Breast Augmentation remains one of the most popular cosmetic plastic surgery procedures. While often the procedure lasts a lifetime, breast augmentation revision is quite common. Breast Implant Revision has emerged as a specialty unto itself. While many of the tenants that lead to excellent Breast Augmentation results will also apply to Breast Augmentation Revision, new and specific techniques have evolved for the correction of the common problems that can occur with Breast Implants.
The most frequent reasons for Breast Augmentation Revision Surgery include the desire to change the size of the breast, breast implant deflation, problems with the position of the breast implants and tightening of the scar that normally forms around the breast. The last listed is called capsular contracture.
San Francisco Bay Area Breast Augmentation
What follows is a Breast Implant Revision Video segment from KRON4′s live Medical Monday show, Body Beautiful. The television broadcast allows viewers to call in and have their questions answered live. The (415) number shown in the video was only for the show, so if you have Breast Augmentation or Breast Implant Revision questions, please call our San Francisco Bay Area Plastic Surgery office directly at (925) 943-6353, or use the contact form on the left.
San Francisco Bay Area Breast Augmentation & Breast Implant Revision Video
San Francisco Bay Area Breast Implant Questions
This Breast Augmentation, Breast Augmentation Revision Surgery video includes:
What to consider before having Breast Augmentation
Is “routine maintenance” for Breast Implants required?
If my Breast Implants are too high, can they be lowered?
If my Breast Implants are too low, can they be raised?
If my Breast Implants are too wide, can they be moved towards the middle?
If my Breast Implants are too close together, can they be separated?
What causes Breast Implants to fail?
Can I maintain my body proportions and have Breast Augmentation?
What are the problems associated with Breast Implants which are too big?
Breast Augmentation and Breast Implants Revision Resources
You are viewing one of four Breast Implants Revision Video segments from Dr. Mele’s recent Body Beautiful television appearance. Here are links to the additional segments:
Breast Augmentation and Breast Implant Revision San Francisco Bay Area – 1 of 4 (You Are Here)
This patient had breast augmentation prior to becoming pregnant. Left: After pregnancy, the breast implant position remains unchanged; however, the breasts have dropped. Right: After breast augmentation revision, the breasts have been lifted and the breast implants exchanged, dramatically improving the breasts' shape and profile.
Pregnancy and Breast Augmentation
Pregnancy can change the volume and shape of breasts, and the result isn’t always positive. If you have been pregnant, you know firsthand. For the lucky few the changes are subtle, or even enhancing, but usually they are not. Many patients opt for breast augmentation after having children to restore what was lost. If you are trying to get pregnant, it is worth delaying your breast augmentation; however, if childbearing is not imminent, waiting may not be desirable.
Breast Implant Problems After Pregnancy
The breast augmentation revision before and after pictures above are of a woman who had breast augmentation at a young age, and enjoyed her breast implants for many years. After childbearing, her breast implants remained in a perky position, but the natural breast tissue sagged. Her breasts would have sagged and deflated whether she had breast implants or not, but with implants the result was normal elongated, deflated breasts, with the addition of disproportionate upper pole fullness from her breast implants.
The Breast Implant Revision Solution
The solution was a breast lift with breast implant exchange. The natural breast tissue was lifted to reduce the length of the breast and firm the natural breast tissue. The breast implant was exchanged to help with both shape and the post-partum changes in breast volume. Larger breast implants can be used to replace lost breast volume. Smaller implants, removal of the breast implants, or even breast reduction can help when the breast remain too large after lactation.
A desire to change breast implant size (larger or smaller)
Deflation of the breast implant
Firmness due to tightening on the breast implant capsule (capsular contracture)
Breast implant asymmetry or malposition like bottoming out, double bubble or symmastia (uniboob)
If you have one of these problems, a Board Certified Plastic Surgeon, like Walnut Creek Breast Implant Specialist Joseph Mele, MD, FACS, can help.
Tomorrow, Dr. Mele will be appearing on Body Beautiful. The show airs live on KRON, channel 4, September 12, 2011, at 11:00 AM. Breast augmentation and breast augmentation revision surgery will be discussed. If you have questions, call in to the KRON studios on Monday at 11:00AM, or send us your question through the contact form on the left. Every effort will be made to answer your questions during the show.
Breast Implant Revision Videos
Below are links to previous television appearances on KRON4 featuring Breast Augmentation Revision Videos and Breast Augmentation Revision Before and After Photos:
Breast Augmentation Scar Revision Before and After Pictures
Breast Augmentation Scar revision is another reason for Breast Implant Revision Surgery. Follow the link for a case presentation of breast augmentation scar revision for a wide-spread periareolar scar : Hypertrophic Breast Scar Revision
Saline Breast Implants or Silicone Breast Implants? The question is asked every day in my Walnut Creek Plastic Surgery Office, and it is often followed by, “Which is Safe?” The decision to have breast augmentation surgery is a personal one. While both saline breast implants and silicone breast implants are both safe, which is best will depend on you.
Why Choose Silicone Breast Implants?
The main reason women choose silicone gel breast implants is because they feel softer. If you are thin and have small breasts, a breast implant will be more palpable. A silicone breast implant tends to give a softer, less detectable result. A silicone breast implant will move more like breast tissue too. These advantages are less pronounced for larger breasts.
Why Choose Saline Breast Implants?
The main reason my patients choose saline breast implants is because they are afraid of silicone. Saline implants are a bit firmer and can provide some additional projection when this is desired. They can also be placed through smaller incisions, because saline breast implants can be inserted empty, and filled after they are inside. The peace-of-mind that saline breast implants offer comes into play when we discuss breast implant leaks.
What Happens if My Breast Implants Leak?
Both the currently approved saline breast implants and silicone breast implants can leak. If and when the FDA gets around to approving the form-stable, gummi-bear breast implants, board certified plastic surgeons will be able to offer an implant that doesn’t leak. For now, leakage rates are low, but account for about one third of all breast implant revision surgery.
When Saline Breast Implants Leak
When a saline breast implant leaks it is obvious. The implant goes flat, and the volume is lost. No special test is necessary to make the diagnosis. Since saline is water with a little salt added to match your body’s saltiness, it is quickly absorbed and leaves no trace. US breast implant manufactures offer lifetime breast implant warranties, so the breast implant will be supplied without a charge, and if a leak occurs within 10 years of your primary breast augmentation, they will also supply money to help defray the cost of surgery to replace the defective implant.
When Silicone Gel Breast Implants Leak
When a silicone gel breast implants leaks, it may not be so obvious. The silicone is a cohesive gel and does not run like water. This is good in that the capsule around the implant often prevents the gel from migrating; however, it also means that the size of the breast does not change. The FDA has recommended that all patients with silicone breast implants obtain an MRI every other year to look for these silent leaks beginning three years after the initial surgery. If the gel migrates outside the capsule, the body will often form additional scar to wall-off the free gel. This can cause a lump in the breast and may be the first clue that a silicon breast implants has leaked.
So … Saline Breast Implants or Silicone Breast Implants?
There is no “correct” answer. For most patients a good result will be obtained with either saline breast implants or silicone breast implants. Silicone breast implants tend to give a more aesthetic result when the breast tissue is small and when the implant is large. The bigger the breast implant, and the smaller the breast, the more obvious breast augmentation may be. The silicone implants feels and acts more like breast tissue, so it can often provide a superior result in this situation. The advantage is not as pronounced if you have more breast tissue and a smaller breast implant.
While information is available on-line, the best way to get an informed opinion is by visiting a Board Certified Plastic Surgeon. If you would like to schedule an appointment with Dr. Mele give us a call at (925) 943-6353 or use the contact form in the left column.
It has been an interesting summer in the San Francisco Bay Area. The rest of the country is trying out the West Coast’s favorite natural disaster – Earthquakes. Earlier this week a 5.5 earthquake hit Cokedale, Colorado and a 5.8 struck in Mineral, Virginia. We are not slacking on that department, as I was awakened Tuesday night by a mild 3.6 quake, one of 75-100 San Francisco Bay Area Earthquakes this week.
Maybe it’s Earthquake weather, but this summer’s weather has been a bit odd. While the rest of the country has been roasting, it has been a mild summer for San Francisco. Bay Area Breast Augmentation, on the other hand, remains hot. In office procedures such as Botox, Fillers and Chemical Peels are still the most frequently performed facial enhancements, but Breast Augmentation (Augmentation Mammoplasty) remains the most popular cosmetic plastic surgery procedure, with 300,000 breast augmentations performed in 2010 just in the US.
Breast Augmentation Before and After Pictures
Reasons for Breast Augmentation
Breast Augmentation is performed for many different reasons, and the choice to get Breast Implants is a personal one. The most common reasons include the correction of breasts that never fully developed, restoring volume lost after pregnancy or weight loss, congenital deformities and the loss of a breast due to breast cancer. Breast Implants help restore body proportions, enhancing the way clothing fits. Some commonly asked questions about Breast Augmentation are answered on my main web site, and links are provided below.
If you are interested in learning more about Breast Augmentation, or you have Breast Implants and are considering Breast Augmentation Revision, give one of San Francisco Bay Area’s premier Breast Implant Specialists a call at (925) 943-6353, or contact us through the contact form in the left column.
Silicone is used in many beauty aids. While most people equate silicone with breast implants, there is much more to how silicone is used. From contact lenses to shampoo (dimethicone) silicone is around us every day. Silicone drainage tubes can be life saving after brain injuries to prevent fluid on the brain and death. Silicone implants are used throughout the body to improve both form and function. Most silicone implants are solid. Injection of free silicone is different than using silicone implants. Free silicone injections are liquid, and unlike with breast implants, the liquid is not contained.
Q: Is Silicone a Liquid or a Solid? A: Yes
Silicone is extremely flexible in its use. At body temperature, silicone can be made with a wide range viscosities: liquid like water, cohesive like honey, soft solid like Jello, more firm like rubber or hard like a rock. The fact that silicone is extremely well tolerated by the human body, makes it an excellent substance for implantation; however, only silicone meant for medical use should be used, and only by a qualified professional should be consulted.
How is Silicone Used
As a Board Certified San Francisco Bay Area Plastic Surgeon, I use silicone implants every day in my Walnut Creek Plastic Surgery practice. In California, silicone implants are used to augment the breast, cheeks, chin, nose and many other areas.
Silicone Facial implants are made of a soft solid silicone. Since they are solid, they cannot leak. They are used routinely for Cheek Augmentation, Chin Augmentation and Nose Augmentation. Since silicone facial implants are used to augment boney prominences, the fact that they are firm is an advantage. They can be molded into specialized shapes and sizes, depending on the amount and location of augmentation desired. The smooth surface does not adhere to normal tissue, so it needs to be meticulously placed. The smooth surface also allows for easy removal, should removal ever become necessary. Solid silicone facial implants are firm but flexible. For larger augmentations, silicone facial implants may not be firm enough.
An example: for small to moderate chin augmentation, silicone chin implants work great. For larger chin augmentations, I prefer Medpore®, which is made from porous high-density polyethylene. It is much firmer, and since it is porous, it allows in-growth. In-growth can help stabilize the Medpore® chin implant, and further decrease the already small risk of infection. These are decisions best made during your presonal consultation with a Board Certified Plastic Surgeon. This allows an open, honest discussion of the pros and cons of each option with a trained expert who has the experience to back-up your specific surgery.
Silicone Breast Implants
All breast implants have a silicone shell, even saline filled breast implants. When we say silicone breast implants we are talking about what is inside. Silicone breast implants have a solid outer shell, and a center filled with a cohesive silicone gel. Some older silicone breast implants were filled with a thin liquid, which would migrate if the shell ever broke. Currently, the cohesiveness varies from a very thick gel that likes to stay together (Allergan Natrelle® and Mentor Memory Gel® breast implants – currently available) to a solid with the consistency of Jello® (Gummy bear, Allergan Natrelle 410′s and Mentor Cohesive III Implants – Not yet FDA approved). These gummy bear implants can be made with various asymmetrical shapes, because they are thick enough to retain their shape.
Free Silicone Injections – Buyer Beware
The San Francisco Bay Area is a great place to be a plastic surgeon. We have an educated population that is interested and aware of many of the latest options in plastic surgery. Unfortunately, new doesn’t mean better, and sometimes new isn’t even new. Silicone injections are a great example. Even San Francisco plastic surgeons are still looking for the perfect injectable to fill wrinkles and augment the face without surgery. A well tolerated, stable substance, free from allergy, that will last a hundred years and remain soft remains elusive. There was a time when silicone was felt to be that substance.
Silicone is well tolerated, and can be made thick enough to prevent migration. The augmentation obtained is better than Restylane®, Juvederm®, Perlane®, Radiesse® or any other available dermal filler. It can remain soft for many years. Unfortunately, the body will form scar around free silicone, and this scar can continue to develop over years into a hard disfiguring mass.
Free Silicone in the Lips
Silicone has been used for lips. Initial results are great; however, the long term results are not predictable. Lisa Rinna, famous for her silicone augmented lips, recently had to have surgery to excise the silicone from her lips.
Free Silicone in the Buttocks
Silicone has been used for buttock augmentation. At first it looks great, but with time, it becomes hard and can cause visual disfigurement. Since medical grade silicone is not available in the United Stated, reports surface every year of an unqualified injector offering cheap buttock enhancement using silicone purchased at the local hardware store.
Free Silicone for Breast Augmentation
Free silicone was used for breast augmentation, as was fat injection, until they were replaced by a much more effective and safer alternative – breast implants. Breast implants use a solid silicone shell to contain the silicone inside. A thicker, more cohesive gel is used inside to help prevent migration, but even this should be removed if the implant breaks. Since the center is highly cohesive, it acts as a unit rather than a liquid, so it can be hard to tell if a silicone filled breast implant has leaked. This is why the FDA recommends women who have silicone gel breast implants obtain an MRI at three years and then every two years after having breast augmentation surgery.
“New” Silicone Injections
Research is on-going to find the perfect formulation for silicone injections. The latest attempts are looking into silicone with increased viscosity to help prevent migration and reduce the scar reaction. Since it often takes years for the scar around free silicone to develop into a noticeable mass, the results are still pending. One problem is that the thicker gel is much more difficult to inject without resorting to something like a caulking gun. Until the known problems are solved, the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery and the FDA do not approve of the use of silicone injections outside of clinical trials.
Tubular breast deformity is a common, congenital breast abnormality found in both women and men. In men, the treatment is straight forward (see the bottom of this article). In women, however, additional aesthetic norms come into play, making the repair more complex.
Tubular Breast Deformity in Women
Tubular breast deformity is known by many names:
Tubular breast deformity
Tuberous breast deformity
Snoopy Nose or Snoopy’s Nose deformity
Constricted breast deformity
Women with mild constriction often come to see me to simply increase the size of their breast, not aware of the diagnosis. Women with more severe deformity, however, are often reluctant to show their breasts to others, and want to improve the size and the shape of their breasts. Correcting these types of problems is more challenging, but at the same time, quite rewarding.
Mild tubular breast deformity with constricted base was corrected with sub-pectoral breast augmentation (behind the muscle) and internal release (no lift needed)
Tubular Breast Abnormality is a Congenital Breast Deformity
While present at birth, the full extent of the tubular breast deformity is often not appreciated until puberty. This is when the breasts normally develop, and the full extend of abnormalities are revealed. While women with tubular breasts have smaller than average sized breasts, not all small breasts are tubular breasts. While the extent to which the deformities manifest can vary widely, several specific abnormalities are present.
Signs and Presentation of Tubular Breast Abnormality
Besides smaller size, the main components of the tubular breast are a constricted base and a tubular shape to the breast. This can be exacerbated by herniation of the breast tissue into the areola, causing “puffy nipples”. Technically, the nipple is not affected, but the areola, the colored skin around the nipple, may project out from the breast mound. The overall effect is an elongated or tubular shape to the breast. The true tubular shape is most noticeable in more severe cases.
The colloquial name for tuberous breasts is the Snoopy Nose or Snoopy’s Nose deformity. Snoopy is Charlie Brown’s white beagle of Peanuts fame. Picture the front of Snoopy’s muzzle. If you are not familiar with Snoopy click the link above. His white face represents the breast mound, his black nose sits like a ball on the end, and represents the herniated breast tissue filling the areola.
Treatment of the Tuberous Breasts
As mentioned above, tubular breasts tend to not fully develop. Often patients with tubular breasts desire breast augmentation to increase the size of their breasts. For mild tubular breast deformity, a breast implant may be sufficient treatment. When the breasts are more tubular, additional maneuvers are necessary to provide an enhanced result.
If the areola is overly full, a periareolar lift can reduce the puffy nipples, and prevent the breast tissue from herniating. Unlike for men, the breast tissue is not usually removed, just pushed back into its normal anatomical position. The constricted base seen with tuberous breasts also tends to shorten the distance between the areola and the base of the breast. The lift has the additional benefit of moving the areola higher on the breast, helping to center the nipple on the breast mound.
Moderate tubular breast deformity with constricted base, elongated breast and mild areolar breast tissue herniation, best seen in right breast (your left). Both size and shape were corrected with breast augmentation and peri-areolar lifts.
Traditionally, tubular breast were treated with breast implants placed in front of the muscle. With a periareolar lift, it usually possible to place the implant behind the muscle. This gives a more natural appearing breast mound, and makes it easier to perform mammography in the future. While silicone and saline breast implants can both give good looking results, for smaller breast, a silicone gel implant may give a better feeling result. It is important to discuss the pro’s and con’s of each option with your Board Certified Plastic Surgeon.
Tubular Breast Deformity in Men
In men, tubular breast deformity presents as an overly full areola or “puffy nipples”. Since men like flat chests, tuberous breasts are easily treated in with resection of the excess tissue. The procedure is similar to that used for Gynecomastia. A small “smiley-face” incision is made from 4 to 8 o’clock around the lower edge of the areola, and the excess glandular tissue is removed. The procedure provides a smoother contour, and a quick recovery.
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.
