Breast Augmentation

Breast augmentation is one of the most frequently performed plastic or cosmetic procedures performed on women aged 18 to 45 in Fresno and in the California central valley area. It is performed to enlarge the breasts and improve its overall shape.

Other names for this procedure include augmentation mammoplasty, breast enhancement, breast implant surgery or breast enlargement.

Listed below are some valid reasons to consider breast augmentation surgery:

  1. You have A or B cup sized breasts that are disproportionately small compared to the rest of your body and you have trouble finding clothes that fit you well.
  2. You have recently lost a significant amount of weight either through bariatric surgery or diet and exercise. As a result of the dramatic weight loss, your breasts have also become smaller.
  3. Your breasts have noticeably decreased in size after you stopped breastfeeding and they no longer fill the bras you used to wear.
  4. One breast is significantly larger or smaller than the other and you would like your breasts to look more symmetrical.
  5. You have unnaturally shaped breasts (tuberous breasts) that are elongated and you feel self conscious about them.

Traditionally, the most common way to enhance the size of the breast is through the insertion of breast implants. Recently, there are procedures that can increase the size of the breast without the use of implants such as fat grafting.

There are pros and cons to each of these procedures and Dr. Sian will discuss these with you during your initial consultation to help you arrive at a treatment plan that will best achieve your desired result.

What is breast implant surgery and how is it done?

Insertion of breast implants is still the most commonly used technique for breast augmentation. The implants used can either be saline or silicone gel filled implants and these are placed either above or below the pectoralis major (chest) muscle. A saline implant is a silicone shell filled with sterile salt water. Silicone gel implants are filled with an elastic gel. Silicone gel implants are available only to women who are 22 years or older.

Breast implants do not last forever and may rupture in the future, thus, necessitating removal or replacement.

Breast implants can be inserted through incisions under the breast (inframammary fold), around the areola (periareolar), or through the armpit (transaxillary). The type of implant used, the placement of incision and the size of the implant are influenced by individual physical characteristics and the patient’s preference. These factors will be evaluated during your initial consultation and the information gathered will be used in choosing the optimal implant size and style for you.

Dr. Sian’s preferred technique is the use of a smooth round implant (saline or silicone gel) that is inserted via the inframammary fold and placed in a pocket created beneath the pectoralis muscle. This incision heals very well in most women and is hardly noticeable when fully healed. The placement of the implant underneath the pectoralis muscle minimizes the visibility of the implant edge and its ripples. In some cases, the implant may need to be placed above the pectoralis muscle. There are situations when a periareolar or transaxillary incision may be used. Dr. Sian can elaborate further on this matter at the time of your consultation.

More information regarding silicone implants can be obtained from the following web sites:


Breast augmentation surgery usually takes 1.5 to 2 hours and is done by Dr. Sian under general anesthesia. This is an outpatient procedure and patients rarely stay overnight. Recovery time is approximately 2 to 3 weeks. Some highly motivated individuals have been able to go back to work in as early as a week after surgery. The time it takes a patient to go back to work depends on numerous factors including the following: the amount of physical work involved with the job, the patient’s overall health and the patient’s pain tolerance.

What are the alternatives for women who want breast enhancement but do not want to use breast implants?

Fat grafting is an option for women who do not want to use implants. With this technique, fat is harvested from another part of the body (usually the abdomen) by means of liposuction. The fat is then processed, washed and/or centrifuged then injected into the breasts. Fat grafting can be done in the hospital (under general anesthesia or IV sedation) or in the office (under local anesthesia).

What will happen during my initial consultation with Dr. Sian? What should I do and bring?

During your initial consultation, Dr. Sian will examine your breasts and take measurements. He will consider factors such as the size and shape of your chest wall and breasts, the quality of your skin and the position of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with breast augmentation. Photographs of your breast will be taken for documentation purposes; the photos do not show your face and will not be shown to anyone else unless you have given consent.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

There is no scientific evidence that breast augmentation increases the risk of breast cancer. however, there is an advisory from the FDA linking breast implants to a rare condition called Anaplastic Large Cell Lymphoma (ALCL).
Click here to learn more about the FDA advisory.

The presence of breast implants may make it more difficult to take and read mammograms. You should warn your mammography technician about your breast implants so that extra care may be taken during the procedure. This may be a special consideration for women who are at higher risk for breast cancer because of their family history or other reasons. Placement of the implant underneath the pectoral muscle may interfere less with mammographic examination, but other factors may also need to be considered as regards to implant placement. Dr. Sian will discuss these with you.

If you are planning to lose a significant amount of weight, be sure to tell Dr. Sian. He may recommend that you achieve a stable weight prior to undergoing surgery.

If you think that you may want to become pregnant in the future, you should mention this to Dr. Sian. Pregnancy can alter breast size and shape in an unpredictable way and could affect the long-term results of your breast augmentation. There is no evidence that breast implants will affect pregnancy or your ability to breast-feed, but if you have questions about these matters, you should ask Dr. Sian.

What should I do in the weeks and days leading up to my breast implant surgery?

Prior to surgery, each patient must undergo a complete medical evaluation by their personal physician to make sure they are in relatively good health.

In some instances, Dr. Sian may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast augmentation, you will still be able to perform breast self-examination.

If you are a smoker, you should stop smoking well in advance of surgery. Smoking has a negative effect on wound healing and may result in complications.

Aspirin, Warfarin (Coumadin), Plavix, Pradaxa, Eliquis, Xarelto, Aggrenox and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications at least 10-14 days before surgery. Other food supplements can also cause bleeding such as Gingko biloba, garlic, ginger, Omega 3 fatty acids, fish oil, ginseng, Vitamins C & E, Glucosamine, Chondroitin, Saw Palmetto etc.. Discuss the pros and cons of discontinuing these medications with your treating physician.

If you are taking birth control pills (BCP) or are on hormone replacement therapy (HRT), you should consider discontinuing these medications if possible. Studies have shown that women on BCP or HRT may have a higher risk for thrombo-embolism during or after surgery. A discussion between you and Dr. Sian is important to address the risks associated with the use of these medications.

Dr. Sian will see you at his office before your surgery to go over the consent form, size and type of implants to be used, pre and post-operative instructions including pain medications, wound dressings etc. He will also make markings on your chest which will guide him during your surgery.

The night before the surgery, patients should avoid eating or drinking after midnight. Continue to avoid any food or liquid on the morning of the surgery. This includes mints and chewing gum. Make sure to come into surgery without makeup, lotion, body piercings or jewelry.

When taking a shower the night before and the day of surgery, the patient is advised to use Chlorhexidine soap but one should be careful not to erase the pre-operative skin markings. Deodorant, hairspray, and perfume should be avoided.

Breast augmentation is usually performed on an outpatient basis. Be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

What should I expect after surgery and what things do I need to do?

You should be walking with or without assistance immediately after your breast augmentation surgery. It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs. When laying in bed, you can flex and extend your foot (pretend you are pumping the gas pedal with your foot), this causes the leg muscles to contract which in turn squeezes the leg veins and promotes blood flow.

The first 5 days following your breast augmentation surgery, you may feel stiff and sore over the chest region. Your breasts may feel tight and sensitive to the touch. Your skin may feel warm or itchy. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but these will disappear over the next few days or weeks. Most of the residual swelling will resolve within a month or two.

Dr. Sian recommends that all the surgical dressings be removed or changed after two days. You can take a shower 48-72 hours after surgery as long as the incisions are intact, dry and healing well. Tub baths and/or swimming are not recommended. After taking your shower, dry your surgical incisions thoroughly with a clean towel, place a clean, dry gauze over the incision and wear your surgical bra to hold the gauze in place. Dr. Sian discourages the use of any tape on the breast as these can cause “tape burns”.

It is recommended that the patient wear a support bra 24/7 for at least 4 to 6 weeks after the procedure. Patients should avoid push-up bras or bras with underwire. Sutures will be removed in about one to two weeks.

While it may take several days to return to more normal activities after your breast augmentation, it is important that you get up and move around to minimize the risk of deep vein thrombosis (DVT) and pulmonary embolism (PE). After breast augmentation, it is often possible to return to work within just a few days or a week, depending on the type of activities that are required at your job.

Strenuous physical activity should be avoided during the first several weeks (4-6 weeks) following surgery.