Bristol Plastic Surgery
John Bandeian, MD
Creating a New You

Breast Augmentation

Bristol Breast Augmentation Surgeon – Dr. Bandeian
Serving Patients in Kingsport, Elizabethton, Tri-Cities, TN-VA Bristol and Johnson City, TN


TOTAL COST: $6500 for saline implants and $7500 for silicone gel implants.

Women who are interested in having a breast enlargement may call Dr. Bandeian’s Bristol cosmetic surgery office for a no-cost consultation.  The initial consultation typically takes between 1 and 2 hours. Dr. Bandeian, a leading Bristol breast augmentation surgeon, explains the pros and cons of saline and silicone gel implants, and helps his patients decide which type they want. Dr. Bandeian will discuss with his patients the size of the implant that he plans to use.

To help his patients determine what size implant is appropriate, Dr. Bandeian asks his patients to try on different size breast implants under a bra. Breast enlargement can help minor degrees of breast sagging, but more advanced sagging will not be improved with breast enlargement. Most of his Kingsport / Bristol breast augmentation patients request inflatable breast implants that will be filled with saline (salt water) at the time of surgery. Silicone gel implants are also available.

One advantage of the saline implant is that it can be inserted through a very small incision. Dr. Bandeian usually makes the incision around the areola (colored skin around the nipple) but he will insert it through an incision in the armpit or below the nipple at the request of the patient. He always puts the implants completely beneath the chest wall muscles, not just under the pectoralis muscles. Dr. Bandeian gives his breast augmentation  patients 4 prescriptions: one for antiseptic soap to use before surgery, one for prophylactic antibiotics, one for nausea  and one for pain management.

Breast enlargements are done at Indian Path Hospital. Patients are put to sleep for their surgery by an anesthesiologist and a nurse anesthetist. The operation takes approximately 2 hours. Patients should have a responsible adult drive them home from the surgery center and stay with them on the night of their surgery.

Dr. Bandeian instructs his Bristol, Johnson City, Elizabethton and Kingsport breast augmentation patients to call him personally on the evening of their surgery to let him know how they are doing. He then sees his patients in his office the day after surgery and several times thereafter. Dr. Bandeian instructs his patients not to drive or do any housework for the first 7 days. After one week, stitches are removed and most women can return to work. Swimming, tennis, and upper body aerobics should be avoided until 6 weeks after surgery.


The most common complication associated with breast implants, is capsular contraction around the breast implants that make the breast implants feel hard. When severe, capsular contraction can cause pain and make the breasts look like round balls, instead of shapely breasts. Capsular contraction is caused by thick, tight scar tissue forming around the implants that squeeze and compress the implants.

To the best of Dr. Bandeian’s knowledge, none of his breast augmentation patients  have developed hard breasts. 

In the spring of 2009, while attending a national meeting, Dr. Bandeian learned that after many years of research, the mysterious cause of capsular contraction, that causes hard breasts, had finally been discovered. The capsular contractions are caused by a type of infection called a bio-film, and that most often, the bio-film was caused by staph epidermidis, a bacterium commonly found in the nipple. He immediately knew why his patients were not returning to him complaining of hard breasts. About 10 years ago, while doing a breast enlargement, some nipple discharge (fluid) appeared on the patient’s skin. Dr. Bandeian was concerned the prophylactic antibiotic that he as well as most plastic surgeons routinely gives patients just before surgery did not have enough time to get into the nipple fluid. He knew that the nipple fluid contained bacterial and that this nipple discharge might cause an infection. Fortunately, his patient did not get an infection. However, to avoid the potential problem of a breast infection in the future from nipple discharge, Dr. Bandeian decided to start his patients on prophylactic antibiotics the night before surgery. It appears that starting antibiotics the night before surgery instead of just before surgery, in an effort to prevent an infection from nipple discharge, he inadvertently discovered a way to prevent hard breasts.


Saline implant ripples typically occur when there is only a very thin layer of the patient’s own tissue covering her implants. That is why ripples are more of a problem in thin women, and prevention of ripples, is one of the reason why some women chose silicone gel implants. To the best of his knowledge, none of Dr. Bandeian’s patients, especially thin patients, have ripples from saline implants. The following explains how he avoids ripples by completely covering breast implants with muscle, fascia (covering of muscle), as well as with breast tissue, fatty tissue and skin.

When most plastic surgeons tell their patients they put breast implants under muscle, they are referring to a subpectoral breast augmentation, in which the bottom of the breast implant is covered only with skin and fatty tissue. Ripples are most likely to occur in thin women where the implant is covered only by skin and a thin layer of fatty tissue. A subpectoral breast augmentation means the implant is placed beneath the pectoralis muscle. What most women do not understand is that the pectoralis muscle only covers upper half of a breast implant. To avoid giving the incorrect impression that her implants were completely covered with muscle when a woman had subpectoral breast augmentation, plastic surgeons coined a new term to more accurately describe the position of the breast implants. That new term that replaced “subpectoral implants” is “dual plane breast implants”. The upper half of the breast implant is under the pectoralis muscle, and the lower half of the implant is on top of the chest wall muscles. Most of the lower half of the implant is covered by breast tissue, but the bottom of the implant is covered only by skin and fatty tissue. If the pocket for the breast implant does not extend below the level of the patients own breast, the implant position will be too high and the augmented breast will look very unnatural. Therefore, to obtain a proper position of the implants and an attractive shape to the breasts, it is always necessary to extent the pocket for the breast implant beneath the fold that marks the bottom of the patient’s own breast. The bottom of the pocket for the breast implant will only be covered by a thin layer of fatty tissue and skin in a thin woman.

For many years  Dr. Bandeian has been completely covering his breast implants with muscle and fascia (layer of tissue that covers muscle). Therefore, even in thin patients, he always gets at good thick layer of the patients’ own tissue to completely cover the implants. That is why his patients do not complain about rippling. Dr. Bandeian did not invent this technique. In fact, this method of placing breast implants is how plastic surgeons have placed breast implants in mastectomy patients for well over 30 years where it is mandatory that they achieve complete muscle coverage of the implants because there is no breast tissue.

An additional benefit of complete muscle coverage of the implant is that there is more support of the implant so there is less sagging over time.  However, the benefits of complete coverage do not come without a price. The price is longer surgery time, and more work for the patients and Dr. Bandeian after surgery. Because the muscles that cover the bottom half of the implant are tightly attached to the ribs, it takes Dr. Bandeian additional operating time to develop the pocket beneath the muscles. Because these muscles are tighter than the pectoralis muscle, the implants often scoot up so that the day after surgery, they are too high.

Dr. Bandeian always sees his patients the day after surgery so he can check them and get them started on proper breast massage to relocate the implants down into the pocket he created at surgery. His patients must work diligently to gently massage the implants downward where they belong. Most plastic surgeons have patients start wearing bras right away to keep the implants from falling down too low. Because of the complete muscle coverage, downward displacement of the implants is not a concern for Dr. Bandeian. In fact, Dr. Bandeian does not let his patients wear a bra until the implants have settled down into the pocket where they belong.

Dr. Bandeian believes the extra work and time on both is part and his patients’, is well worth the effort because it results in more natural looking, softer breasts that look better, not worse, with the passage of years.

Dr. Bandeian does not recommend one type of implant over another. However, there is some misinformation about saline implants that he wants his patients to be aware of. First, silicone gel implants are not softer than saline implants. Second, saline implants do not need to be replaced because they might leak when they get older. A leaky saline implant causes no harm. 

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