Op Room

Dr. Pousti takes pride in performing his best to achieve the best results for his patients.

A  complete range of cosmetic, plastic,and reconstructive surgical  procedures are available in a state-of-the-art surgical facility. Dr.  Pousti and our office staff keep up to date with the most advanced procedures today.

His operating room staff has worked with him for many years and they know his routine.

Dr. Pousti performs plastic surgery in an ambulatory surgical center (Surgical Center of San Diego) with a highly skilled team of Anesthesiologists, nurses, and technicians to enhance patient comfort and to provide peace of mind to patients and their families.

Dr. Pousti is always up to date with the most current and advanced procedures. With his specialized care, Dr. Pousti is equipped for any challenges at hand. 

Dr. Pousti and Operating Room team to the left, Anesthesiologist and state of the art monitoring to right.

Breast Procedures

Dr. Tom Pousti now offers Vectra 3D simulations so patients can see what specific implant types, sizes and profiles would look like on their body.

Dr. Pousti takes time to put the pictures that the patient has chosen up on the wall. He will refer to the pictures as a reference as to what the patient would like to achieve during surgery. He does his very best to help the patient achieve as close to their goal as possible keeping in mind that all patients have unique qualities that make them an individual.

For all Silicone Gel Breast Procedures, Dr. Pousti now uses the Keller Funnel method (initiated in 2009). This allows Dr. Pousti to make the minimal possible incision line on the patient and minimize scarring. He keeps up with all advancements in the cosmetic field for better results and the patient’s experience.

In the operating room Dr. Pousti checks for breast symmetry. Breast asymmetry is a condition where one breast is noticeably larger than the other. Patients may start with different sized breasts before surgery (most patients are not perfectly symmetrical). Some cases of breast asymmetry are more severe than others, but there are several surgical options to promote better symmetry. Different types of implants may be used, different volumes may be used to fill up the breast implants, or changes in the pocket dissection may be used to help achieve as much symmetry as possible. Board Certified Plastic Surgeon, Dr. Pousti takes his time in the operating room to make sure he achieves the patient’s goals. Dr. Pousti will determine which procedure will benefit each individual patient based on her concerns.

Breast Augmentation

Dr. Tom Pousti is a highly skilled breast augmentation San Diego specialist. He has helped many breast implants and breast enlargement patients achieve a more youthful and shapely appearance.

One side with implant.

The length of the incision is minimal and heals beautifully with time.

Breast Lift (Mastopexy)

Mastopexy refers to lifting and reshaping of the breast. It can be combined with an increase in breast size (augmentation-mastopexy) or a reduction in breast size. The operation involves rearranging the breast tissue, shifting the nipple position and increasing the breast firmness by tightening the skin. Modern innovations in breast lift techniques include limited incision techniques, nipple sensation sparing techniques.

Limited Breast Lift (Stage 1 / Donut)

Stage 2 Breast Lift (Lollipop)

Stage 3 Breast Lift (Anchor)

Breast Lift With Implants

Mastopexy refers to lifting and reshaping of the breast. It can be combined with an increase in breast size (augmentation-mastopexy). The operation involves rearranging the breast tissue, shifting the nipple position and increasing the breast firmness by tightening the skin. Modern innovations in breast lift techniques include limited incision techniques, nipple sensation sparing techniques.

While breast augmentation or mastopexy surgery performed separately have less potential risk and complications, breast augmentation/mastopexy surgery performed together carry a higher chance of complications and need for further surgery. For example, there is an increased risk of infection, implant exposure, breast asymmetry, loss of nipple-areola sensation, inability to breast feed, mal-positioning of the nipple-areola complex, mal-position of the implants, wound healing problems, tissue necrosis, loss of blood supply to the nipple-areola complexes. Any of these complications may require further surgery, therefore, increasing the likelihood of revisionary surgery. To avoid these risks Dr. Pousti frequently recommends a ‘2-stage procedure’. First stage being a breast lift followed by augmentation once the patient heals. Generally good candidates for a 2-stage procedure are patients that need a significant amount of skin removed or patients interested in extra large implants.

Measurements and markings made prior to surgery — the lines indicate where the patient wants more fullness. Temporary sizers were used in the operating room to see what implant size would achieve the patient’s  goal.

XL Breast Implants

Having exotic taste and living a colorful life sometimes means wanting a little extra. When it comes to large breast implants, finding a reputable plastic surgeon with impeccable skill and an understanding of how a large breast augmentation should be performed is of the utmost importance. Dr. Pousti has a lot of skill and experience working with Saline Overfilled breast implant patients.

Markings were performed before surgery, arrows show the areas that  fullness was desired by the patient.

Markings here show the implant mal-position (the implants were falling into her armpits). Internal sutures (internal bra) were used to reinforce the new position of the breast implants.

Below are 2 XL breast implant patients immediately post surgery.

Breast Reduction

Breast reduction is designed to improve the appearance and symptoms of overly large breasts by reducing their size and reshaping them. The surgery is specifically designed to relieve symptoms of pain and discomfort in the breasts, shoulders, neck and upper back.

Measurements and marking were carefully made prior to surgery.  The “x” is where the nipple-areola complexes would be moved to.

Breast Implant Exchange

With the amount of patients with breast implants growing the number of those wishing to remove their implants is increasing as well. More and more people are inquiring implant explanation surgery for a variety of reasons. Some interested in replacing the implants and some not.

The asymmetry of the patient’s current breast implants is extremely noticeable. Even while the patient was wearing clothes, she felt extremely uncomfortable.

Once the patient is in the operating room, her previous breast implants are removed through a small incision along the areola. Sizers are then set in the breast pockets to determine the size of the breast implant need to meet the patient’s desired look.

After Implant Exchange

Dr. Pousti replaced the patient’s previous implants with 600cc Silicone Implants. The patient is still very fresh from surgery but is extremely happy with the results of her revisionary breast surgery.

Tuberous Breast

Tuberous Breasts have a very narrow base and usually a long skin envelope. In the most severe cases of Tuberous Breast, a breast lift can be done through an incision around the areola, making the breast into a more rounded shape that the patient will be happy with. In many cases however, a lift is not necessary. The patient should be aware that the final result will take months to see and that they will need to be patient. Since Dr. Pousti has considerable experience with using breast implants to improve the appearance of Tuberous Breasts for patients, many women from around the country choose to fly to San Diego to obtain his services.

Markings were performed prior to surgery. Careful measurements were taken to achieve as much symmetry as possible.

Saline breast implants were used– temporary sizers were used to determine the implant size that would make the patient happy.

Side view of right breast with implant, compared to left breast without implant.

With the implant in the pocket that Dr. Pousti created you can see that the roundness on the bottom was able to be achieved as well as the fullness on top.

Incision around the areola were used to release the constricted tissue and slightly lifts the breasts, also removing some excess skin envelope making the breasts into a more desirable shape.

Pectus Excavatum

In pectus excavatum, also known as funnel chest, the sternum (breastbone) is depressed relative to the rest of the chest wall. Breast implants can be used to camouflage mild to moderate pectus excavatum. Dr. Pousti has considerable experience with using breast implants to improve the appearance of the chest wall for patients with pectoralis excavatum.

Dr. Pousti marked the depressed areas

A moulage was made as a guide for the custom silicone implant.

Markings were made in detail for the planned procedure.

The severity of the patient’s chest depression is shown.

The incision from his previous “Nuss procedure” was used, in order to avoid creating additional scars.

Custom silicone implant

The implant is prepared for placement.

Immediately after surgery.

The depression of the right chest is filled and symmetric.

Breast Revision

Dr. Pousti is double board certified in plastic and reconstructive surgery and is well known for his vast experience with revisionary breast surgery. Breast revision surgery can be performed to implant allograft, correct asymmetry, correct bottoming out, remove scar tissue, close the breast pocket, change size or type of implant, replace a deflated implant, correct double bubble, open the breast pocket, correct rippling or palpability, and / or perform symmastia repair.

The patient previously had silicone breast implants with 350cc on the right and 325cc on the l

In order to achieve her desired look, the silicone breast implants were removed, then replaced with new saline breast implants overfilled to 1020cc in both breasts with submuscular placement. You can see how the upper pole of the breasts are more full and how the nipple-areola complexes have been raised. We are able to see the patients final results in the operating room due to the fact that the pectoralis muscles are relaxed under anesthesia.

The patient is now 2-days post-op surgery and is very happy with her new size and appearance. The implants will settle into the pockets with time and massage and the patient will have a beautiful result.

Nipple Reduction

Length reduction– Nipples that are too long either droop down or project too far out. Usually, to create a shorter nipple length, the tip of the nipple will be removed and sutured for closure. Sometimes the skin along the neck of the nipple will be removed. In those circumstances, the tip of the nipple is then sutured to the bottom of the nipple, creating a shorted nipple length.

Width reduction– If the nipple is too wide, but not too long, a pie-shaped wedge will be removed from the undersurface of the nipple. This allows the nipple to be “taken in” and the circumference reduced. Dissolving sutures are used.

This patient was interested in nipple reduction. This shows one side reduced.

Tummy Tuck (Abdominoplasty) Surgery

Abdominoplasty, also known as the “tummy tuck,” is an operation performed to remove excess fatty tissue and skin folds in the mid and lower abdominal region and to tighten up the abdominal wall.

There are several types of abdominoplasty or tummy tuck procedures including:

  • Regular Tummy Tuck
  • Mini Tummy Tuck
  • Extended Tummy Tuck

These procedures range from minor removal of hanging skin (a mini-tummy tuck) to a major abdominoplasty where the entire abdomen is tightened. It is designed to remove only as much excess skin and fatty tissue as is practical and safe. Stretch marks, where possible, will be removed along with the excess skin. However, stretch marks on the remaining abdominal skin cannot be removed.

The Mini Tummy Tuck is for contour problems without as much loose skin as a standard abdominoplasty. An Extended Tummy Tuck is for extensive loose skin and fatty tissue of the abdominal area. The extended abdominoplasty, regular abdominoplasty and the mini-abdominoplasty procedures can include the following:

  • Liposuction of the surrounding areas.
  • Skin excision – (limited for the mini tummy tuck).
  • Tightening of the lower and upper parts of the abdominal rectus muscles


Liposuction surgery has now become the most commonly performed operation in Plastic Surgery. This procedure is used to improve your figure in either one specific area, or in several areas. Modern liposculpture is a both a scientific procedure and an artistic one, incorporating a concern for the patient’s well-being and health during and after surgery with a genuine artistic sculpting of tissues.


Gynecomastia is defined as the visible or palpable development of breast tissue in boys or men. Gynecomastia is a condition in which males develop enlargement of the breast. This is quite common in adolescents and is often first noted at the onset of puberty. Gynecomastia affects an estimated 40% to 60% of men. It may affect only one breast or both. When gynecomastia is severe, when it persists, and in those cases where there is suspicion of malignancy surgical treatment may be indicated. For men who feel self-conscious about their appearance, breast-reduction surgery can help. The procedure removes fat and or glandular tissue from the breasts, and in extreme cases removes excess skin, resulting in a chest that is flatter, firmer, and better contoured.

Labial Reduction

Enlarged or hypertrophic labia minora can be functionally or psycho-socially bothersome. Local irritation, problems with personal hygiene, interference with sexual intercourse and discomfort during cycling, horse back riding, wearing exercise clothing, walking or sitting are indications for surgical reduction. Patients usually like to decide the size of their labia but it is important to remember the function of the labia minora as well. The labia minora protect the vaginal orifice when the thighs are spread and therefore, overcorrection is not recommended. During this procedure, a clitoral hood reduction may also be performed to further expose the clitoris to both improve the sexual functioning of a women as well as to achieve more pleasing aesthetic results.

Armlifting: Brachioplasty

Arm tissue relaxes with age, gravity and weight loss. The drooping of skin is from a stretching of the anchoring system of the arm and loss of supporting fat. Patients are very unhappy with this “loose hammock” appearance.

Eyelid Surgery: Blephroplasty

Blepharoplasty is performed to reduce the wrinkling and/or bulging of eyelid tissue. Not all patients need to have both excess skin and excess fat (bags under the eyes) removed. In many cases only one or the other procedure is needed. Every wrinkle and fold of skin around the eyes cannot be removed. Most recently, there have been innovations in eye surgery to preserve and redistribute fat around the eyes rather than just to remove it. This results in less of a hollow, “done” appearance.

Facelifting: Rhytidectomy

The face lift is a surgical procedure whose purpose is to improve your appearance. The improvement is achieved by tightening the skin and facial muscles and, where needed, removal of fat. The degree of improvement varies from individual to individual, and is influenced by the physical traits of the skin, and the amount of sun damage, the underlying bony structure and a variety of other factors.

Prime Plastic Surgery consists of the top board-certified surgeons in the country providing the highest caliber of patient care. We offer cosmetic and reconstructive procedures, both surgical and non-surgical, to help patients achieve truly life-changing results. Our surgeons are members of several prestigious organizations, including:

  • American Society of Plastic Surgeons
  • American Society for Aesthetic Plastic Surgery
  • International Society of Aesthetic Plastic Surgery
  • American Association for Accreditation of Ambulatory Surgery Facilities

Discover what the Prime difference can do for you. Request a consultation online or call our practice at (858) 285-4667.

Contact Prime Plastic Surgery

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