Get Informed

Heidi Montag prior to her recent breast augmentation.

Many options are available for gathering the breast augmentation information you need. The Internet offers a wealth of information — some good; some not so much. While not all the information you read will apply to you, visiting reputable web sites can give you an idea of what your options are.

Friends and family members can be important allies. If you are fortunate enough to have friends or family members who have had breast augmentation, they can provide you with unique and personal insight into the procedure. It is important to note, however, that everyone’s experience (and body) is unique.

The best breast augmentation advice is found during your consultation appointment. As a diplomate of the American Board of Plastic Surgery, I put the focus on your goals, so that I can formulate a plan that addresses your unique needs.

Here are a few resources I have created to help you with some of the most common questions:

My main web site has a page dedicated to breast augmentation, including many frequently asked questions. It reviews options for incisions, implant placement, types of implants and size selection . Click here to visit the breast augmentation page on DrMele.com.

On this blog there are many posts and videos discussing breast augmentation. Clicking on “Breast Augmentation” to the left under Categories will give you pages of all the pertinent breast augmentation articles. The subheading “Breast Implant Options” list articles discussing how to pick the best implants for you.

Top Three Breast Augmentation Questions

• Size – How to Choose the Correct Breast Implants: Size
• Silicone vs. Saline – How to Choose the Correct Breast Implants: Silicone vs. Saline
• Breast Implant Profile/Diameter – Breast Diameter and Breast Implants in Breast Augmentation

Breast Augmentation Videos

Many of my television appearances discussing breast augmentation can also be viewed via YouTube. Clicking the YouTube button at the top of the left column will take you to my YouTube channel. For breast augmentation, I have also created two YouTube playlists:

• Breast Augmentation San Francisco
• Breast Augmentation (Breast Implant) Revision San Francisco

The Next Step

Whether you are considering breast augmentation, or you want breast augmentation revision, when you are ready, the next step is to schedule a consultation appointment with a Board Certified Plastic Surgeon. You can check my (or any doctor’s) certification on the American Board of Plastic Surgery website.

A consultation with a Board Certified Plastic Surgeon will allow you to express your goals, explore your options and ask your questions. If you are ready to take the next step, call (925) 943-6353 for your personal consultation appointment.

I had the opportunity to compare notes with other breast augmentation revision specialists both formally and informally. National meetings are a great place to share information. Instructional courses are useful, but informal conversations with other Board Certified Plastic Surgeons who are faced with the same opportunities and challenges that I face can be just as enlightening.

What’s new in Breast Implant Revision Surgery?

Neosubpectoral Pockets

Implant malposition includes breast implants which are:

• too close to the center (symmastia or bread loafing)
• too low (bottoming out)
• too wide apart (heading for the armpit)
• or too high

are all addressed by modifying or changing the pocket in which the implant sits.

For symmastia, the problem is that the implants are too close together, so that the skin between them becomes elevated. Traditional treatment has been to close off the pocket centrally to reestablish cleavage. If the implant is above the muscle, they can be moved to new pockets below the muscle. This allows for the creation of two new pockets that are separated sufficiently in the center to preserve the definition between the two breasts.

When the implants are below the muscle, they can be moved to in front of the muscle. There are some disadvantages to moving the implants to a subglandular (in front of the muscle) position. This is where the neosubpectoral pockets can help. The name literally means “new pocket under the pectoralis muscle”. By working outside the old pocket’s capsule, a new space can be created for the implant. This can be used to correct symmastia and other problems with implant malposition.

Acellular Dermal Matrix (ADM’s)

An Acellular Dermal Matrix is dermis that has been treated to remove all the living cells, leaving a collagen matrix that can be used as an internal patch to help cover breast implants. It can be used to help disguise rippling and to help support an implant that is displaced. Both human and pig skin are used in the manufacture, and the off-the-shelf availability is a big plus when the native tissue is sparse. Brand names include:

• Alloderm (Lifecell-human derived)
• Strattice (Lifecell-pig derived)
• Flex HD (Ethicon-human derived)
• NeoForm (Mentor-human derived)

The downside – it is very expensive. A sheet of ACD costs more than a breast implant. So when local tissues are available, it can save you thousands of dollars.

Fat Grafting and Stem Cell Grafting to the Breasts

Interesting cases where presented of utilizing fat (which contains lots of stem cells) as a volume expander for the breast. Some techniques involve suction expansion of the breasts for a month or longer before grafting to increase the size and vascularity of the recipient bed. This is bleeding edge new, and the long term results are unknown.

Breast are mostly fat, and the principle of replacing like with like is a good one. However, if some of the graft doesn’t take – it dies, and dead fat can lead to lumps, hard spots, infection and calcifications. The problems with lumps, hard spots, and infection are pretty clear, so what is the problem with calcifications? Calcifications are what we look for on mammograms to help identify breast cancer. They stand out as bright white spots in the relatively dark breast tissue, and make identifying breast cancer much easier. If a breast is already full of calcifications, it can be very hard to identify a breast cancer. Either every calcification would need to be removed (making the breast smaller) or risk the early detection of a breast cancer. The implications of increasing the number of stem cells (cells that can become anything) in the breast is also unknown.

For now, research in this area should only be performed in carefully controlled studies. The problems that still need to be overcome include insufficient volume, unpredictable take, interference with mammography, long term outcome. Remember, before breast implants, not too long ago, free silicone was injected into the breasts to increase their size. It worked and felt very natural, at first. Long term, however, the breast became firm, lumpy and painful. The outcome may not be the case with fat grafting, but long term follow up is not yet available, and an assumption that everything will be fine is naive.

Gummy Bear Implants (Gummi Bear Implants)

Still awaiting FDA approval.

The most recent delay was rumored to be that the FDA was waiting to see that the current breast implant follow-up studies where progressing. I am an investigator for both Allergan and Mentor, and each has filled both their Saline Breast Implant and SIlicone Breast Implant follow-up studies. All that remains is to collect 10 years worth of data.

Will it take 10 more years to get FDA approval for the gummy bear implants? It took 14 years to get the current silicone implants re-approved.

Emend

Originally marketed to prevent the nausea and vomiting associated with chemotherapy (CINV), Emend is meant to prevent nausea and vomiting rather than treat it after it has occured.

Emend would need to be administered prior to post operative nausea and vomiting (PONV) to be effective. Currently this is an off-label use, and it has only sparingly been tried to date. Zofran, another medication that is currently widely used, started down the same path 20 years ago.

Risk factors for PONV:

• female gender
• young age
• non-smoker
• motion sickness

Since most of my breast augmentation patients have several of these risk factors, they all get treated prophylactically, often with several medications. If one med could prevent all PONV, it would simplify the treatment. Fingers crossed…

Breast augmentation revision surgery may be elective, and may be performed to increase or decrease the size of your breast implants. Increasing breast implant size is one of the most common, and simplest forms of breast implant revision.

Breast implant revision surgery may be needed to replace a deflated implant or to revise the scar around the implant (capsular contracture). The major US breast implant manufacturers offer lifetime replacement of their breast implants if a breast implant deflation occurs. They also provide financial support if the breast implant leaks occur within ten years of the primary breast augmentation.

You will find videos on breast augmentation and breast augmentation revision surgery posted on the San Francisco Plastic Surgery Blog. They can be viewed here or on my YouTube channel. Please remember, the 800 number appearing on the video was only for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.

This video comes from a segment of KRON’s Body Beautiful. You can hear:

• What is Breast Augmentation Revision surgery?
• Who needs Breast Implant Revision surgery?
• Do your silicone breast implants or saline breast implants come with a warranty?
• Is there an expiration date on my breast implants?
• Before and after pictures of Breast Implant Deflation Replacement Surgery?
• Can breast implant asymmetry be improved?
• How does Capsular Contracture present?
• Can breast surgery be performed for a diabetic (a person with diabetes)?

If you are considering Breast Implant Revision Surgery in the San Francisco Bay Area, a Board Certified Plastic Surgeon can help. This first step is a consultation appointment so that existing problems can be defined and achievable goals can be set.

Breast Implant Revision Links

Breast Implant Revision – Part 1

Breast Implant Revision – Part 2

Breast Implant Revision – Part 3

Breast Implant Revision – Part 4: (You are here.)

Thanks for visiting the San Francisco Plastic Surgery Blog.

Many times there is no complication, and the primary motivation for breast augmentation revision surgery is to change the size of the implants. Perhaps the most common breast implant revision surgery is to replace breast implants with a larger pair. This is the reason I place so much emphasis on defining the goal size for breast augmentation before surgery. Even so, minds and goals can change with time.

Other times breast implant revision surgery is less volitional, and may be due to gravity (requiring a breast lift), breast implant failure (breast implant deflation or breast implant rupture) or capsular contracture (tightening of the nature scar that surrounds the implant causing movement or firmness of the breast implants).

Other videos on this subject have been posted on the San Francisco Plastic Surgery Blog and they can be viewed here (see bottom of article for links) or on my YouTube channel. When you are watching this video, please note, the 800 number on the video was for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.

On this episode of KRON’s Body Beautiful you can learn:

• What are the main reasons for Breast Augmentation Revision surgery
• Do breast implants wear out?
• What is the capsule around the breast implants?
• What is Capsular Contracture?
• How long is the Breast Implant Warranty?
• How many Breast Augmentations are performed each year?
• How is Breast Implant Revision Surgery performed?
• What is the recovery like after Breast Augmentation Revision?

Breast Augmentation Revision Surgery requires a careful analysis of the existing problem, a thoughtful discussion about the good (and bad) aspects of all available treatments, the ability to adapt the plan to any new findings found during surgery, and a careful recovery, to speed you return to daily life. The first step is a private consultation with a Board Certified Plastic Surgeon.

Promised Links

Breast Implant Revision – Part 1

Breast Implant Revision – Part 2

Breast Implant Revision – Part 3 (You are here.)

Breast Implant Revision – Part 4

Thanks for visiting the San Francisco Plastic Surgery Blog.

I am often asked what is the best breast implant profile or best breast implant volume for a certain bra size. The answer depends on many specifics, but the base width diameter (BWD) of the breast is one of the most important measurements used to determine the optimal breast implant diameter.

This patient desired restoration of her lost breast volume. Note the patient's left breast is higher than her right breast prior to breast augmentation.

After breast augmentation. Breast implant diameter was selected to enhance cleavage without overly enhancing width.

There is more to choosing the best breast implant than just picking an implant with a diameter that matches the chest, but it is a great place to start. While no implant is the perfect breast implant, choosing one that is proportional to the body is the best way to get a full and natural result.

It’s like Goldilocks. If the beast implants are to wide, they will hang over the sides and you will be bumping into them with your upper arm. If the breast implants are too narrow, they will tend to fill the outside of the breast and leave a space between the beasts. If the implants are just right, the breast can be filled over the entire base width and create a naturally full cup.

After choosing the appropriate beast implant diameter, the volume can be adjusted by choosing the appropriate profile. Low profile breast implants are flatter than high profile breast implants. The larger the volume desired, the higher profile selected and the more projection obtained.

Prior to breast augmentation. The breast maintains a low projection but more volume is desired.

After breast augmentation. Enhanced projection is obtained by using a higher profile implant.

When I trained as a Plastic Surgery fellow at Saint Francis Memorial Hospital in San Francisco, California, only moderate profile saline breast implants were available for breast enlargement. Today, saline breast implants come in three different profiles: Low, Moderate and High. The variation in projections is even greater for silicone breast implants with five profiles available. When the form-stable gummy-bear beast implants are finally approved, even more choices will be available.

Choice is good. When you are choosing, be certain to pick a Board Certified Plastic Surgeon who can help you make the most of your options.

For more information on how to choose the correct breast implants see these links:

How to Choose the Correct Breast Implants: Size

How to Choose the Correct Breast Implants: Silicone vs. Saline

Wide spread periareolar scars below the nipples after breast augmentaion.

This is noticeable because the scar is white, wide and irregular within the tan skin of the areola. This incision was not placed at the edge of the areola, making the white scar even more noticeable. This is also a poor scar. It is very wide for this location. This scar not a fine line, it’s not a line at all, but rather, an irregular blotch.

The periareolar incision is one of my favorite incisions for breast augmentation because a nice, fine, discrete scar is the normal result. The original scar was not of my making. Since I’ve done hundreds, if not thousands of breast augmentations using this approach, I felt very confident that this particular scar could be improved.

The plan was to excise the previous scar, and obtain a narrow scar that follows the contour of the areola. With the new scar placed at the junction between the areola and the normal skin, the scar’s location is disguised.

After scar revision the periareolar scars are thin, fine and follow the natural contours.

This scar revision was performed in the office, under local anesthesia, without complications. The resultant scar is narrow and follows the natural contour of the areolas. Close up views are included below for comparison.

Before scar revision - Right breast with wide white irregular misplaced scar.

Before scar revision - Left breast with wide spread hypopigmented scar.

After scar revision - Right breast with thin soft pale scar following the natural curve of the areaola.

After scar revision - Left breast with less noticeable and improved scar.

Scar revision can be a very rewarding procedure. The scars cannot be completely erased, but by making scars less noticeable, they can be forgotten.

This is part two of two from an episode of KRON 4′s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery, including before and after pictures and viewer questions.

Specific examples are shown. The first patient (shown below) had breast augmentation in her twenties. Years later, she had children and was not happy with the changes in her breast resulting from pregnancy and breast feeding. Before and after breast augmentation revision surgery pictures are shown. In her case a breast implant exchange and breast lift and were performed to adjust for lost volume and improve the shape of the sagging breasts.

A different patient had breast implant bottoming out. In her case the implants had fallen below the inframammary fold leaving the nipples high and flattening out the normal curve beneath the breast. Corrective beast augmentation surgery included breast implant implant exchange to adjust the volume, and the inframammary fold was reconstructed internally to raise the implant and form a distinct curve beneath the breast.

The caller in this video had a question about ruptured silicone gel implants that were placed in the 1970′s. If any breast implant has ruptured, it needs to be removed. Most frequently, a ruptured breast implant is replaced at the same operation. Silicone gel implants in particular should be removed sooner than later. A ruptured silicone gel implant, over time, can cause increased scarring and hardening of the breasts, as the body tries to wall off the free gel. If not treated promptly, this type of scarring can lead to further problems than may not be correctable.

Silicone gel filled implants placed before 1985 seem to have a higher deflation rate than the new silicone breast implants. In fact, the outer shell of silicone breast implants has changed twice since the 70′s. The first change, in the mid 80′s, was to decrease the rupture rate. The second change, in the mid 90′s, was to reduce gel bleed (the ability of the silicone gel to leak through outer shell without a rupture). Both US FDA approved breast implant manufactures, Allergan and Mentor, offer lifetime replacement of their implants should they fail, and often provide financial support should this occur within ten years of your breast augmentation procedure. For details of the Mentor and Allergan (Natrelle) Breast Implant Warranties click on the manufactures names. It is best to get the information direct from the manufacturer; however, the Mentor site has been going through some changes, perhaps with the merger with Johnson & Johnson, so if you can’t link there, JustBreastImplants.com also has information on breast implant warranties.

Additional Breast Augmentation Revision Videos

Breast Implant Revision – Part 1

Breast Implant Revision – Part 2 (You are here.)

Breast Implant Revision – Part 3

Breast Implant Revision – Part 4

Thanks for visiting the San Francisco Plastic Surgery Blog.

Breast augmentation revision surgery is sometimes necessary even in the best of hands. Revision surgery can range from simple, like changing breast implants after deflation or changing sizes, to more complicated, like when treating breast ptosis (sagging) or capsular contracture. The best way to reduce your risk of needing breast revision surgery is to choose a qualified Board Certified Plastic Surgeon.

If you need breast revision surgery, choosing a well trained Board Certified Plastic Surgeon with a broad experience in breast enhancement surgery is the best way to get a satisfying result. By choosing a Board Certified Plastic Surgeon who specializes on cosmetic surgery, you get a doctor who is well trained and well rehearsed in a wide range of treatment options.

Breast implant revision in San Francisco is no different than in other areas of the United States. Sometimes the results of the breast augmentation where just not what was expected. Other times, the result were great and either the breasts change, the implants change or the desires change. When these situations arise, breast augmentation revision surgery could be your best option to get back into the shape you want.

This is part one of two from an episode of KRON 4′s Body Beautiful with Vicki Liviakis that aired last month. This video discusses breast augmentation revision surgery. Part two will include more discussion, before and after pictures and viewer questions.

The best way to be certain your plastic surgeon is appropriately trained to perform breast augmentation surgery is to make sure that he or she is a Board Certified Plastic Surgeon. By choosing a Plastic Surgeon who is a member of the American Society of Plastic Surgeons (ASPS), you can be certain that their credentials have been verified. ASPS members are held to higher standards in ethical care of patients and continuing medical education requirements. ASPS standards are above and beyond those required by State licensing boards and hospital credentialing committees.

A small percentage of ASPS members are also members of the American Society for Aesthetic Plastic Surgery (ASAPS). ASAPS members are ASPS members who specialize in the cosmetic side of Plastic Surgery. ASAPS members must meet the standards of ASPS, apply independently for membership to ASAPS and demonstrate a commitment to cosmetic plastic surgery both in education and in patient care.

ASPS is the largest plastic surgery specialty organization in the world. Founded in 1931, the society is composed of board-certified plastic surgeons who perform cosmetic and reconstructive surgery. ASAPS is the leading organization of board-certified plastic surgeons specializing in cosmetic surgery of the face and body, and I am proud to be an active member of both.

Next time I will talk more about the reasons for breast augmentation revision surgery and how a qualified Plastic Surgeon can help.

Additional Breast Augmentation Revision Videos

Breast Implant Revision – Part 1 (You are here.)

Breast Implant Revision – Part 2

Breast Implant Revision – Part 3

Breast Implant Revision – Part 4

Thanks for visiting the San Francisco Plastic Surgery Blog.

Yesterday I was on NBC Bay Area, KNTV, Living Well with host Peggy Pico. We discussed the Mommy Makeover San Francisco, focussing on breast augmentation, tummy tuck, mini tummy tuck and liposuction. I will be posting several excerpts of the show on the San Francisco Plastic Surgery Blog. This video discusses breast enhancement and the future postings will discuss the belly enhancement, tummy tucks and liposuction. The full episode is also available on line. To view the entire segment, just click on the NBC Bay Area logo above.

Breast augmentation is one component of the Mommy Makeover. It has become the most frequently performed cosmetic plastic surgery procedure in the United States with 400,000 breast enlargement surgeries performed last year. That’s 800,000 breast implants.

This segment discusses the types of breast implants available: saline breast implants, silicone breast implants and even the soon to be available gummy bear solid gel implants. Comparisons area made between smooth round breast implants and textured shaped breast implants. The importance of body proportions is stressed, and before and after pictures are reviewed.

I will add additional video from the show about tummy tucks, mini tummy tucks and liposuction in the near future so stay tuned. If you would like more information on Breast Augmentation San Francisco, click here to visit the Breast Augmentation page on DrMele.com.

KRON4′s Body Beautiful, is a weekly news show hosted by News Anchor Vivki Liviakis. It originates right here in San Francisco and is know through out the Bay Area for its coverage of the lastest trends in cosmetic plastic surgery.

This week’s topic will be breast augmentation, specifically breast implant revision surgery. Information about breast augmentation and the most common reasons for breast implant revision will be presented. Topics will include, choosing the best breast implant size, breast implant deflation, capsular contracture, dealing with breast asymmetry, and how to decrease your risk of needing breast augmentation revision surgery.

If you have questions that you would like me to answer on air, please send them via the contact form on this page. Please do mention that you would like me to answer your question on Body Beautiful, otherwise all inquiries are kept confidential. Alternatively, you can send your questions directly to KRON4 via the Body Beautiful web page. You can also phone into the studio while we are on the air, and get your questions answered live.

Previous shows discussing breast augmentation, tummy tucks, liposuction, eyelids surgery and many other cosmetic plastic surgery procedures can be found on my website in the DrMele.com Video Gallery

A unique aspect of Body Beautiful is it live broadcast live. Broadcasting live allows for more a more dynamic and interactive presentation. A segment of the show will be dedicated to viewer questions. So be sure to call in.