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Breast Augmentation
Breast Augmentation: Silicone or Saline Breast Implants for Breast Enhancement

The American Society of Aesthetic Plastic Surgery lists breast augmentation among the TOP 5 cosmetic procedures for women.  Breast augmentation can increase confidence in women and can improve the natural contours of the body.

Breast Implant surgeon in Los Angeles for silicone and saline breast implants by Mentor or sientra

There are many options available for breast augmentation, including the style, texture, and type of breast implants.  During your consultation for breast augmentation with Dr. Raffy Karamanoukian, he will complete a comprehensive evaluation of your desires for breast enhancement and discuss your options for breast implants.  In the United States, both saline and silicone breast implants are available for breast augmentation. 

Candidates for breast augmentation include women who are concerned about cosmetic volume enhancement of the breasts, or women who have asymmetry of the breasts. Some common reasons to undergo breast enhancement include the following:

  1. Improve the shape and volume of small breasts pre-pregnancy
  2. Improve breast fullness and volume post-pregnancy and childbirth
  3. Improve cleavage
  4. Balance asymmetry caused by normal breast development
  5. Recontour breast volume and breast shape with increased volume

As a board certified plastic surgeon in Beverly Hills and Santa Monica, Dr. Karamanoukian feels that it is important to provide women with choices.  Both saline and silicone breast implants are available in our office and Dr. Karamanoukian will provide you with many options for these implants that vary in terms of overall volume, shape, style, texture, and profile.  Saline breast implants provide a high level of safety and can be placed through very small incisions; whereas silicone breast implants are prefilled and require larger (although still small) incisions on the breast.  Both implants have high safety records and undergo rigorous scrutiny by the FDA to assure safety after breast implantation. Almost all of the silicone breast implants available in the United States are now cohesive gel breast implants and these allow for more safety and less problems should there be a breast implant rupture over the course of an implant's lifetime. The decision to have breast implants placed above or below muscles relies on a woman's specific breast shape and anatomy.  During your consultation, Dr. Karamanoukian will discuss the options for submuscular, subglandular, or dual plane breast augmentation. 


There are several different types of incisions that are used for silicone or saline breast augmentation.  During your consultation for breast implant surgery with Dr. Karamanoukian in his Santa Monica office, a discussion of the different types of incisions can be made after a careful examination of your breast dimensions.  The most favored incision types for breast augmentation include the periareolar or circumareolar incision, the inframammary or submammary incision, the armpit or axillary incision, and the umbilical or belly button incision.  Each of these incision types has its distinct benefits and disadvantages.  All share the similar goal of minimizing surgical scarring and breast scarring with placement of a silicone or saline breast implant. 

Once you have decided to undergo breast augmentation with silicone or saline breast implants, the first decision to make is incision placement.  There are many options available for incision placement when performing breast augmentation. 


The most obvious choices are the inframammary fold and the peri-areolar locations.  The inframammary fold incision is located below and slightly lateral to the areola along the lower crease of the breast; whereas the peri-areolar incision is located on the lower border between the areola and the breast skin along the lower margin of the areola.  These two options provide outstanding exposure for the surgery and allow for careful and meticulous dissection of the breast implant pocket for placement of saline or silicone breast implant. 


Inframammary and periareolar incisions also allow for surgical dissection to correct asymmetries of the breast, including loss of cleavage and upper fold fullness. 


The advantages of the inframammary fold incision is that it is usually well hidden when there is mild ptosis and when a breast forms a crease along the lower part of the bra line.  The inframammary fold incision can be extended and usually heals nicely with minimal scars after surgery.  The disadvantages of the inframammary incision are that in patients with smaller breasts, the scar may be visible in a small bikini. 

The peri-areolar scar also has its own advantages and disadvantages.  The advantages are that the scar is usually well hidden along the transition point between the areola and the surrounding skin.  This difference in pigmentation allows for good scar camouflage after the scar has healed.  The peri-areolar scar also provides outstanding access to the medial and lateral folds of the breast in order to expand the cleavage line and to correct asymmetries of the breast.  The disadvantages of the peri-areolar scar are that the incision is usually small and cannot be performed if the areolar diameter is smaller than 35 cm.


Dr. Karamanoukian will discuss your options and evaluate your candidacy for either the inframammary or peri-areolar incisions during your breast augmentation consulation.  Both saline and silicone breast augmentation can be performed with peri-areolar or inframammary incisions and the ultimate placement should be decided by you and Dr. Karamanoukian during your preoperative evaluation.  During the surgery, the incisions will be closed with intermediate layered closures on multiple planes including the deep tissue, subdermal layer, and also the skin.  This allows for a good healing environment which will ultimately lead to better scars. 


Natrelle Silicone Breast implants have a dedicated history of safety. The following is a list of attributes of the silicone gel breast implants manufactured by Natrellle:

  1. Approved by the FDA as breast implant medical devices in 2006.
  2. Contain a gel-filled cohesive silicone gel and an outer elastic silicone shell.
  3. According to Natrelle, silicone gel implants meet one of the most rigorous standards for all medical devices.
  4. Rupture Rates: Clinical studies on breast implant rupture found that after 11 years, 92 percent of breast implants were still intact. Inamed Corporation's PMA P020056: Silicone Gel-Filled Breast Implants, FDA Presentation from April 12, 2005, slide 11, Only round gel-filled implants are included. Style 153, anatomical, dual lumen implants are excluded.

Natrelle Saline Breast implants also have a dedicated history of safety.  The following is a list of attributes of the saline filled breast implants manufactured by Natrelle:

  1. Approved by the FDA as a saline filled breast implant in May 2000.
  2. Manufactured with an elastic silicone shell and are filled intraoperatively with sterile saline. 



Dr. M. Mazzocchi et. al recently published an article in Aesthetic Plastic Surgery Journal describing women's posture after breast augmentation.  His results showed an interesting and fundamentally positive result of breast augmentation in that women who underwent breast implantation had invariably better posture after surgery, which included retropositioning of the head and compensatory  anterior positioning of the pelvis.  According to Dr. Raffy Karamanoukian, breast augmentation has many advantages and increases patient confidence and self-esteem. 


The preoperative assessment of breast augmentation remains the most important single factor determining the successful outcome of your breast augmentation.  Dr. Karamanoukian will spend a dedicated amount of time helping you choose your breast implants and determining crucial factors that may influence your long term success with saline or silicone breast implants. 
On the day of surgery, you will have the opportunity to review the size, type, and shape of the breast implants you will be obtaining.  A team of nurses and doctors will guide you through the preoperative details and review your postoperative recovery and activity restrictions. 
Breast implant surgery demands meticulous attention to detail and Dr. Karamanoukian and his personal team of nurses and surgical assistants will ensure that you receive the best surgical care.  During the surgery, Dr. Karamanoukian will make a small incision and create a implant pocket behind the pectoralis muscle of the chest.  This will allow safe placement of the silicone or saline breast implant. Once the implant is sterilely inserted into the breast pocket, the incisions are closed and irrigated with antibiotic solution. The skin will then be sutured and dressed with a padded cotton gauze. 
Once you are gently awakened, you will be lead out of the operating room where a nurse will attend to your needs.  During surgery, you will be given a dose of antibiotics and some anti-nausea meds to minimize vomiting or nausea after surgery. 


Some patients may require breast augmentation using the dual plane or biplanar method of breast augmentation.  For revisional breast surgery the dual plane technique can be used for patients with changes in the implant when the pectoralis muscle is flexed.  In other words, if a patient flexes their pectoralis muscle and notices significant changes in the lower pole of the breast implant, conversion to a dual plane implant technique may help eliminate the contraction related problems. 


The advantages of a dual plane breast augmentation include the fact that the upper pole of the breast is still covered with the pectoralis muscle but the lower pole of the breast under breast implant is relaxed and allows for lower pole expansion of the implant pocket.  This is particularly important in patients who have a double-bubble deformity caused by pectoralis muscle contraction or inadequate release of the lower pole of the breast.  The dual plane technique performed by board certified plastic surgeon Dr. Raffy Karamanoukian allows for release of lower pectoralis attachments.  By releasing the lower pectoralis muscle, the implant is allowed to drop inferiorly to promote a tear-drop shape.  If the pectoralis muscle attachments are not released adequately, the saline or silicone breast implants will tend to move superiorly with time, especially in the setting of capsular contracture.


Beverly Hills Plastic Surgeon Dr. Raffy Karamanoukian explains when a breast implant should be combined with a breast lift. 

If you are planning to undergo breast augmentation with saline or silicone breast implants, the initial consultation with Beverly Hills Plastic Surgeon Dr. Raffy Karamanoukian will help you evaluate your candidacy for breast enhancement and determine whether you will also require a mastopexy or breast lift at the same time as your breast implant surgery. 


Deciding to undergo breast augmentation with a breast lift depends on the degree of breast ptosis, which is a medical term used to describe the degree of droopiness of the female breast.  If the breast is truly ptotic and if the position of the nipple and areola are below the inframammary crease, then it is likely that a breast implant alone will only exaggerate the degree of breast droopiness.  In this case a breast lift will have to be added to your breast augmentation surgery in order to lift the nipple and areola and to create a more natural contour with perky breasts.  The number one criteria for deciding the necessity of a breast lift is the degree of droopiness and the second major factor is the amount of skin resiliency along the breast.  If you have severe stretch marks and looseness of the skin, especially after childbirth and breastfeeding, your breast skin may not have enough tone to maintain its shape for the years to come.  If this is the case, Dr. Karamanoukian may recommend a tailoring breast lift which will remove the excess skin and stretch marks from the breast and recreate a more useful breast contour.


During combination breast implant + breast lift surgery, Dr. Karamanoukian will begin by placing saline or silicone breast implants underneath the pectoralis major muscle, as is normal with a breast augmentation.  Once the intact breast implants are placed under the muscle, the breast implant pocket is closed using sutures and attention is then placed on to the overlying breast skin and breast tissue. An internal mastopexy is then performed, which provides an internal supportive network to lift up the breast and the nipple areolar complex to a more suitable position. 


The position of the nipple and areola during breast lift surgery is determined by exacting measurements from the sternal notch and mid sternum the nipple/areolar complex.  The position of the areola and nipple is also determined by the degree of lateral and medial fullness of the breast.  If you are a candidate for a combined breast lift and breast implant surgery, the results provide outstanding natural contour with minimal scarring. The scars for breast lift surgery are placed around the areola and also vertically from the bottom fold the areola to the inframammary crease.


  1. Can I combine breast augmentation with a small breast lift? A study performed on cosmetic plastic surgery patients reveal that breast asymmetry is a very real problem for women undergoing breast augmentation.  It is normal for women to have asymmetry of the breast prior to breast augmentation and this asymmetry occurs as a result of differences in size, shape, and nipple position.  If you are concerned that one of your nipples is slightly lower or displaced when compared to the other breasts, there are many options for breast augmentation with a small breast lift.  These minor breast lifts include a crescent breast lift in which a small piece of skin is removed from the lower nipple position in order to lift up that nipple and areola on the breast after breast augmentation.  Dr. Raffy Karamanoukian is an expert on combination breast augmentation with breast lift surgery and can provide you for many options for this procedure.  If the degree of breast asymmetry is moderate-to-severe, there are other options including a short scar breast lift that can be performed during your breast augmentation procedure.  Breast augmentation can be performed alone or in combination with a mommy makeover including liposuction, labiaplasty, and abdominoplasty.  Dr. Karamanoukian advocates silicone and saline breast implants for use during your breast enhancement surgery.  There are new options for breast implant surgery that are now in the market as a result of a new FDA approval of the Sientra silicone breast implants.  If you have questions regarding breast implant surgery and breast lift, Dr. Karamanoukian can discuss your options and provide you with full details regarding a crescent breast lift, short scar breast lift, or traditional breast lift during your breast augmentation surgery.  Please call our Los Angeles plastic surgery patient care coordinator at 310-998-5533.  During your consultation, you will be provided full opportunity to discuss you questions and concerns regarding silicone or saline breast implants and whether there are options for cocurrent breast lift during the procedure.
  2. Are Breast Implants Permanent? What are MemoryGel breast implants? MemoryGel is the brand name for a very safe silicone breast implant that is manufactured by Mentor, one of the leading companies for breast implants in the United States. MemoryGel breast implants contain a proprietary cohesive gel that acts as a cohesive unit when ruptured.  MemoryGel is an excellent option for women who demand safety with silicone breast implants.  Dr. Raffy Karamanoukian uses Mentor MemoryGel breast implants for submuscular and subglandular breast augmentation in healthy females who request volume enhancement of the breasts. 
  3. What are Natrelle breast implants? Natrelle breast implants are an FDA approved implant with a high record of safety and efficacy in breast augmentation.  Dr. Raffy Karamanoukian is a certified Natrelle breast implant provider and can assist you in choosing the right size for your breast augmentation.
  4. Can I breastfeed after breast augmentation or breast implant surgery? The majority of women will be able to breastfeed after undergoing breast augmentation surgery, especially if the implants are placed in the submuscular plane.  Most breast augmentation surgeries do not significantly damage the lactiferous ducts that help produce and deliver milk through the nipples.  An important consideration is that not all women can breast feed, regardless of breast implants being present. Can I breast feed after breast implants?
  5. What type of anesthesia is administered during breast augmentation? Both saline and silicone breast implants are performed in an outpatient setting under general anesthesia.  Dr. Raffy Karamanoukian, a Beverly Hills board certified plastic surgeon, performs breast augmentation alongside a board certified anesthesiologist who will administer the anesthesia in order to maintain the highest standards of safety.
  6. What does saline mean? Saline is the medical term used to describe a solution of sodium chloride that is used in hospitals as an i.v.  In plastic surgery, some breast implants are placed into the breast pocket and filled with a sterile solution of saline, much like an i.v.  Once the desired breast implant volume is achieved, the saline implant is closed and remains within the breast to add volume to the breast mound.  These implants are known as saline breast implants because they contain saline.  Other types of implants contain a medically inert substance known as silicone, which are known as silicone breast implants.
  7. What are the three main incision types for breast augmentation? Periareolar, axillary, and inframammary incisions. 


Memory Gel Cohesive Breast implants are FDA approved and prefilled with a set-fill volume for breast implant placement.  Implants can be placed in a submuscular or subglandular breast implant pocket.  Implants come in two shell surface choices, smooth and textured.  Memory Gel implants are covered by the Mentor Premier Advantage Warranty. Most importantly, Memory Gel breast implants hold uniformly and retain a natural compliance that resembles breast tissue. 

  1. Memory Gel Breast Implants: Smooth Round Moderate Classic (130 cc to 800 cc)
  2. Memory Gel Breast Implants: Smooth Round Moderate Plus Profile (100 cc to 800 cc)
  3. Memory Gel Breast Implants: Smooth Round High Profile (125 cc to 800 cc)


Dr. Karamanoukian Memory Gel Smooth Silicone implant photo




Dr. Karamanoukian performs a Rapid Recovery Breast Augmentation that incorporates several anesthetic principles to minimize postoperative pain after your breast augmentation surgery.  During your breast augmentation surgery, Dr. Karamanoukian will use a long-acting anesthetic to maximize your comfort for 12 hours after your operation.  You may still have some chest tightness and pain on movement of your arms, but this will quickly subside.  After your surgery, we recommend that you leave your surgical compression wrapping intact until your first postoperative breast implant visit.  At home, you will be able to move around and sleep, although the first 24 hours are usually associated with discomfort.  When you return for your follow-up visit, you will be examined by Dr. Karamanoukian and be given a special support bra or elastic wrap that will help your breast implants settle into their final position. Oral pain medications will be prescribed to you during your preoperative and postoperative clinic visits if they are necessary.



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