Breast augmentation continues to be one of the most popular procedures for women with almost 300,000 performed in the United States.  According to the American Society of Plastic Surgery, 72% of breast augmentations were performed with silicone gel implants versus 28% with saline implants.

Breast augmentation is a cosmetic procedure with the aim of increasing the size, changing the shape or fullness of a woman’s breasts. Breast implants are placed in the breast pocket under the breast tissue or under the muscle during the surgery.





Who is a candidate?
Any healthy woman who is able to undergo breast augmentation. Breast augmentation is available to any female over the age of 18 years old without the consent of an adult. A female’s growth should be complete and stable. If choosing silicone gel implants and you are less than 22 years of age it would be considered an off label use.

That being said, we recommend a thorough understanding of the risks, alternatives and benefits of undergoing a breast implant augmentation and possess the maturity to make the right decision.

How is it performed?
An incision is made in the fold of the (inframammary) or along the areola of the nipple (peri-areolar) most frequently. Some surgeons will also make an incision in the axilla (trans-axillary). The implant is then placed in a pocket that is dissected underneath the breast tissue (subglandular) or the pectoralis major muscle (submuscular).Dr.Koumanis will discuss incision options with you and the advantages and disadvantages associated with the different methods. The biggest advantage of putting them under the muscle is that there is less chance of a capsular contracture (hardening of the breast capsule around the implant).

The surgery usually takes 1.5 to 2 hours and is performed most frequently under general anesthesia but sometimes under intravenous conscious sedation where the patient does not require a breathing tube and is given medication to make them very drowsy.

Where is the incision made?
The most common place for the incision is hidden just under the breast fold. The incision is usually under 2 inches. Another common place is a small incision around the areola if the patient is a candidate. The implants are then introduced through this small space in a safe and sterile manner.

What is the optimal size of implants used?
The size of implants is different for everyone. Dr.Koumanis listens to your desires and then compares it with your skin strength or quality and where the nipple sits on your breast mound. The goal is to give you an ideal shape, breast fullness but reduce any complications such as a thinning skin envelope that cannot withstand the weight of a particular size implant. Dr.Koumanis and his nursing staff will pre-fit you with sample implants in the office so we can see how they look in a bra and that gives us a good estimate of the size that will be most attractive.

What are some of the possible complications associated with breast augmentation and implants?
Although breast augmentation surgery is generally a very safe and successful cosmetic procedure, the following possible complications will be discussed with you to ensure that you as the patient are well informed:

  1. Infection
  2. Bleeding
  3. Scarring
  4. Capsular Contracture
  5. Reoperation rates
  6. Implant rupture
  7. Asymmetry

This is not a definitive list but takes into account the most prevalent issues surrounding breast augmentation surgery involving implants. Dr.Koumanis will also discuss the approaches and safety measures he utilizes to minimize the chances of each of these occurring for his patients. Dr.Koumanis takes great pride and attention in keeping his complication rate low for his patients.

Does breast augmentation with implants affect breast feeding?
Breast feeding has become an important topic in recent years due to the positive health effects that have been defined by a large body of research. Breast-fed babies have been found to have enhanced protection against eczema skin condition, ear infections, diabetes mellitus, respiratory issues such as asthma and iron-deficiency anemia.  Breast-fed babies also show better digestion, nervous system development and ability to thrive.

That being said, women who undergo breast augmentation are less likely to produce adequate milk to nourish an infant and will likely need to supplement. This may be an important issue for women who are still in their reproductive years and planning to start a family. Dr.Koumanis will discuss this with you in detail during your visit if it applies to your situation.

What happens if the implants rupture?
If they are saline, then you absorb the saline and only the outer shell of the implant has to be removed. Silicone ruptures require removal of the shell and the gel. Studies have shown the newer breast silicone implants to have a much lower rupture rate than the old generation implants. However, as implants age their rupture probability increases.

Most ruptures usually occur within the breast pocket capsule meaning the silicone gel is contained but extra-capsular rupture still occurs. The new cohesive silicone gel implants aim to give one a better look and feel, but also help in keeping the silicone from bleeding out compared to previous generation silicone implants.

How is a rupture diagnosed?
Usually we order an ultrasound first. If inconclusive, an MRI is very sensitive in detecting implant ruptures.

What is my postoperative course and recovery?
There is some discomfort after the case but this is well managed with analgesics and the patient rarely experiences severe pain from this procedure. You will be put in bandages and a surgical bra. Most patients discomfort is fully relieved within 3-7 days in our experience.

You will be given specific postoperative instructions including exercises and care for your dressings.

Costs of Breast Augmentation
Dr.Koumanis typically charges $6500 to $7500 for breast augmentation. This includes the surgeon’s fees, facility and anesthesia fees.

Before and After Breast Implants

Before & After Breast Augmentation performed by Dr Dimitri Koumanis, MD

Why Choose Dr.Koumanis?
Servicing patients from Albany, Saratoga Springs, Glens Falls and the New York Capital Area, Dr.Koumanis is  a board certified plastic surgeon with many years of experience in all forms of breast surgery. With an artistic eye and attention to detail Dr.Koumanis strives for a result that the patient will be happy with while achieving the lowest complication rates possible. He will make your experience a positive one and you will feel very comfortable in his care throughout the whole preoperative, operative and post-operative process. He has performed over 500 breast surgery cases and is one of the busiest parts of his practice!