Breast augmentation is one of the most common plastic surgery procedures performed by Dr. Panossian. Choices on implant style and type exist to get you the shape that is most complimentary to your shape. Dr. Panossian stresses a "natural" augmentation style. This doesn't necessarily mean that you have to settle for small, which most surgeons will mean by "natural." Instead, using the latest technology of breast implants, Dr. Panossian will select the style, size and material (eg, silicone vs saline) that will get you the look you desire. He tailors the procedure to meet each patient’s individual needs and provides some of the best breast augmentation Los Angeles and Pasadena has to offer.

Breast augmentation is one of the most commonly requested plastic surgical procedures. The basic principle involves inserting an implant underneath the breast gland or pectoralis muscle. The procedure is fast, and the results are truly amazing. Dr. Panossian also uses the latest techniques to augment breasts using one’s own fat in select individuals. 


What is breast augmentation?

Person with gloves holding silicone breast implant.Presently available breast implants include silicone and saline varieties. Silicone implants are composed of a gelatinous substance contained within a rubberized silicone shell. In the past, this included the more liquid form of the implant which did pose issues related to rupture and leakage. Modern silicone implants are referred to as “cohesive.” In other words, the issues with spread of liquid within a breast pocket are avoided since the substance tends to coalesce with itself in the event of leakage or rupture. The newest iteration of silicone implants includes the highly intriguing “gummy bear implant.” These implants are termed “form-stable” and tend to hold their original post-manufacturing shapes. They resemble the natural teardrop shape of an ideal breast and come in numerous sizes.

Saline implants are composed of a rubberized silicone shell which is filled inside the breast cavity with saline fluid. Fewer options exist for implant shapes. However, the ability to size the implant accurately once in the breast pocket can be much more adjustable. Also, in the event of a rupture, saline fluid leaks into the surrounding tissues and is harmless. The end result in this circumstance is a “deflated” breast, whereas this will be less obvious with a cohesive silicone gel implant.

Most surgeons will agree that a silicone breast implant offers more realistic results in terms of both shape and consistency. Past concerns regarding silicone toxicity have not been substantiated by scientific data. In the end, patients have more choices these days than they ever did with regards to breast augmentation.  


How is breast augmentation performed?

Schematic of breast augmentation incision locations.In the case of implant augmentation, several options exist in both surgical approach and implant choice, as described. Incision options include inframammary (under the breast fold), periareolar (around the nipple), transaxillary (from the armpit), and transumbilical (through the belly button). In addition, Dr. Panossian will put the implant above or below your pec muscle given your goals and body type. Each option has its pros and cons. Dr. Panossian has extensive experience in all options and will guide each patient to the most appropriate option during an extensive consultation.

In addition, placement of the implant is an important decision that Dr. Panossian will make with you to get the most natural result. In most situations, he will recommend placing the implant underneath the pectoralis major muscle in order to hide the borders of the implant and prevent any issues with breast contracture or rippling of the implant. This is known as sub-pectoral or submuscular placement. In other athletic or slender women, Dr. Panossian prefers placement above the muscle layer of your chest to prevent distortion of the implant with aggressive muscle activity. This is called subglandular placement.

Placement options for breast implant below or above pectoralis muscle.

Fat augmentation is a more recent trend. In appropriate patients, fat is harvested from the lower abdomen through a small incision inside the umbilicus (belly button) and injected into each breast. Additional fat is harvested using liposuction from the thighs, buttocks and love handles when more is needed. The process of fat augmentation may need to be repeated due to some resorption that occurs of the transferred fat.

Although the decision to pursue breast enhancement must come from patients, Dr. Panossian will guide you to the right option given your body type and goals. Patients frequently choose implants that are too large to be supported by their frame. Various factors will determine whether or not the patient’s choice is suitable. Rest assured that Dr. Panossian’s will help you in the process of choosing the best type, size, and style of implant. 


What is recovery like?

Breast augmentation is an outpatient procedure which can take between 1 and 2 hours to perform. A family member or friend should accompany the patient for transportation and assistance during the first 24 hours after surgery.

Although most patients may feel only mild discomfort, it is important to avoid strenuous activities including sports, heavy lifting, exercise, and running after children. Having someone at home who can assist with daily activities is highly recommended. Keeping activity level at a minimum during the first week is imperative for healing and return to usual activities. At 2 weeks following surgery, patients can exercise gradually, beginning with walking and low impact activities. Upper body exercises, weightlifting, and running are avoided for 4 weeks. A noncompressive bra without underwiring is worn for support. Dr. Panossian’s staff is available at all times to answer any questions regarding symptoms or postoperative care instructions.


What are the risks and complications of breast augmentation?

Complications following breast augmentation are rare. Nonetheless, several noteworthy outcomes are possible. It is important to understand these issues ahead of time when considering breast enlargement surgery.

Bleeding is a risk with any surgery. In the setting of breast augmentation, a large pocket is opened along the chest wall. This is a relatively bloodless area; however, there may be small blood vessels that can rupture after surgery and create a blood collection known as a hematoma. This may require a small office surgical procedure to drain the fluid. In rare circumstances, the implant may need to be removed or replaced.

Infection following surgery is rare also. If this occurs, it usually manifests within the first week following surgery. This can sometimes be controlled with oral or intravenous antibiotics. In some cases, the implant will need to be removed to allow for clearing of the infection. A new implant can then be reinserted several months later.

Nipple sensitivity issues can also arise. Some people complain of oversensitivity, undersensitivity, or complete loss of sensation. The incision itself can have areas of numbness. Patience and time will usually resolve these symptoms.

Capsular contracture is a known response of the human body to a foreign object such as a breast implant. This involves a natural inflammatory process resulting in scar formation and creation of a lining (i.e., capsule formation) that can, at times, result in distortion of the implanted breast or pain. The texture of the implant underneath will also go from supple to firm during this process. It may take several months or years to develop and may require surgical revision in some patients.

Implants can rupture occasionally. This can result from an injury or even from normal compressive forces. In the event of a rupture, both saline and silicone breast implants are safe and unlikely to cause anything more than a misshapen breast. If a rupture or leak does occur, then Dr. Panossian may recommend a second operation to replace the damaged implant.

There is currently no conclusive scientific study to suggest an increased risk of breast cancer in the setting of breast augmentation with smooth implants. However, routine mammography will need to be adjusted to account for the implant located beneath the breast gland. Additional x-rays or ultrasound studies may be required to evaluate lumps or the implant itself. In some instances, an MRI may be necessary.

The typical lifespan of a breast implant is difficult to estimate. There is currently no requirement to replace implants that are not problematic. Dr. Panossian is highly skilled in identifying potential problems and will assist you throughout every phase of this procedure.