Cosmetic surgery of the breast encompasses many varied procedures. Breasts can be enlarged with breast implants via breast augmentation, or reduced in size with breast reduction or a reduction mammoplasty. If you are happy with the volume, but not the shape of your breast, a breast lift, or mastopexy, may help by lifting and firming the breast. Even problems with the size and shape of the nipple and areola can be addressed via breast enhancement surgery.
I recently had the opportunity to discuss the many aspects of cosmetic breast surgery, on KRON’s Body Beautiful. A portion of the show is dedicated to viewer questions, which are answered live on the air. Below is an excerpt from my interview with the Bay Area’s News Station’s Vicki Liviakis, which includes several interesting viewer questions. Please note, the 800 number in the video was used exclusively as part of the live show. If you have questions, or would like to schedule a consultation appointment, please call (925) 943-6353, or use the contact form on the left side of this page.
This breast augmentation video includes answers to viewers questions about:
When is it safe to replace breast implants to change size?
What problems can occur with breast augmentation to sizes larger than a D-cup?
Can breast size be matched to maintain proportions?
Is it safe have elective cosmetic surgery with diabetes or other medical illnesses?
Can breast implants really lift the breasts? (Click for additional information about Breast Augmentation Lift)
Finding the Right Breast Augmentation Surgeon
If you are considering breast augmentation, be certain to review the benefits, and the risks, with a Board Certified Plastic Surgeon like myself, as part of your breast augmentation consultation appointment. If you have developed problems with your breast implants, a consultation with a Board Certified Plastic Surgeon is the best first step toward finding relief.
Additional Information on Cosmetic Breast Enhancement
If you were peaking ahead, the preview screen on the video shows a side-by-side comparison of before and after pictures for breast reduction (reduction mammoplasty). I perform many different aesthetic breast enhancement surgeries. Sometimes reducing the volume and lifting the breasts is the best course of action. For patients with large breast and symptoms like lower neck and upper back pain, shoulder rutting from the bra straps and even recurrent rashes beneath the breasts, breast reduction surgery can provide an improved quality of life. It goes beyond being able to find clothes (and bras) that fit, but my patients are happy about that too.
Breast Reduction, Breast Augmentation and Breast Implant Revision Before and After Pictures
The 800 number in the video was used as part of the live show to allow viewers to have their questions answered by me, live, during the original broadcast. If you have questions, or would like to schedule a consultation appointment, please call (925) 943-6353, or use the contact form on the left side of this page.
Bay Area Breast Implants – Part 2 or 4
This cosmetic breast enhancement video includes information about:
Cosmetic breast enhancement including before and after pictures
I cannot emphasize this enough. If you are considering breast augmentation, be certain to review the benefits, and the risks, with a qualified Board Certified Plastic Surgeon, like myself. This is an important part of any breast augmentation consultation appointment. This is equally important if you have developed problems with your breast implants. A consultation with a Board Certified Plastic Surgeon is the best first step toward finding relief.
Additional Information on Cosmetic Breast Enhancement
Cosmetic breast surgery is an important facet of my Walnut Creek Cosmetic Plastic Surgery practice. San Francisco Bay Area Breast Augmentation patients, in particular, have come to expect a caring and professional approach to breast augmentation before, during and after surgery. I had the opportunity to discuss Breast Augmentation, and other aspects of cosmetic breast surgery, on KRON’s Body Beautiful earlier this month. Below is an excerpt from my interview with the Bay Area’s News Station’s Vicki Liviakis. The 800 number in the video was used as part of the live show. If you have questions, or would like to schedule a consultation appointment, please call (925) 943-6353, or use the contact form on the left side of this page.
This breast augmentation video includes information about:
Some common, and uncommon, questions about breast augmentation
Breast implant deflation and the treatment
Other topics listed in more detail below
Bay Area Breast Augmentation
When considering Breast Augmentation, it is important to consider breast implant selection, breast augmentation surgery and breast augmentation revision.
Bay Area Breast Implant Selection
Today’s breast implants now come with options. The size, shape and filler can all be varied. It is important to have a good idea of what you want out of your breast augmentation, so that the best options can be selected for you. The most important decision, is your desired size. The size of your breast implants will depend on the size you currently are, your body type and your desired goal size. More information is available in the San Francisco Plastic Surgery Blog regarding Breast Implant Options.
Bay Area Breast Augmentation Surgery
Options also exist regarding how to insert breast implants.
Incision placement
Periareolar – Around the lower border of the areola below the nipple
InfraMammary – In or just above the natural crease beneath the breasts
Axillary – in the armpit
Umbilical – TransUmbilcal Breast Augmentation (TUBA)
At some time in the future, your breast augmentation may require a tune-up. Breast augmentation revision surgery is one of my specialties. A common reason to revise breast augmentation is to change sizes. Most commonly, this is done to increase the size of the breast implants, but occasionally the implant volumes are reduced.
Breast implants can sometimes deflate, and may require replacement. Replacing a deflated breast implant is another common breast augmentation revision surgery. It also gives us the opportunity to make adjustments to the size, or other issues that may have been present before the deflation.
Breast implants tend to stay soft, but if capsular contracture occurs, the breast may become firm. Breast Augmentation Revision Surgery, like a capsulectomy or capsulotomy, can restore the softness to the breast. These types of procedures modify the scar that makes up the wall of the implants’ pocket. This scar serves an important roll in keeping the implant in its proper position. If the scar becomes tight, it can cause asymmetry.
Finding the Right Breast Augmentation Surgeon
If you are considering breast augmentation, be certain to review the benefits, and the risks, with a Board Certified Plastic Surgeon like myself, as part of your breast augmentation consultation appointment. If you have developed problems with your breast implants, a consultation with a Board Certified Plastic Surgeon is the best first step toward finding relief.
Additional Information on Cosmetic Breast Enhancement
Dr. Joseph Mele appears on KRON4's Body Beautiful.
To celebrate the debut of the new San Francisco Breast dot com (SanFranciscoBreast.com), a site dedicated to cosmetic breast surgery for the San Francisco Bay Area, I will be dedicating my appearance on Monday’s Body Beautiful on KRON4 to the breast. Breast augmentation, breast lifts, breast reductions, breast implant revisions, everything related to enhancing the breasts is open for discussion.
Body Beautiful is broadcast live at 11:00 AM on KRON4, so tune in and phone in with your breast questions. Whether you have had breast surgery, or are considering it, the show will cover a variety of topics. For a preview of what’s in store visit SanFranciscoBreast.com.
What’s new in Breast Enhancement Surgery?
The new web site is a comprehensive and authoritative review of the latest techniques in aesthetic breast surgery. Located in the San Francisco East Bay Area city of Walnut Creek, Plastic Surgeon, Joseph Mele, has lent his years of experience, and breast expertise, to this free patient education resource. The site is illustrated with graphics, videos and before and after pictures, and there is more to come. The list of topics covered is long and includes:
I look forward to hearing from you on Monday. If you will not be able to watch KRON4 at 11 AM on Monday, December 13, 2010, and you have a question you want answered, you can send your question via the contact form to the left. I will send you a personal response, and perhaps your question will be answered live during Body Beautiful.
San Francisco plastic surgery patients have an extensive new local resource encompassing all aspects of cosmetic breast enhancement surgery. I have consolidated my years of experience, and the common questions that my patients ask, to create a site that is both informative and understandable. If you are considering cosmetic breast surgery, SanFranciscoBreast.com is a comprehensive collection of consumer information.
The web site is illustrated with videos and before and after pictures. The list of topics covered is long and includes:
SanFranciscoBreast.com is a specialty site dedicated to all aspects cosmetic breast surgery. Since the site is focused only on the breast, it gives me the opportunity to describe each procedure in detail, and to provide you with specific information to help you make an informed decision.
What happens when a breast implant leaks, depends on the type of breast implant. When the breast implants are saline filled, the saline is water with 0.9% salt (NaCl). A small defect in the shell, or leak at the valve, will allow the saline to quickly escape. Since saline has the same saltiness as our body, the fluid causes no harm. There is no reaction to the leaking saline, and it is quickly absorbed. The leaking saline breast implant will deflate, and it becomes quickly obvious that there is a problem. No additional tests are usually necessary, and under most circumstances, arrangements are made to replace the defective breast implant; the sooner the better. Did you know that breast implants come with warranties?
Silicone gel filled breast implants give a different result. Silicone gel is cohesive (sticky) and tends to stay together. Because of this, it is possible to have a “silent leak” with silicone breast implants. A silent leak is when the implant has leaked, but there is no evidence of the problem on physical examination. The silicone gel can leak out of the implant, but continues to be contained by the capsule, the thin scar that forms around the implant that helps keep the implant from moving. Saline is absorbed by the scar, so a silent leak is not possible with saline implants.
If the silicone gel gets outside the scar, the body will try to contain it by forming additional scar. This can lead to lumps in the breast. To avoid this complication, the FDA has recommended that women with silicone gel filled breast implants get an MRI three years after surgery, and then every two years thereafter. The hope is that a leak can be detected in the silent stage, and treated (replaced) before the gel escapes the capsule and begins to form more scar tissue in the breast.
In addition to breast augmentation mastopexy, this video discusses breast implant leaks and breast implant replacement surgery. Combining breast augmentation with other surgeries is also reviewed. The two most common combinations breast lift with breast implants and breast augmentation and tummy tuck (the mommy makeover) are mentioned.
This is segment three of four from a recent airing of KRON’s Body Beautiful with Vicki Liviakis. The 800 number shown was for the live broadcast, so if you have questions please call my office directly at (925) 943-6353, or use the contact form to the left. Additional information can also be obtained from the links at the end of this article.
This episode includes:
Breast Augmentation vs. Breast Lift or the combination Augmentation Mastopexy.
How soon should a Breast Implant deflation be treated?
What is the recovery after Breast Implant replacement for deflation or size change?
Is leaking saline dangerous?
Is it a good idea to bring my friend, boyfriend or husband to the consultation appointment?
Why would I need a Breast Lift with my Breast Augmentation?
Can Breast Augmentation be safely combined with other surgery? Mommy makeover?
What are the indications for Breast Reduction surgery?
If you are interested in learning what specific treatment will work best for you, a personal consultation appointment is the way to find out. A Board Certified Plastic Surgeon can help define your goals and tailor the treatment to best achieve the results you desire. To schedule your consultation, please call (925) 943-6353.
Additional information on Breast Augmentation and Breast Lifts can be found here:
Breast implant warranties vary by manufacturer and by implant. In the United States, Allergan and Mentor are the two FDA approved breast implant manufacturers. Their implants are essentially the same, and they have been known to match each others warranties when changes are made. Below are the details of the warranties for 2010.
Allergan’s Natrelle® Breast Implant Warranty
Allergan markets their breast implants under the brand Natrelle®
Allergan’s breast implants are sold under the brand name Natrelle®. Every implant, saline or silicone gel, comes with the ConfidencePlus® warranty, and there is the option to buy the enhanced ConfidencePlus® Premier warranty.
The ConfidencePlus® warranty is free with the purchase of your Natrelle® breast implants, and it includes:
Free lifetime product replacement
Financial assistance of $1200 to defray the costs of surgery to replace the implant for 10 years after surgery
Non-cancelable terms
Enrollment Fee = Free
The ConfidencePlus® Premier warranty is $100 with the purchase of your Natrelle® breast implants, and it includes:
Free lifetime product replacement
Financial assistance of $2400 to defray the costs of surgery to replace the implant for 10 years after surgery
Non-cancelable terms
Implant replacement on the opposite (non-deflated) side for 10 years after surgery
Enrollment Fee = $100
Through 2010 (EDIT – extended through 12/312011), breast augmentation patients receiving Natrelle Silicone Gel implants will get the ConfidencePlus® Premier warranty for free. As an added bonus, the financial assistance of $2400 to defray the costs of surgery, will also be increased to $3500 for 10 years after surgery.
Warranties are changed frequently, so be certain to get the latest information direct from Allergan (<-click here).
Mentor’s Saline and Memory Gel Warranty
Mentor markets their silicone gel implants under the name MemoryGel®
Like Allergan, Mentor too has different warranties for different implants. Here are the Mentor Breast Implant Warranty details:
The Mentor Standard Advantage warranty is free with the purchase of your Mentor breast implants, and it includes:
Free lifetime product replacement
Financial assistance of $1200 to defray the costs of surgery to replace the implant for 10 years after surgery
Non-cancelable terms
Implant replacement on the opposite (non-deflated) side for 10 years after surgery
Enrollment Fee = Free
The Optional Mentor Enhanced Advantage warranty is $100 with the purchase of your Mentor breast implants, and it includes:
Free lifetime product replacement
Financial assistance of $2400 to defray the costs of surgery to replace the implant for 10 years after surgery
Non-cancelable terms
Implant replacement on the opposite (non-deflated) side for 10 years after surgery
Enrollment Fee = Free
Through 2010, breast augmentation patients receiving Mentor Memory Gel implants will get the Premier Advantage Limited Warranty for free. Like Allergan financial assistance of $2400 to defray the costs of surgery, will also be increased to $3500 for 10 years after surgery.
Since the warranty details do change, be certain to check for the latest directly from Mentor (<- click here).
The rule of thumb is that breast implants should be changed every ten years, but is this really true? Should breast implants be replaced at their tenth anniversary? If your breast implants are ten years old, is it time to change them? The question comes up every day in my Walnut Creek breast augmentation practice, so here are the current recommendations on the San Francisco plastic surgery blog.
Why are Breast Implants Removed?
According to the FDA, breast implants are not considered lifetime devices. In order of occurrence, the most common reasons for breast implant removal are:
1) the patient’s desire to change implant size or style, 2) deflation and 3) capsular contracture. These three reasons account for about 90% of all the breast implants that are removed. Sheyla Hershey had her implants removed due to infection, and possibly exposure. This is not a common reason for breast implant removal, and she is not the ordinary breast augmentation patient. Excess breast implant size is associated with a higher reoperation rate. Other less common reasons for implant removal and replacement include: implant malposition, wrinkling, palpability, breast pain and iatrogenic injury (inadvertently broken by a doctor). Not on the list: breast implants are ten years old.
The Older the Breast Implant the More Likely it is to Fail
If you are happy with your size, there is no indication of leakage, your breast remain soft and are not painful, the fact that your breast implants are ten years old is not a reason to have your implants removed or exchanged. The older the implant, the more likely it is to wear out, but most breast implants last longer than ten years.
For saline implants, leaks are pretty easy to determine. If saline filled breast implants leak, they flatten, and it is obvious that there is a leak. For silicone gel filled breast implants, the shell of the implant can be damaged without any outward sign of leakage. This is termed a silent rupture. If you have silicone gel filled breast implants, the FDA recommends obtaining an MRI of your breasts at three years, and then every two years after surgery to check for a silent leak. If a leak is discovered, the implant should be removed, or replaced, to prevent gel migration and additional scar formation.
Breast Implant Warranties
The two US based breast implant manufacturers offer warranties on their breast implants. Both offer similar warranties, although the details vary by manufacturer and implant (saline vs. gel).
At the time of this post, both companies will replace a defective implant for free. Both companies will allow you to change style with the cost based on the differential between the current implant and the new style selected. If the new style costs more, you are charged only the difference in price in most cases. Financial support is also available during the first ten years to reduce the cost of the replacement surgery.
Details can be found on your breast implant manufacturer’s web site. For the United States in 2010, it will be either Allergan or Mentor. Click here for the Allergan (Natrelle) Breast Implant Warranty or here for the Mentor Breast Implant Warranty. If you do not know the manufacturer, please contact your plastic surgeon. They should keep a record of your implant manufacturer, catalogue number and size.
So What Are the Odds of Needing My Implants Changed 10 Years After Surgery?
The best numbers currently available come from the post-approval studies available online from the manufactures. Reoperation rates for any reason, varied from 25% to 50% at ten years, and about half involved removal or replacement of the breast implants. This means as many as 25% of women undergoing breast augmentation had their implants removed or replaced at the ten year mark. It also means that 75% of women followed did not need their implants changed at 10 years. Unfortunately, almost half the patients originally enrolled in the studies were unavailable at ten years. It is unclear how to extrapolate to include those that are missing from the data. Are they having surgery at the same rate, or have they dropped out because they are fine and don’t have any problems?
If I Have a Problem With My Breast Implants, Can They be Replaced Immediately?
While some women do elect to have their breast implants removed and not replaced, the majority have them exchanged, usually for larger breast implants. The numbers vary from study to study. Both Allergan and Mentor have ongoing ten year saline and silicone breast implant follow-up studies to try to obtain the highest quality data with the newest implants available. Hopefully, compliance will be enhanced since study questionnaires can now be completed by patients on-line. If you are participating in one of the breast implant follow-up studies, I encourage you to complete your surveys and make your follow-up appointments to enhance the study’s accuracy.
Breast Implant Revision Surgery
The bottom line is that most breast implants do not need to be replaced at ten years. If you have breast implant surgery, it is reasonable to expect to need another surgery at some point in the future. The chances of having breast augmentation revision surgery within ten years of your initial breast augmentation is somewhere between 25% and 50%, and only about half of these breast augmentation revision surgeries involve replacing the breast implants. Reoperation rates are higher for breast reconstruction after a mastectomy. If your breast implant has deflated, be certain to check your warranty. Most deflated implants will be replaced at no cost, and you many be eligible for assistance to defray the cost of surgery if the replacement occurs within ten years of your primary breast augmentation.
Sheyla Hershey is a Brazilian born, Houston resident, who is most famous for the size of her breasts. She made national headlines early in 2009, when she wanted to increase her bust from 38FFF to 38KKK and ran into a Texas sized roadblock. Apparently, “Everything is bigger in Texas,” has its limits when it comes to breast implants. Unable to have larger implants placed in Texas, she returned to her native Brazil for the surgery.
Sheyla is again making headlines. Sadly, this time it is for complications of her breast augmentation. Earlier this summer she developed an infection around her implants, necessitating their temporary removal. On her blog this morning, Sheyla shares that she is doing well at home recovering from her surgery last Thursday. She also plans to have her implants replaced. This is usually done after the infection has cleared and the injury has healed — three to six months after surgery, and sometimes longer.
Breast Implant Infection
Breast implant infections are one of the complications covered on all breast augmentation informed consent forms. While rare, infections after breast augmentation can occur. Most are superficial infections that clear with oral antibiotics; however, deep infections can also occur. These are more serious and may require intravenous antibiotics and even hospitalization. When the infection is deep, around the implant, sometimes the only way to clear the infection is to remove the breast implants and leave them out for several months while the body heals.
Bigger is not always better. Larger breast implants put more strain on the body’s systems. The stretch and compression of a large breast implant decreases the circulation in the surrounding soft tissues. Less circulation means decreased oxygen delivered, fewer white blood cells, and lower levels of antibiotic delivery to the breasts. Larger implants also create a larger potential space in which the bacteria, usually staph, can hide. All these factors make it harder for the infection to clear.
Breast implant infections are much more common after breast reconstruction than after cosmetic breast augmentation. The additional insult to circulation that results from the mastectomy is just one contributing factor. Tissue expansion is often used to stretch the skin which remains on the chest. This is done to compensate for the skin removed during the mastectomy. Chemotherapy reduces the bodies ability to fight infections, though this is usually temporary. Radiation causes injury to the skin and chest wall. One effect is scarring of the blood vessels. This causes a long term decrease in circulation that gets worse with time.
Implants which are placed behind the muscle have better protection from infection. The circulation in the muscle is a major contributor. Unlike the breast gland proper, the space behind the muscle is sterile. The breast is a gland, and is open to the outside world at the nipple. This increases the likelihood of bacteria being under the skin, and closer to breast implants placed in front of the muscle. This leads to a slightly increase the risk of infection when breast implants are not behind the muscle.
What are the Chances of Breast Implant Infections?
Infections can occur any time the skin is cut. Most surgical infections appear within a few days to weeks after an operation. The risks of getting an infection after any “clean” surgery, like breast augmentation surgery, is 1%. If you have an infection anywhere in your body at the time of surgery, your risk of a breast implant infection will dramatically increase. This is one reason I sometimes have to postpone elective cosmetic surgery. It is better to be inconvenienced than to take the risk of getting a postoperative infection and losing your breast implants.
For cosmetic breast augmentation, infection is rarely the reason breast implants are removed. For all implants removed within ten years of breast augmentation surgery, infection was the reason in only 2% of cases. The most common reasons breast implants are removed are the desire to change the breast implant’s size (usually larger), deflation of the breast implant or capsular contracture.
For breast reconstruction, the chances of infection are increased 2 to 4 fold. While breast reconstruction is similar to cosmetic breast augmentation, the patients and their breasts are different. For all implants removed within ten years of breast reconstruction surgery, infection was the reason in 12% of cases. For breast reconstruction, placing the implant behind the muscle has been shown to prevent complications.
While no one likes dwelling on everything that can go wrong in life, if you are considering elective cosmetic surgery, like breast augmentation surgery, it is important to review the risks and well as the benefits. While complications like infection are rare, remember, the more the limits are pushed, the greater the risk.
Whether it is spring fashion or spring fever, the demand for breast augmentation is on the rise. If you are considering breast augmentation, you are looking in the right place.
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.
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:
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.
