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Breast implant placement has changed significantly over the years as implant technology has improved. Techniques that were once considered standard were largely based on the limitations of older implant designs rather than what was most anatomically appropriate for patients.

In this video, Dr. Dimitri Koumanis explains how implant placement has evolved, why subfascial placement is now commonly used, and how modern cohesive implants allow for more natural results and easier recovery. He also discusses why placement decisions should be individualized rather than based on outdated standards. The full video transcription is included below.

Video Transcription

Historically, placing breast implants under the muscle was very common, especially when implants were less cohesive. Surgeons relied on muscle coverage to soften the upper breast, reduce visible implant edges, and lower the risk of rippling in thinner patients. At the time, this approach made sense based on the implant technology available.

However, implant technology has evolved dramatically. Modern cohesive implants provide improved structure and shape, which means we no longer need to rely on the muscle to disguise the implant in most patients. This advancement has allowed us to move toward more anatomically appropriate placement.
In our practice, we now rarely place implants under the muscle. Instead, we most often use a subfascial placement, where the implant sits over the muscle but beneath the muscle’s natural fascial layer. This approach provides coverage and support while allowing the implant to sit in a more natural position on the chest.

One of the biggest advantages patients notice is recovery. When implants are placed under the muscle, the muscle must be stretched and manipulated, which can significantly increase post-operative pain. With subfascial placement, the muscle is left undisturbed, leading to less discomfort, faster recovery, and a quicker return to normal activity.

Subfascial placement also results in more natural movement and appearance. Implants placed under the muscle can sometimes cause unnatural breast movement when the chest muscles contract, known as implant animation. Because subfascial implants sit over the muscle, this animation does not occur. The breast moves naturally at rest and during activity, which is especially important for athletic or active patients.

With cohesive implants and subfascial placement, the breast often looks and feels more natural, particularly in the lower pole and central breast. The implant is not distorted by muscle movement, allowing the breast to settle into a more natural shape over time.

That said, implant placement is always individualized. There is no single option that is right for everyone. Factors such as anatomy, tissue thickness, aesthetic goals, and prior surgery all play an important role. The key is choosing an approach that aligns with today’s implant technology and your individual body, rather than relying on outdated standards.

Ultimately, the decision between over versus under the muscle is not about trends—it’s about evolution. With modern cohesive implants, subfascial placement often provides a more natural look, less pain, faster recovery, and eliminates animation issues.

For more information about breast augmentation procedures, or to schedule a consultation with Dr. Koumanis, please contact Saratoga Springs Plastic Surgery today.

Breast augmentation has a high satisfaction rate, but some patients experience results that change over time or do not feel right. Breast revision surgery addresses these concerns and offers solutions when problems arise.

In this video, Dr. Dimitri Koumanis explains when breast revision surgery is needed, why issues can occur, and how modern techniques allow for effective correction. The full video transcription is included below.

Video Transcription

Breast augmentation has one of the highest satisfaction rates in plastic surgery. But not every patient ends up happy with the result the first time. If you’ve had breast surgery and something doesn’t look or feel right, you’re not alone. Today, I want to talk honestly about breast revision surgery, when it’s needed, why it happens, and how we safely and effectively fix problems.

My name is Dr. Koumanis. I am here at Saratoga Springs Plastic Surgery, and breast revision surgery is a significant part of what we do. Many patients come to us feeling frustrated or discouraged. But the good news is that most issues can be corrected with the right approach.

So what is breast revision surgery? It’s any procedure performed to improve or correct the results of a previous breast surgery. That may include replacing implants, adjusting implant position, correcting asymmetry, or addressing changes that occurred over time. Revision surgery is not a failure. It’s a solution.

Common reasons patients need revision surgery. There are several common reasons women seek breast revision. These include implants that are too large or too small. Implants sitting too high, too low or unevenly. Visible rippling or unnatural shape. Capsular contracture where scar tissue tightens around the implant and implant rupture or deflation. Changes after pregnancy, weight loss or aging. Sometimes the issue was present early on. Other times it develops gradually over years.

So even with good surgery, problems sometimes happen. It’s important to understand that not all revisions are due to poor surgery. The body changes, tissue, stretch, gravity, hormones, and life events all affect breast shape over time. Additionally, older implant technology or outdated techniques may not age as well as modern approaches.

We assess implant type, placement, capsule quality, breast tissue, skin elasticity, and your goals. Every revision is customized because no two situations are the same. The key is identifying the root cause of the problem before planning the solution.

So how do we fix the common breast surgery problems? Depending on the issue, revision surgery may involve changing implant size or type, adjusting implant position, releasing or removing scar tissue, adding internal support, combining revision with a breast lift to restore shape and position. Modern implant technology and advanced techniques allow us to achieve more natural, stable, and long-lasting results than ever before.

So, what should patients expect for revision surgery? Revision surgery is often more detailed than primary augmentation, but when done thoughtfully, it can be incredibly rewarding. Most patients feel a sense of relief, finally having breasts that look and feel right for their body.

So, if you’ve had breast surgery and you’re unhappy with the results, know this. options exist. Breast revision surgery can correct problems, restore balance, and help you feel confident again.

For more information about breast revision procedures, or to schedule a consultation with Dr. Koumanis, please contact Saratoga Springs Plastic Surgery today.

Many women considering breast augmentation want results that look natural and balanced rather than obvious or overdone. Achieving a natural appearance depends on more than implant size alone.

In this video, Dr. Dimitri Koumanis explains how a natural-looking breast augmentation is achieved through careful implant selection, placement, and individualized surgical planning. A full transcription of the video is included below.

Video Transcription

One of the most common requests I hear in consultation is this. I want breast augmentation, but I want it to look natural. The good news is that natural-looking breast augmentation is absolutely achievable. The key is understanding that it’s not about one decision. It’s about many thoughtful choices working together. Today, I want to explain how we consistently achieve natural-looking results.

I’m Dr. Dimitri Koumanis at Saratoga Springs Plastic Surgery. And natural results are a cornerstone of our approach. When breast augmentation is done correctly, it should enhance your body, not announce itself.

So natural results start with anatomy, not trends. The first step in creating a natural result is respecting your anatomy. Your chest width, shoulder frame, rib cage, shape, and existing breast tissue all determine what will look balanced on your body. We don’t chase trends or copy photos from social media. Instead, we design an implant choice that fits you. When an implant is sized appropriately for your frame, it blends seamlessly with your natural proportions.

So, implant choice matters, especially width and profile. Many people focus on implant size alone, but width and profile are just as important. An implant that is too wide can look unnatural at the sides, while one with too much projection can look overly round or artificial. Choosing the right dimensions allows the breast to look soft, feminine, naturally contoured.

Proper implant placement enhances the shape and softness. Where the implant is placed also plays a role. Placing the implant partially under the muscle can help soften the upper breast contour and create a gentle slope rather than a sharp edge.

So, when do we address sagging when necessary? If there is breast sagging, simply adding volume won’t always produce a natural result. In some cases, combining augmentation with a breast lift can reposition the breast and nipple so the implant sits correctly in the right location. Ignoring sagging can make even the best implant choice look unnatural over time.

For more information about breast augmentation procedures, or to schedule a consultation with Dr. Koumanis, please contact Saratoga Springs Plastic Surgery today.

If you are considering breast augmentation, many of the most important decisions happen before surgery ever begins. Choices based on cup size, photos, or incomplete information can lead to results that do not feel balanced or appropriate for your body.

In this video, Dr. Dimitri Koumanis explains the most common breast augmentation mistakes he sees and what patients should understand before moving forward. He covers implant selection, anatomy, expectations, and recovery planning. The full video transcription is included below.

Video Transcription

If you’re thinking about breast augmentation, I want you to pause for a second because the biggest mistakes I see don’t happen in the operating room. They happen before surgery when women are choosing size, shape, and expectations based on the wrong information. In the next few minutes, I’m going to tell you what I wish every woman knew before breast augmentation so you feel confident, prepared, and excited about your decision.

I’m Dr. Dimitri Koumanis at Saratoga Springs Plastic Surgery. I’ve cared for many women considering implants for the first time, revisions or augmentations with lifts.

First, forget cup size. Cup size isn’t a medical instrument. One brand’s C is another brand’s D. What actually matters is your proportions, your chest width, shoulder balance, rib cage shape, and the amount of natural tissue you already have. When you choose implants based on a number or a photo alone, you risk ending up too large, too wide, or not fitting your frame.

Second, your skin and tissue quality determine what’s possible. Some women are happier with an augmentation plus lift because the lift reshapes the breast envelope and the implant provides volume. So, the key takeaway line is that an implant adds volume. It doesn’t always fix the droop.

Natural is a design choice. Shape, profile, and placement matter. Natural results come from smart design. That design includes implant dimensions, profile, and sometimes placement over or under the muscle based on the goals in anatomy. Some women want a subtle athletic enhancement. Others want a fuller upper pole. Neither is right or wrong. What matters is making sure your surgical plan matches your aesthetic goals and your lifestyle.

If you’re very athletic, if you lift weights, if you’re lean, or if you have a smaller natural breast, these details can influence the plan. Recovery is usually easier than fear makes it. But plan it right. Most women are surprised by recovery in a good way. The first few days are the most uncomfortable, and then it tends to improve quickly.

So, you need to choose a surgeon for safety, planning, and honesty, not hype. The best surgeon isn’t the one promising perfection. It’s the one explaining trade-offs clearly. You want someone who prioritizes safety, listens to your goals, shows consistent results, and makes you feel supported through the entire process.

So, if you’re considering breast augmentation, my biggest advice is this. Don’t rush the decision. A great result comes from a personalized plan that fits your body and your goals.

For more information about breast augmentation procedures, or to schedule a consultation with Dr. Koumanis, please contact Saratoga Springs Plastic Surgery today. We’ll talk you through sizing, options, recovery, and what would look best on you so you can move forward with total confidence.

If you are unhappy with breast sagging or shape, you may be wondering whether a breast lift alone is enough or if implants are also needed. This is one of the most common and important questions patients face when exploring surgical options.

In this video, Dr. Dimitri Koumanis explains how to tell if you are a good candidate for a breast lift alone or if combining a breast lift with implants may produce a better result. He discusses the role of natural breast volume, anatomy, and expectations. A complete transcription of the video is included below for those who prefer to read along.

Video Transcription

If you’re unhappy with the position or shape of your breasts and you’ve been told you might need a breast lift or mastopexy, you may be wondering, am I actually a good candidate for this
procedure? Today, I want to walk you through how to tell if a Mastopexy alone is right for you.
And one very important factor that often gets overlooked is having enough natural breast volume to achieve a beautiful result.

I’m Dr. Dimitri Koumanis at Saratoga Springs Plastic Surgery, and Mastopexy is one of the most rewarding procedures we perform, but only when it’s done on the right patient. Understanding
who benefits most helps prevent disappointment and ensures long-term satisfaction.

What does a Mastopexy actually do? A Mastopexy, or breast lift, reshapes the breast by removing excess skin and repositioning the nipple higher on the chest. It improves shape and position, making the breasts look firmer, perkier, and more youthful. What it does not do is add volume.

The ideal candidate is someone who has sagging breasts with adequate volume. You may be a
good candidate for a Mastopexy alone if your main concern is sagging, but you’re generally
happy with your breast size. These patients typically still have enough natural breast tissue to
create a nice full shape once the breast is lifted and tightened and shaped.

So the clear takeaway is a successful Mastopexy depends on having enough existing breast
volume to reshape. So why does the volume matter so much in a breast lift? This is one of the most important points. I wish every patient understood. If a woman has significant volume loss, especially in the upper breast, the lift alone can sometimes result in a breast that looks higher, smaller, or flatter than expected. In other words, the breast may be in a better position but still lack fullness. This isn’t a failure of surgery. It’s a matter of anatomy.

So, what are the signs you may not be an ideal candidate for mastopexy alone? You may
not be the best candidate for a lift if your breasts look deflated or empty on top, you’ve lost
significant volume after pregnancy or weight loss. You want more fullness or cleavage than you
currently have. In these cases, combining a mastopexy with implants often produces a much
more satisfying and balanced result.

So, combining a lift with implants is sometimes the better choice. When a patient has both
sagging and loss of volume, a lift alone corrects position but not fullness. Adding an implant
restores volume while the lift reshapes and supports the breast. If volume is lacking, combining
procedures may be the best path to a result you’ll truly love.

For more information about breast lift procedures, or to schedule a consultation with Dr. Koumanis, please contact Saratoga Springs Plastic Surgery today.

Many women considering breast surgery feel confused about whether they need a breast lift, implants, or a combination of both. While implants add volume, they do not always address sagging, and a lift improves position without increasing size.

In this video, Dr. Dimitri Koumanis clearly explains the difference between breast lifts and breast implants and how to determine which option fits your concerns and goals. Understanding what each procedure does can make the decision process much clearer. The full transcription of the video is included below.

Video Transcription

If you’re unhappy with the appearance of your breasts and you’re considering surgery, one of the most confusing questions is this. Do I need a breast lift, implants, or both? Many women assume implants will fix everything, but that’s not always the case. Today, I want to explain the difference clearly so you can understand which option is right for your body.

I’m Dr. Dimitri Koumanis at Saratoga Springs Plastic Surgery, and this is one of the most common conversations I have in consultation. Once patients understand what each procedure actually does, the decision becomes much easier.

Breast implants are designed to add volume. They increase fullness and can enhance cleavage. However, implants do not lift the breast tissue or reposition the nipple. If your breasts sit higher on the chest and you mainly want more size or fullness, implants alone may be all you need.

What a breast lift actually does is a breast lift is a mastopexy, which reshapes the breast by removing excess skin and repositioning the nipple higher on the chest. A lift improves shape and position not size. It can make the breasts look perkier and more youthful, but it does not add volume unless combined with an implant.

So, how do you tell which one you might need? A simple way to think about it is this. If your main concern is size, implants may be enough. If your main concern is sagging, drooping, or nipples pointing downward, a lift is likely needed. If you want both more volume and a higher perkier shape, then the lift with breast implants is often the best solution.

Why implants alone sometimes disappoint patients. One of the most common reasons patients are unhappy after surgery is when implants are used to mask sagging. While an implant can fill loose skin, it doesn’t correct the underlying droop, and over time, gravity can make the result worse. In these cases, combining a lift with an implant creates a more stable and longer-lasting result.

So, why do some women not need an implant at all? Not every patient wants to be larger. Some women are happy with their volume, but want their breasts to look firmer, higher, and more youthful. For those patients, a breast lift alone can be incredibly transformative.

There’s no one-size-fits-all answer. Your anatomy, skin quality, lifestyle, and goals all matter. A good consultation focuses on evaluating your breast position, tissue support, and expectations, not just implant size.

For more information about breast surgery procedures, or to schedule a consultation with Dr. Koumanis, please contact Saratoga Springs Plastic Surgery today.

I will retire from active practice as a specialist in cosmetic medicine and plastic surgery on July 31, 2025. I feel a deep sense of fulfillment for the over three decades I’ve spent caring for patients. If you are a patient of mine, I thank you vehemently for choosing me to help you. I am still available for injectable treatments until the end of July.

Dr. Dimitri J. Koumanis joined our practice on July 3rd. Upon my retirement, Dr. Koumanis will take over as president, chief medical officer and as an experienced plastic surgeon at Saratoga Springs Plastic Surgery, PC. I have known Dr. Koumanis as a respected colleague and friend for over 15 years. Dr. Koumanis is a highly skilled and compassionate board-certified plastic surgeon with 20 years of experience in the field. After spending five years as a staff plastic surgeon at Albany Medical Center, he entered private practice in Glens Falls, NY for 15 years. I have full confidence in his abilities and believe he will provide the same exceptional level of quality service and care that you have come to expect from me and my staff. He shares my commitment to personalized, high-quality service. I know he will be a wonderful addition to your healthcare journey. Like me, Dr. Koumanis is an “Expert Injector” and does all of his own patients’ injectable treatments.

Saratoga Springs Plastic Surgery, PC will remain at our current location, 7 Wells Street, Suite 303, Saratoga Springs, NY 12866, and the phone number will be the same: (518) 583-4019. If you have any questions or concerns about your care or the transition, please don’t hesitate to call our office anytime.

For those who I have helped to look and feel their best over the last 36 years, I thank you for trusting me with your care. It has truly been an honor to be a part of your life and health journey. I am grateful for the relationships we have built. Whether you are one of my patients or someone else looking for a plastic surgeon who specializes in cosmetic medicine and surgery, I know Dr. Koumanis will provide you with excellent care and attention. Wishing you all the best in health and happiness.

Warmly,
Steven Yarinsky, MD, FACS