AESTHESTICS IN AYURVEDA W.S.R BREAST AUGMENTATION .

INTRODUCTION - The dictionary meaning of word “Aesthetics” is “related with beauty

or the appreciation of beauty”. Though the word ‘Beauty’ has many facets like physical
beauty, beauty of enriching thoughts, beauty of Samaritan acts etc. here the focus is on
enhancing physical beauty, why? , the answer is Nowadays lot of importance is given to
outlook of a person because of which lot of youngsters are under pressure to look good and
maintain a perfect body physique but unfortunately not all are blessed with perfection many
of such females develop body image complex. Body image complex is a phenomenon
wherein people are not happy with the way their body looks and as a result of which they are
disturbed psychologically, they lack confidence some may even cut down on their social
appearances. In ayurveda also aacharyas has described ideal breasts (stana sampad)1 as not
too huge or not too small. This study is an attempt to provide economical remedy for breast
augmentation. Breast augmentation surgery cost in india is approximately 1-1.3 lakhs .
whereas cost involved in preparation of oil would be much lesser than this. Needless to say
this remedy is devoid of any anesthetic complications,hospital stay or is accompanied with
difficult breast feeding or possibility of breast cancer in future. Hence non surgical method to
enhance breast size is essential , this study aims to explore the same.

Aim:

To study clinical efficacy of local application of Kasisadi tail in breast augmentation.

Objectives:

1. To review the literature of breast development with special reference to breast hypoplasia.

2. To prepare formulation of Kasisadi tail and to standardize it.

3. To assess the safety of Kasisadi tail in female patients suffering from breast hypoplasia.

4. To assess whether duration of study i.e 60 days and duration of local application i.e 12
minutes for each breast is sufficient to get optimum results

NEED OF THE STUDY

Breast augmentation surgery is the most common cosmetic surgery procedure, according to
the American Society of Plastic Surgeons with 279,000 procedures performed in the US in
2015. The Food and Drug Administration (FDA) warns of a wide range of potential
complications from this surgery, including capsular contracture, rippling, rupture of the
implants, infection, hematoma, and many others.

The most common breast implant complications include:

 thick, noticeable scarring that does not fade

 hardening of the breast tissue, due to scar tissue shrinking around the implant

 a rupture where the implant leaks that can cause small lumps called silicone
granulomas to form

 noticeable creases or folds in the implant

 rotation of the implant within the breast

Reasons to Choose a Natural Method

 Risk of Complications - A main reason that women choose to try natural breast
enhancement methods over surgery is the risk of complications during or after
surgery. Some possible complications are very serious or require additional surgeries
to correct.
 Expense of Surgery - Cosmetic surgical procedures are quite expensive, costing
several thousand dollars. This type of surgery is generally not covered by health
insurance, so you would have to pay the cost out of pocket.
 Results are Possible Without Surgery - Many women have found that it is possible
to increase breast size naturally without surgery.

REVIEW OF LITERATURE

MODERN VIEW2 -

The glandular tissue of breast consist of acini that are aggregated to form lobules. Several
lobules collect to form lobe. there are about 15-20 such lobes in each breast. The acini of each
lobe are drained by small ducts which ultimately end in one lactiferous duct for each lobe.
The ducts open on the surface of the nipple. A little proximal to the opening each ducts shows
a dilatation called lactiferous sinus.

Deep to the areola there are numerous modified sebaceous glands. These glands becomes
enlarged during pregnancy and produced surface elevation or tubercles. The secretion of
these glands provide a protective covering for the areola and nipple during lactation.

Breast tissue as held in the place by bundle of fibrous tissue that connected to the skin and the
underlying deep fascia. These bands are referred to as the suspensory ligaments(or ligament
of cooper). inspite of these bands the normal breast has reasonable mobility over the deep
fascia and its skin can be pinched up.

In the female the initial enlargement of the breast at puberty is mainly due to accumulation of
fat. It is later that duct system proliferates and acini appears. considerable further
proliferation takes place during pregnancy. There is partial atrophy of glandular element after
the end of lactation. the breast atrophies in old age.

EFFECTS OF HORMONE ON BREASTS3 –

EFFECTS OF ESTROGEN ON THE BREASTS :-

 Estrogen causes development of stromal tissue of the breast ,

 growth of an extensive ductile system ,

 deposition of fat in breast. The lobules and alveoli of the breast develop to a slight

extent under the influence of estrogen alone , but it is progesterone and prolactin that

causes the ultimate determinative growth and function of these structures.

In summary , the estrogen initiate growth of the breast and of the milk producing apparatus.

They are also responsible for characteristic growth an external appearance of the mature

female breasts.

EFFECTS OF PROGESTERONE ON THE BREASTS:-

progesterone promotes the development of the lobules and alveoli of the breasts , causing the
alveolar cells to proliferate , enlarge and becomes secretory in nature.
AYURVEDIC VIEW

Stana (Breasts) are an extra strotas present in females body which also contains ten extra
peshis (muscle) , it also has marma like stanamool and stanarohit which have potential to
cause death (after some while) if any trauma occurs (kalantarpranahar ) in nature, aacharya
sushrut has also narrated that two veins in each breast is avedhyai.e should not be operated
upon , this itself elucidates how breasts implants is a risky operation and how do it leads to
several complications.

CONCEPT OF ABHYANG -
As per Ayurveda oil gets absorbed into the dhatu as follows:4

Matra Dhatu

300 Roma

400 Rasa

500 Rakta

600 Mamsa

700 Meda

800 Asthi

900 Majja

1000 Shukra

REVIEW OF PREVIOUS WORK DONE –

Though there are many ayurvedic products which claim to cause breast enlargement ,there is
not a single scientific research study present.

Following is the list of allopathic researches conducted for breast augmentation by various
methods.

1) Nonsurgical Breast Enlargement Using an External Soft-Tissue Expansion System.

Roger K. Khouri, M.D., Ingrid Schlenz, M.D., Brian J. Murphy, M.D., and Thomas J. Baker,
M.D.
2) Breast Augmentation (Indian journal of Plastic Surgery) K.Ramachandran.

3) Study of the Safety and Effectiveness of Motiva Implants (clinical trials.gov)

4) IDEAL IMPLANT Structured Breast Implants: Core Study Results at 6 Years

Nichter, Larry S. M.D.; Hardesty, Robert A. M.D.; Anigian, Gregg M. M.D. (Journal of
American society of Plastic surgeons)

5) Silicone Breast Implant Safety and Efficacy

Garry S Brody, MD, MSc, FACS; Chief Editor: James Neal Long, MD, FACS

MATERIALS & METHODS:

The study was carried out in two parts

A) Preparation and standardization of Kasisadi tail5

B) Assessment of efficacy of local application of Kasisadi tail in breast augmentation.

A) Preparation and standardization of Kasisadi tail

1) Collection & standardization of raw materialsRaw materials, i.e. Ashwagandha, Shatavari,

Gajapippali, Kasis bhasma, til tail were purchased from authentic sources.

The authentication & standardization of these raw materials was done at certified lab.

2) Preparation of Kasisadi tail

Once the authenticated and standardized raw drugs were collected, Kasisadi tail was prepared
as per the SOP of oil preparation in pharmacy of dept. of Rasashastra & Bhaishajya Kalpana,
School of Ayurveda.

Table no. 2- Ingredients with quantity of Kasisadi tail

For preparation of 1 litre of Kasisadi oil following concentration was taken

 Drug Quantity
Shatavari 50 gm
Ashwagandha 50 gm
Gajapippali 50 gm
Kasis Bhasma 50 gm

B) Methodology of Clinical Study of efficacy of local application Kasisadi tail in breast

augmentation

 Place of study-

* Approval was obtained from the Research Advisory Committee (RAC) and Institutional
Ethics Committee (IEC) of the D. Y. Patil Deemed to be University School of Ayurveda,
Nerul, Navi Mumbai. This study was conducted at D. Y. Patil Ayurvedic Hospital, Nerul,
Navi Mumbai. Consent was obtained from the patients prior to any study related procedures.

controlled, prospective clinical study.

* Sampling technique: Selective sampling.

 Source of data:

Sample size: 60 females eligible under the inclusion criteria were selected for study

Inclusion criteria:

• All nulliparous women between 18-35 years of age.

• Patients with breast measurements 32 inches or less.

• Patients who are willing for breast augmentation.

Exclusion Criteria:

• Age - patient with age < 18 years & > 35 years

• Pregnancy and parous women.

• Patents with or with h/o

fibroademoma, cystic breast disorder, mastitis, benign or malignant breast tumour.
Study design:

• In this study, 60 female patients were selected after taking their consent. The eligible
selected females were instructed accordingly regarding application of oil over breasts.

METHOD OF APPLICATION – Patient was trained to do local application of

lukewarm kasisadi tail over both breasts in circular motion for 12 minutes over each

breast once a day (at night) for a period of two months with follow up after every

twenty days.

Pre and post treatment reading were recorded to assess various parameters of study.

 Selected patients – 60
 Breast measurement at the start of the treatment
 Calculation of Breast Hypoplasia rating score (BHRS) Before treatment.
 The patients of this group were trained to apply lukewarm kasisadi oil over breasts.
 Quantity – approximately 15 ml for each breast.
 Kala: At night before sleeping
 Method of application – in upward circular motion.
 Duration of massage – 12 minutes over each breast .
 Course of treatment – 2 months
 Follow up after – every 20 days for breast measurement.
 Calculation of Breast Hypoplasia rating score (BHRS) After treatment.

Assessment tool –

Breast size ( in inches)

Breast size ( in inches)

BEFORE TREATMENT AFTER TREATMENT
F/U 20 DAYS 40 DAYS 60 DAYS
Subjective Criteria-

Breast hypoplasia rating scale (BHRS) :

Breast size ( in inches) Score

32 and more 0
31 -32 1
28 -30.9 2
26 – 27.9 3

Note – score 3- severe breast hypoplasia , Score – 2- Moderate breast hypoplasia, Score 1 –
Mild breast hypoplasia., 0- no hypoplasia

B) Clinical Assessment:

BT Day 20 Day 40 Day 60

Sample Size (n) 60 60 60 60

Mean ± SD 28.75 ± 0.62 29.30 ± 0.65 29.90 ± 0.79 30.52 ± 0.95

Median 28.90 29.150 29.950 30.50

Range 28.0 – 30.0 28.0 – 31.0 28.0 – 32.3 28.0 – 33.2

Data passed No No No No
Normality
Test?

Test of Friedman test (Nonparametric Repeated Measures ANOVA)

Significance

Sum of Ranks 72.500 123.50 177.00 227.00

Statistics Friedman Statistic Fr 154.53

P Value The p value is < 0.0001, extremely significant

Intra-Group Comparison by Wilcoxon Matched-Pairs Signed-Ranks Test

BT vs Day 20 The p value is < 0.0001, extremely significant

BT vs Day 40 The p value is < 0.0001, extremely significant

BT vs Day 60 The p value is < 0.0001, extremely significant

The average breast size in females before treatment (BT), on Day 20, Day 40 and after
treatment i. e. on Day 60 were 28.75 ± 0.62 inches, 29.30 ± 0.65 inches, 29.90 ± 0.79 inches
and 30.52 ± 0.95 inches. The Friedman test (Nonparametric Repeated Measures ANOVA)
was applied for intra-group comparison. The difference in breast size among four visits was
statistically significant (p < 0.0001).

The difference between average breast size on Day 0 (BT) vs Day 20, Day 40 and Day 60
(AT) was found to be statistically significant (p < 0.0001).

Assessment of BHRS (Score) in study participants:

BT AT

Sample Size (n) 60 60

Mean ± SD 2.00 ± 0.00 1.50 ± 0.65

Median 02 02

Range 02 – 02 00 – 02

Data passed Normality No No

Test?

Test of Significance Wilcoxon Matched-Pairs Signed-Ranks Test

Sum of all signed ranks (W) = 325.00

Number of pairs = 25

The p value is < 0.0001, extremely significant

The average BHRS (Score) before treatment was 2.00 ± 0.00 which has got changed to 1.50
± 0.65 after treatment. The difference in BHRS (Score) on treatment for 60 days was found to
be statistically significant (p < 0.0001).

Grade Before Treatment (BT) After Treatment (AT)

No. of Patients Percentage No. of Patients Percentage

0 00 00% 05 08.33%

1 00 00% 20 33.33%

2 60 100% 35 58.33%

Total 60 100% 60 100%

BHRS (Score) of all the female participants was 02 before treatment. After treatment, BHRS
(Score) was zero in 05 (08.33%) participants, one in 20 (33.33%) participants and two in 35
(58.33%) participants.

Chi – Square test was applied to discrete data generated through the study.

Chi – Square Value = 22.5

P Value < 0.001, highly significant

OVERALL ASSESSMENT OF THERAPY:

Sr. Results No. of Percentage

No. Participants

1 Completely cured (4 or more than 4 00 00%

inches growth)

2 Markedly improved (3 - 3.9 inches 04 06.67%

growth)

3 Moderately improved (2 - 2.9 inches 16 26.67%

 growth)

4 Mild improvement (0.1 - 1.9 inches 32 53.33%

growth)

5 No change (no growth) 08 13.33%

Total 60 100%

Out of total 60 study participants, no one got complete relief. Four (06.67%) participants
were markedly improved, 16 (26.67%) participants got moderately improved whereas mild
improvement was observed in 32 (53.33%) participants. There was no change seen in eight
(13.33%) participants.

DISCUSSIONS

1) PROBABLE MODE OF ACTION OF OIL MASSAGE

Ayurvedic viewIn sushrutsamhita, abhyangi.e local application of oil has been cited to lead to

dhatupushtee. Breast tissue is primarily composed of fattissue (Medadhatu), so the

application of kasisadi oil in breast augmentation is justified. Further aacharyadalhan has

narrated in tika of the same shlok that if massage is done for 700 matrasi.e approximately 12

minutes, the oil will reach to fatty tissue (medadhatu) which will lead to its

augmentation(dhatupushtee) leading to breast enlargement.

Modern view

Dermal Absorption:

The skin is relatively permeable to fat soluble substances and relatively impermeable to

water soluble substances. Essential oil molecules are so minute that when they are applied to

the skin; they are able to pass through the strateumcorneum (the outer layer of the

epidermis). From here the oil molecule passes through dermis, into the capillaries and into

the bloodstream.

Absorption also occurs through the hair follicles and sweat ducts. There are many factors

that effect absorption of an oil molecule. Both rate of circulation and the warmth of the skin

increase blood flow to the surface, therefore increasing the skin’s ability to absorb the oil.

Circulation and warmth can be increased by massage(abhyang).

2) PROBABLE MODE OF ACTION OF CONTENTS OF KASISADI OIL

A) Kasis( Ferrous sulphate, Feso4 7H2O) –

Rasa – Tikta, amla

Virya- ushna

Guna- snigha, guru, nirmala

Kasis is also cited to cure emaciation (kshayrogahar) , so it promotes the proliferation of

fatty tissue of the breast, thereby leading to its enlargement.

B) Gajapippali (Scindapsusofficinalis) –

Rasa – katu,

Virya – ushna

Vipak-madhura

Gajapippali by virtue of its hot properties and madhurvipak leads to pacification of vitiated
vatadosh . breast hypoplasia (kshay) results from vitiated vatadosha hence its pacification

leads to breast enlargement.

C)Ashwagandha (Withaniasomnifera)

Raka –madhur, kashaya, tikta

Virya-ushna

Vipak-madhur

In addition to being excellent vatashamak ,ashwagandha is also rasayan(rejuvenating)

&vajikaran (aphrodisiac) which aids in better production of shukradhatu (oestrogen &

progesterone) and breast being a secondary sex organ directly influences its growth.

D) Shatavari (Asparagus racemose) –

Rasa-Madhura

Virya-sheeta

Vipaka-madhura

All the characteristics of shatavari are vatapittashamak, also its Rasayan ( rejuvenating) i.e.

leading to new and superior body tissue production, Balyai.e increased & better strength of

body tissues (here firm contour of breasts). It’s an excellent galactogogue(stanyajanan), so it

has action on both breasts (aashray)& milk (aashryee).

E) Sesame oil (til tail)-

Breast Hypoplasia (kshay)is a result of either vitiated vatadosha or vata being predominant

component of one’s body constitution (prakriti).

Oil massage (abhyang) is first line of treatment of vatadosha as skin is one of the organ

where vata resides hence massage of breast with lukewarm oil like sesame which in itself is

the best remedy for vitiated vatadosha , hits the target with double action. It also serves as a

vehile to deliver the contents of kasisadi oil to muscles, fatty tissue and production of
oestrogen & progesterone (Mamsa,meda&Shukradhatu)

CONCLUSIONS –

1) Oil massage (Abhyang) leads to production of body tissues exactly in the same way as

a seed starts germinating once it is watered7

2) Kasisadi oil serves as an economical alternative to breast implants.

3) Contents of kasisadi oil are very wisely chosen & each one of them has their own

unique action in breast augmentation.

4) Breast hypoplasia (small breasts) is a cause of significant mental disturbance in

certain individuals.

5) In addition to treating breast hypoplasia efforts should be made to train individuals to

focus on their strength rather than weaknesses, this will help in reducing incidences

of Body image complex.

6) Lot of young girls should be taught that confidence stems from how you see yourself

rather than how other people see you!

REFERENCES

1. Ayurvedia prasuti tantra evum stree roga , premvati tiwari publisher chaukhambha
oriantalia, first edition , cha. sha. 8/53 , chap- 99 page no – 646

2. text book anatomy with colour altas, inderbir singh, publisher by – jitendar p vij jaypee
brother medical publisher (p) ltd, edition fourth , chap- 10 page no – 185,186
3.text book of medical physiology, guyton and hall, publisher – Elsevier 11th edition,
chap- 81 page no – 1017, 1018

5. Chakradatta samhita , 63/56, page no-392, Indradev Tripathi, chaukhambha orientalia

Varanasi.

6. Sushrut samhita,Dalhan tika chikitsasthan 24/30 page no-488, Aacharya Priyavat Sharma,
edited in 2002,chaukhambha orientalia Varanasi.

7. Sushrutsamhita, Dalhan tika chikitsasthan 30/32, page no-358, Aacharya Priyavat Sharma,
edited in 2002,chaukhambha orientalia Varanasi.