Natural-Looking Breast Augmentation | Santa Monica Beverly Hills
Breast augmentation is one of the most popular cosmetic surgical procedures in the world, helping women enhance breast size, improve contour, and restore volume lost after pregnancy, weight loss, or aging. Modern breast augmentation is highly customizable, allowing patients to choose implant type, size, shape, incision placement, and surgical technique to achieve their desired results. Today’s procedures emphasize natural aesthetics, safety, and individualized planning. Board-certified plastic surgeon Dr. Raffy Karamanoukian is widely recognized for his expertise in breast augmentation, breast implant revision, and breast lift procedures performed as part of comprehensive mommy makeover surgery.
Understanding Breast Augmentation
Breast augmentation is a surgical procedure designed to increase breast volume and improve breast shape using implants. The procedure can enhance naturally small breasts, restore fullness after pregnancy, correct asymmetry, or complement other body contouring procedures. Each surgery is tailored to the patient’s anatomy, aesthetic goals, and lifestyle.
A successful breast augmentation depends on several important factors, including the type of implant selected, implant size and projection, implant placement relative to the chest muscle, and incision location. Modern implant technology has also evolved significantly, offering improved safety, durability, and natural-appearing results.
Choosing Between Saline and Silicone Breast Implants
The two primary categories of breast implants used in cosmetic surgery today are saline implants and silicone gel implants. Both implant types share a similar structure: a silicone outer shell filled with a different internal material.
Saline Breast Implants
Saline implants are filled with sterile saltwater solution. During surgery, the implant shell is inserted into the breast pocket empty and then filled to the desired volume once it is in position. Saline implants offer several advantages. Because they are filled after insertion, they typically require slightly smaller incisions. Surgeons can also adjust the implant volume during surgery to improve symmetry between the breasts. If a saline implant ruptures, the body safely absorbs the saltwater and the breast deflates, making the rupture immediately noticeable. However, saline implants tend to feel slightly firmer than natural breast tissue and may be more prone to visible rippling under thin skin or in patients with limited natural breast tissue coverage.
Silicone Breast Implants
Silicone implants contain a cohesive silicone gel that closely resembles the softness and consistency of natural breast tissue. Many patients and surgeons feel that silicone implants provide a more natural look and feel compared with saline implants. These implants are pre-filled before insertion and are available in a wide range of shapes, projections, and sizes. Highly cohesive silicone implants—sometimes referred to as “gummy bear” implants—maintain their shape even if the implant shell is compromised. Because silicone implants are prefilled, they require slightly larger incisions for placement. Additionally, a rupture may not always be immediately noticeable, sometimes requiring imaging such as MRI or ultrasound to detect. Despite these considerations, silicone implants remain the most commonly chosen option for breast augmentation due to their soft texture and natural movement.
The New Generation: Motiva Breast Implants
Advances in implant design have led to the development of next-generation implants such as Motiva Breast Implants, which are designed to provide improved safety and natural aesthetics. These implants incorporate several technological innovations.
Motiva implants feature an innovative shell-silicone interface, which adapts to body movement and gravity, allowing the breast to assume a natural teardrop shape when standing and a rounder shape when lying down. This dynamic behavior closely mimics the natural behavior of breast tissue.
The implants also utilize advanced Silk Surface technology, a specialized smooth surface designed to promote better tissue integration while potentially reducing complications such as capsular contracture. Motiva implants are available in a variety of shapes and projections and are particularly favored for achieving soft, natural-looking breast augmentation results.
Choosing Between Subglandular and Subpectoral Breast Implant Placement
One of the most important decisions in breast augmentation surgery is the location of the implant relative to the chest muscle. Dr. Karamanoukian will discuss your options for implant placement that goes above or below the muscle. There are several reasons for each option and this can only be determined by your cosmetic goals and individualized anatomy.
Subpectoral (Under the Muscle)
Subpectoral placement, also called submuscular placement, positions the implant partially beneath the pectoralis major muscle. This technique is commonly used for patients seeking a natural-looking result, particularly those with minimal existing breast tissue. Placing implants under the muscle provides additional soft-tissue coverage, which can reduce the visibility of implant edges and decrease the likelihood of rippling. It also allows for smoother transitions along the upper portion of the breast, creating a gentle slope rather than an overly round appearance. Many surgeons prefer this technique for thinner patients or those seeking subtle, natural enhancement.
Subglandular (Over the Muscle)
Subglandular placement positions the implant above the pectoralis muscle but beneath the breast glandular tissue. This technique allows for shorter recovery time and avoids distortion of the implant during chest muscle contraction. Subglandular placement may be suitable for patients who have sufficient natural breast tissue to conceal the implant. It can also create more pronounced upper-pole fullness, which some patients desire for a more dramatic aesthetic. The choice between subpectoral and subglandular placement depends on each patient’s anatomy, aesthetic goals, and lifestyle.
Options for Breast Implant Incisions
Breast augmentation surgery requires a carefully placed incision through which the implant is inserted. Two of the most commonly used incision techniques are the inframammary and periareolar incisions. The inframammary incision is placed within the natural crease beneath the breast. This approach provides excellent visibility for the surgeon, allowing precise implant placement and optimal control during surgery.
Because the incision is hidden within the breast fold, it typically heals inconspicuously. This technique is widely used for silicone implants and advanced implant designs such as Motiva implants. The periareolar incision is placed along the border of the areola where the darker areolar skin meets the surrounding breast skin. This natural color transition helps camouflage the scar. This incision provides direct access to the breast pocket and can be especially useful for patients undergoing breast lift procedures combined with augmentation.
Natural-Looking vs. Large Volume Breast Implants
One of the most important aspects of breast augmentation planning is choosing the appropriate implant size and projection. Some patients desire subtle enhancement that complements their natural proportions, while others prefer larger implants that create dramatic volume and cleavage. A natural-looking breast augmentation focuses on harmonious proportions with the patient’s body frame. Implant size is selected to match the width of the chest wall and the elasticity of the breast tissue. This approach often produces soft contours and gentle upper-pole fullness. In contrast, large-volume breast implants create a fuller and more prominent appearance. These implants may produce more upper-pole projection and a rounder breast shape. While some patients prefer this aesthetic, careful planning is necessary to avoid excessive tension on the tissues and maintain long-term implant stability. An experienced surgeon evaluates the patient’s anatomy, skin quality, chest width, and lifestyle to recommend the ideal implant size.
Breast Lift and Mommy Makeover Procedures
Pregnancy, breastfeeding, and weight fluctuations can lead to loss of breast volume and sagging. In many cases, breast augmentation alone is not sufficient to restore youthful breast shape. A breastlift, or mastopexy, may be performed in combination with implants to elevate the breast tissue and reposition the nipple to a more youthful position. Breast augmentation with lift is a key component of the popular mommy makeover, a comprehensive surgical approach designed to restore a woman’s body after pregnancy. This combination procedure may include breast augmentation, breast lift, tummy tuck, and liposuction to address multiple areas simultaneously.
Expertise in Breast Implant Surgery and Revision
Achieving beautiful, long-lasting results in breast augmentation requires both technical expertise and artistic judgment.
Dr. Raffy Karamanoukian is a board-certified plastic surgeon recognized for his precision in breast implant surgery and advanced aesthetic techniques. With decades of experience in cosmetic and reconstructive surgery, Dr. Karamanoukian performs a full range of breast procedures, including primary breast augmentation, breast implant revision, implant removal, capsulectomy, and breast lift surgery. His extensive experience allows him to address complex revision cases, including implant malposition, capsular contracture, or unsatisfactory prior surgical outcomes. Each breast augmentation procedure is carefully customized to the patient’s anatomy and aesthetic preferences. Advanced surgical techniques, meticulous planning, and modern implant technology allow Dr. Karamanoukian to achieve elegant, natural-appearing results while prioritizing patient safety.
A Personalized Approach to Breast Augmentation
Modern breast augmentation is not a one-size-fits-all procedure. The ideal outcome requires careful evaluation of the patient’s body proportions, implant selection, surgical technique, and long-term aesthetic goals. With innovations such as Motiva implants, refined surgical techniques, and individualized treatment planning, breast augmentation can deliver results that are both beautiful and natural.
For patients considering breast augmentation, consultation with an experienced board-certified plastic surgeon is the first step toward achieving safe, balanced, and satisfying results. Through expert surgical planning and advanced technology, breast augmentation can enhance confidence, restore body proportions, and help patients feel comfortable and empowered in their own bodies.
Breast Implant Removal and Revision in Los Angeles
A small percentage of patients who have had breast implants may request their removal at some point in their lives. The reasons for implant removal vary by individual, but the desire to remove a saline or silicone breast implant should always be approached with a protocol-based surgical treatment plan. Los Angeles plastic surgeon Dr. Raffy Karamanoukian removes breast implants with or without capsulectomy using an inframammary or peri-areolar incision. Usually, breast implant removal is an outpatient surgical procedure without the need for prolonged recovery.
There are two variables that dictate the extent of surgical breast implant removal, the presence of a capsule and the amount of breast droopiness before implant removal. If there is significant breast implant capsular contracture, it may be a good idea to remove the breast implant capsule at the time of implant removal. If the breasts are droopy before surgery, there is a strong chance that a combined breast lift or staged breast lift is needed.
Dr. Raffy Karamanoukian is a specialist in breast implant removal and replacement for textured breast implants that were recalled by the FDA in 2019. Textured breast implants have been linked to a rare breast cancer that may be attributed to the microfibrils contained on the surface of a textured implants. Our office offers evaluation and can contact Allergan to financially cover some, if not all of the costs of removal and replacement of your implant.
Treatment of Capsular Contracture
The treatment of unilateral capsular contracture begins with an assessment of breast symmetry, volume, size, nipple position, and biometrics. Capsular contracture on one side can cause significant asymmetry, discomfort, and hardening of the breast which may distort the overall harmony of the breasts. The cause of unilateral capsular contracture or his largely unknown but may be attributed to tissue trauma, hematoma formation, subclinical infection, or acute and/or chronic inflammation.
Capsular contracture should be managed in the early onset stage in order to minimize the complexity of the surgical repair. Although many patients wish to preserve there intact saline or silicone implants in favor of a new one, it is more prudent to replace the implant entirely. The most common procedures to improve capsular contracture include capsulotomy or capsulectomy which remove parts of the tissue capsule or the entire circumferential capsule altogether.
Dr. Raffy Karamanoukian is a specialist in capsular contracture repair and revision and can help you determine if you are a candidate for capsulotomy or capsulectomy. It is usually important to obtain old medical records including the size and type of breast implant that was previously placed into your breasts. Patients who have textured implants may wish to have them removed as per the FDA recall that was instituted for specific models of textured implants by the United States FDA.
Recovery after a capsular contracture surgery depends on the severity of the problem and the scope of repair. Patients usually note a 3 to 5 day recovery with limited range of motion of the upper arms for approximately one week. Some patients may continue on anti-inflammatory medications based on the progression rate of their capsular contracture
