruption in their plans. Early detection
and evacuation can help prevent explantation in
some patients5,6. It is imperative to inform the
patients of this potential complication and its
implication before proceeding for the surgery.

Fig – 5: Postoperative picture after breast implant
with abdominal liposuction
Plastic surgeons all over the world feel that
mammoplasty can alleviate psychological pain
in women with hypoplastic breasts and can help
regain their confidence and social status7. Studies
in Canada and America have focused attention on
the fact that a lower incidence of breast cancer
in patients with long term exposure is attributed
to silicone implants8,9. A word of caution by
experienced surgeons is that they should use the
commercial brand with which they are familiar
with and avoid using implants whose efficacy is
not known and unpredictable4.
Capsular contracture can be encountered, but
this could be minimized by careful dissection,
adequate pocket size, absolute hemostasis,
using the correct size textured implants and
by instituting regular self-massage in the post
operative period10.

The use of transaxillary approach was reserved for
patients who were unmarried and required small
to medium size implants. Dissection becomes
progressively difficult when approaching the
inframammary folds in large frame patients 11.
Ignorance and skepticism led to the delayed start
in the use of breast implant surgery in our country.
We believe that proper counseling of patient can
alleviate unnecessary fear of this type of plastic
surgery. If we can focus towards prevention of

Breast Implant Surgery in Bangladesh: An Experience of 126 cases
complications and their management, breast
implant surgery can be a regular operation for the
plastic surgeons of this country in future.
1. Coburn, R.I., Dehaan, C.R. and Fischer,
J.B. (1980)
Augmentation mammoplasty. In Aesthetic
plastic surgery,
Editors Stark, R.B. and Aufricht, G.
Little Brown and Company, New York, pp
2. Grotting, J.C., Urist, M., Maddox, W.A. et
al (1989)
Conventional TRAM Flap for immediate
breast reconstruction,
Plast. Reconstr. Surg. 83, P 828
3. Siddiky, S.A. (2002) Augmentation
Mammoplasty using Silicone Implants:
First Case in Bangladesh. The Orion Vol.
13, September issue, pp 11-12
4. Berlin, Jr. C. M. Silicone breast implants
and breastfeeding. Pediatrics. 1994 Oct,
94, (4, part 1): 547-549.
5. Barloon, T. J., Young, D. C., and Bergus, G.
The role of diagnostic imaging in women
with breast implants. American Family
Physician. 1996, 54, (6): 2029-2036.
6. Bantick, G. L., and Taggart, I.
Mammography and breast implants.
British Journal of Plastic Surgery. 1995,
48, (1): 49-52.
7. Beale, S., Hambert, G., Lisper, H. O.,
and et al. Augmentation mammoplasty:
The surgical and psychological effects of
the operation and prediction of the result.
Annals of Plastic Surgery. 1985 Jun, 14,
(6): 473-493.
8. Berkel, H., Birdsell, D. C., and Jenkins,
H. Breast augmentation: A risk factor for
breast cancer. The New England Journal of
Medicine. 1992 Jun 18, 326, (25): 1649-
9. Brody, G. Silicone implants and the
inhibition of cancer
Plast. Reconstr. Surg. 1995, 96, P 519
10. Beegle, P. H., Bostwick, J., Hargraves,
H., and Hester, T. R. Evaluation of
capsular contracture in submammary vs.
submuscular breast augmentation. Surg.
Forum. 1982, 33, 586-587.
11. Bevin, A. G. On augmentation mammaplasty
by the transaxillary approach. Plast.
Reconstr. Surg. 1977