When Breast Augmentation Needs A Lift | SF Bay Area

Posted February 05, 2017 in Breast Augmentation, Breast Lift (Mastopexy), Home, Mommy Makeover, Tubular Breasts

Mastopexy Augmentation is the combination of Breast Augmentation and Breast Lift. When is Breast Augmentation alone enough? When is a Breast Lift the best choice? When should a combination of Breast Augmentation Lift be performed? It’s a big subject, and requires an in-person consultation for your specific needs, but some general rules for the procedures are explained below. There are many options, so be certain to consult with a Board Certified Plastic Surgeon before making the decision.

Breast Augmentation Lifts Come in May Sizes

Breast Augmentation with Breast Lift was used to enlarge the breasts, elevate the nipple and tighten the breast skin, especially the skin that hangs at the bottom of the breasts. The technique used, a horizontal breast lift, does not require the vertical scar seen in the anchor or inverted-T type breast lifts.

Breast Augmentation with Breast Lift was used to enlarge the breasts, elevate the nipple and tighten the breast skin, especially the skin that hangs at the bottom of the breasts. The technique used, a horizontal breast lift, does not require the vertical scar seen in the anchor or inverted-T type breast lifts.

Breast Augmentation lifts, like the breasts themselves, come in many shapes and sizes. When the shape of the breast is good, but a larger version is desired, Breast Augmentation with a Breast Implant is often enough. When the size of the breast is good, but the breast tissue sags, a Breast Lift alone may be enough. The exception in this case is when there is no upper pole fullness, often seen as gapping of the upper bra. A small implant may be beneficial to add a bit of volume to the upper breast in these cases. When the breasts are small and saggy, the Breast Augmentation Lift is the procedure of choice.

The case above is an unusual lift in that a periareolar (defined below) and an inframammary incision (hidden in the crease beneath the breasts) were used, but there is no vertical scar. The “Horizontal Breast Lift” is great for breasts that have bottomed out or for breasts with more extreme sagging.

Breast Augmentation Lift for Tubular Breast

Smaller Breast Lifts require smaller scars. In the case above, a periareolar scar was used to reposition the nipple and reshape the breasts. Periareolar literally means “around the areola”. The areola is the pigmented skin that surrounds the nipple. While this does provide the smallest scar, it does the least. It tends to flatten the end of the breast and it is not great for reducing the size of the areolae.

The Breast Augmentation and Breast Lift combination with the smallest scar is the Periareolar Mastopexy Augmentation. An incision around the areola is used to raise the nipple and insert the Breast Implant. In the above case, the flattening effects of the periareolar lift are exploited to help reshape these tubular (tuberous) breasts.

The Breast Augmentation and Breast Lift combination with the smallest scar is the Periareolar Mastopexy Augmentation. An incision around the areola is used to raise the nipple and insert the Breast Implant. In the above case, the flattening effects of the periareolar lift are exploited to help reshape these tubular (tuberous) breasts.

For cases of Tuberous Breasts, flattening of the shape of the breast is a plus. It can be used to prevent the puffy nipple from sticking out like a cherry on top of a sundae. This patient’s breasts are narrow at the base, and the constriction gives a narrow, elongated, tubular breast. The Breast Implant helps to round the breast out, but it may not correct the areola when it is puffy.

Bigger Sagging, Bigger Problems, Bigger Breast Aug Lifts

For patients with severe postpartum breast involution (shrinkage), and for patients after massive weight loss, the breast volume has left the building, leaving only a loose, empty flap of skin. Breast Augmentation Lifts are the only solution to this problem. Breast Implants are used to restore the breasts’ volume, and it is combined with a Breast Lift to restore the breasts’ shape.

Severely deflated breasts, like those seen above after massive weight loss, need more volume and bigger lifts. An Anchor shaped scar was needed to raise the nipple, remove the overhanging lower breast skin and to tighten the breast skin in the horizontal direction, too.

Severely deflated breasts, like those seen above after massive weight loss, need more volume and bigger lifts. An Anchor shaped scar was needed to raise the nipple, remove the overhanging lower breast skin and to tighten the breast skin in the horizontal direction, too.

Often, I will see on the Internet the misconception that if a big enough implant is placed, you will not need a lift. This is not true. Imagine an implant, the size of the one used above, placed under the skin of the pre-op picture. The breast would be the same size; however, the loose skin holding the nipple would hang off the end. In the above case, only a Breast Lift can correct the problems with the breasts’ shape, nipple position and excess skin at the bottom of the breast.

More Scar = Happier Patient?

The ultimate goal of Cosmetic Plastic Surgery is a happy patient. So how can more scar lead to a happier patient? It all depends on the circumstances. If a scar is not needed, then more scar is bad. I have had patients on the borderline of needing a lift elect to not have lift because of the extra scar. Some are happy with their decision of not completely correcting the sagging, and not having extra scars. Others have come back for a Breast Lift after their Breast Augmentation, and are much happier now, after the Breast Lift. Staging does make it easier to see what each procedure has to offer the final result.

The main goal of Cosmetic Plastic Surgery is a pretty result. The Breast Augmentation Lift allows for control of both the size and the shape of the breasts. The cost is additional scar. In this case, an Inverted-T scar was needed.

The main goal of Cosmetic Plastic Surgery is a pretty result. The Breast Augmentation Lift allows for control of both the size and the shape of the breasts. The cost is additional scar. In this case, an Inverted-T scar was needed.

Above, an inverted-T Breast Lift was performed along with placement of a Breast Implant. A periareolar lift would have left the nipples low, the areolae much larger and the end of the breasts flat. A vertical lift would not have tightened the lower pole sufficiently, or coned the shape of the breast as beautifully. In my experience, the incision underneath the breasts is well hidden. By keeping its length short, the scar will hide in the shadow under the breasts.

Breast Augmentation Lift Consultations

If you are considering a Breast Augmentation, Breast Lift or the Combination Augmentation Mastopexy, be certain to consult an experienced Board Certified Plastic Surgeon. While there are advantages to combining the procedures, it is also more complicated than both procedures done separately.

If you are in the San Francisco Bay Area, give me a call at (925) 943-6353, and schedule a private comprehensive consultation. Your options will be reviewed and the best course selected to optimize you breast aesthetics.

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What is Breast Implant Capsular Contracture?

Posted February 20, 2016 in Breast Asymmetry, Breast Augmentation, Breast Implant Revision Surgery, Capsular Contracture, Home

Breast Augmentation remains the most popular cosmetic plastic surgery procedure year after year. Breast Implants enlarge small breasts, whether you were born with small breast, lost breast volume with weight loss or your children have sucked the life out of your breasts. Capsular Contracture can interfere with good results, but before I explain what Capsular Contracture is, I need to discuss Breast Augmentation and normal healing.

How Do Breast Implants Stay In Place?

During Breast Augmentation surgery, the Breast Implants are carefully positioned. A pocket is made, often behind the pectoralis major muscle, to the dimensions required. The size of the pocket is determined by the dimensions of the breast implant used, and the implant is determined by your anatomy and the amount of augmentation desired.

What is the Breast Implant Pocket?

Breast Augmentation depends of the formation of a proper Breast Implant Pocket for the best results.

Breast Augmentation depends of the formation of a proper Breast Implant Pocket for the best results.

After Breast Augmentation surgery, your body will naturally form a pocket, lined with collagen, that encapsulates the breast implant. Ideally, the capsule is tight enough to keep the implant from moving, but not so tight that the augmentation feels hard.

With Breast Implants, Size Matters

The size and shape of the Breast Implant is important to get the optimal breast shape. Your cosmetic result is determined by a combination of a good plan, good surgery, good healing and little good luck doesn’t hurt either.

  • A Good Plan is formulated before surgery, during your consultation appointment. It should be tailored to your anatomy and your goals. Good communication is critical. It takes teamwork to get a good result, so the best way to start your Breast Augmentation journey is with an experienced plastic surgeon whom with you communicate well.
  • Good Surgery is only possible after a good plan is agreed upon. Just like the consultation, there is teamwork involved with the surgery, too. As the patient, you have to prepare yourself properly before surgery, and after surgery, you need give your body time to heal and adjust to the breast implants. The surgeon is responsible for the actual Breast Augmentation procedure. While exact results can never be guaranteed, choosing an experienced, Board Certified Plastic Surgeon maximizes the predictability and safety of your procedure.
  • Most patients have Good Healing. The majority of healing is how your body responds to the procedure. Following your surgeon’s postoperative instructions and cooperating with their aftercare helps improve your outcome. Each surgeon will have individual variations in care, depending on the technique they use, their experience and most importantly, you. The Internet is unlikely to provide you with a better plan, so any knowledge you receive online, even from the San Francisco Plastic Surgery Blog, should be discussed with your surgeon prior to implementation. Even if you are my patient, I will construct a specific plan for you. Given the specifics of your situation, I will adapt your surgery to you, rather than the generic Internet breast aug patient.

The Breast Implant Pocket

When it comes to great results, the Breast Implant Pocket is second only to selecting the proper implant in importance. The proper breast pocket supports the breast implant and protects it. The pocket needs to be both in the proper place and of the proper size. A pocket in the wrong position means your implant is in the wrong position, but the size of the pocket matters equally.

With Breast Pockets, Size Matters Too

A pocket that is the wrong size will diminish your results. A pocket that is too large results in a implant that moves around too much. The implants in a pocket that is too large may fall under your armpits when you lay down, or bottom-out when you stand.

When the Breast Implant Pocket is too big, the breast implant does not have sufficient support. The result is breast implant malposition with Bottoming-Out when standing. A capsulorrhaphy was performed to close the lower pocket and increase the breast implant's support.

When the Breast Implant Pocket is too big, the breast implant does not have sufficient support. The result is breast implant malposition with Bottoming-Out when standing. A capsulorrhaphy was performed to close the lower pocket and increase the breast implant’s support.

A pocket that is too small squeezes the implant, and makes it immobile. A tight pocket makes the breast implant feel hard and may over time move the implant away from its ideal position. When this happens it is called Capsular Contracture.

Capsular Contracture

So, Capsular Contracture is when the normally helpful breast implant pocket becomes too tight. It is one of the most common reasons for Breast Augmentation Revision. Unfortunately, it is also one of the most unpredictable problems associated with Breast Implants.

Capsular Contracture results in a compressed breast implant that looks, smaller, feels harder and in the worst case scenario hurts. A capsulectomy and breast implant exchange was performed to provide this patient with softer, larger, painless breasts that look and feel better.

Capsular Contracture results in a compressed breast implant that looks, smaller, feels harder and in the worst case scenario hurts. A capsulectomy and breast implant exchange was performed to provide this patient with softer, larger, painless breasts that look and feel better.

Treatments for Capsular Contracture vary with the problems it is causing. Thin, tight capsules can often be opened by dividing them with a Capsulotomy. Thick, tight capsules may require complete removal with a Capsulectomy. Sometimes replacement of the breast implant is recommended, and sometimes ADM patches are recommended, to help prevent recurrence of the Capsular Contracture.

Breast Augmentation

If you are considering Breast Augmentation, or if you have breast implants and are considering Breast Augmentation Revision Surgery in the San Francisco Bay Area, give me a call at (925) 943-6353. A brief consultation appointment is usually all that is needed to review the details of your case and to formulate a plan that makes sense for you.

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Breast Augmentation Revision Surgery SF Bay Area

Posted January 02, 2016 in Breast Augmentation, Breast Implant Revision Surgery, Capsular Contracture, Home, Mommy Makeover, Videos

Breast Augmentation remains on top of the list as one of the most popular Cosmetic Plastic Surgery procedures year after year. With hundreds of thousands of women receiving Breast Implants every year in the United States, it is no wonder that Breast Augmentation Revision has become its own area of specialization.

What is Breast Revision Surgery?

Breast Revision Surgery is any surgery on the breasts to repair or improve the appearance of a previous Breast Augmentation. The urgency ranges from completely elective to an emergency. It can be caused by aging, pregnancy, changes in weight, changes in goals or changes caused by the breast implants themselves. Some of the more common reasons for Breast Augmentation Revision Surgery are covered in the video and text below.

Breast Implant Revision Surgery Video

Below is a segment from a recent Body Beautiful appearance. This video about Breast Implant Revision Surgery first appeared on the San Francisco Bay Area’s New Station, KRON 4.

Breast Augmentation Revision Surgery Video (Breast Implant Revision)

Breast Augmentation Revision to Change Breast Implant Size

There are many reasons for Breast Implant Revision Surgery. Changing size is one of the most common, and usually the desire is to Enlarge Breast Implant volumes. After pregnancy, weight loss or aging, the breast may shrink. Increasing the size of the Breast Implants may be all that is needed to restore both breast shape and confidence. Sometimes, however, the goal is to Decrease Breast Implant volumes, and rarely, Breast Implant Removal is desired. When downsizing or removing the Breast Implant, it may be necessary to perform a Breast Lift to obtain the best possible results.

Breast Implant Revision for Capsular Contracture

Hardening of the Breast Implants occurs when the normal scar pocket that holds the implant in place becomes too small. The tight pocket squeezes the Breast Implant causing firmness, increased projection, decreased diameter and sometimes discomfort. The medical term for this is Capsular Contracture. Most of the time, the breasts can be softened with release (capsulotomy) or removal (capsulectomy) of the capsule as an outpatient procedure.

Breast Implant Revision for Deflation

A deflated Breast Implant needs to be fixed. Breast Implant Replacement is most common, though sometimes a patient will elect to remove her Breast Implants instead. For Saline Breast Implants, the diagnosis is simple. The breast will quickly return to its non-augmented size. The body quickly absorbs the saline, and it is eliminated as easily as when we drink extra water.

For Silicone Gel Filled Breast Implants, the diagnosis is harder, because the gel is not absorbed. New, highly cohesive breast implants, have an extremely low risk of gel migration, so the gel most often stays in the capsule and maintains the breast fullness. Often, an MRI is needed to diagnose a leaking silicone gel implant, but even this is only 90% accurate. If an MRI shows that your silicone breast implant is leaking, it should be removed and, if desired, replaced.

Breast Augmentation Revision for Malposition

Breast Implant Malposition means the implant is in the wrong position. It can be too high, too low, too medial (to the center) and too lateral (to the side). Often, the capsule requires modification in these cases to encourage the Breast Implant to stay in the proper place. Implants that are too large, or soft tissue (skin, breast of muscle) that is too thin, can make management more difficult. Breast Implant Malposition is one of the items discussed on the Breast Revision page of DrMele.com.

Breast Augmentation Revision Surgery Consultations

There are many reasons for Breast Implant Revisions. If you are considering surgery to improve the results of your Breast Augmentation, be certain to seek a Board Certified Plastic Surgeon with years of experience, like Dr. Joseph Mele.

To schedule a personalized Breast Revision Consultation call (925) 943-6353 today.

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Body Beautiful This Saturday on KRON 4 the SF Bay Area’s News Station

Posted December 11, 2015 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction (Men), Home, Thigh Lifts (Thighplasty), Tummy Tuck (Abdominoplasty)

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful - December 12, 2015 at 11:00 AM

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful – December 12, 2015 at 11:00 AM

The latest installment of Body Beautiful will air tomorrow, December 12, 2015, at 11:00 AM on the San Francisco Bay Area’s News Station KRON 4, channel 4. Topics will include:

San Francisco Plastic Surgery Expert

Body Beautiful is a half-hour television show dedicated to the latest in Cosmetic Plastic Surgery. Frequently asked questions about Thigh Lifts, Male Breast Reduction, Breast Augmentation Revision Surgery and Tummy Tucks are answered and illustrated with numerous before and after pictures.

Past Body Beautiful Episodes Available Here

Previously aired KRON 4 Body Beautiful episodes are available here on the San Francisco Plastic Surgery Blog. As of this post, 120 Plastic Surgery Videos are available. Click on Videos under Categories in the left column. Most of the latest and more popular Cosmetic Plastic Surgery procedures are reviewed. Most shows were broadcast live, and many answer questions called in by viewers. In the coming weeks, tomorrow’s show will also be added. Videos may also be viewed on Dr. Mele’s YouTube Channel.

More Information Available On Line and In Person

More Plastic Surgery Information is available here and on the other websites listed under Useful Links in the margin. While every attempt is made to provide accurate information, there is no substitute for a private, in-person consultation. Call (925) 943-6353 to schedule your personalized consultation appointment.

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Un-Botched – When Bad Implants Go Good

Posted August 16, 2014 in Breast Augmentation, Breast Implant Revision Surgery, Capsular Contracture, Home

The popularity of Botched was confirmed this week when the E! Network announced the Plastic Surgery reality show has been renewed for a second season.

Botched will be Unbotching again next year.

Botched will be Unbotching again next year.

If you haven’t watched Botched, the show features two Plastic Surgeons on a quest to revise bad plastic surgery results with a liberal sprinkling of interesting personalities.

Life is What Happens to You While You’re Busy Making Other Plans

Perhaps you’ve heard the quote above. It is often attributed to John Lennon, but it seems Allen Saunders said it first. Life also happens to Plastic Surgery, sometimes literally, in the form of pregnancy. The Mommy Makeover is named after the procedures, Breast Augmentation and Tummy Tuck, combined to repair the breast and belly damage that pregnancy can cause.

The Mommy Makeover - When you're unhappy with what life does to your body, there is something that can be done.

The Mommy Makeover – When you’re unhappy with what life does to your body, there is something that can be done.

Breast Augmentation Revision After Pregnancy

Many patients who become pregnant after Breast Augmentation have no problems, especially if they were small before getting Breast Implants. For others, life happens to their beautiful results. The Breast Augmentation Revision Before and After Photos below show what can happen, and how it can be unbotched.

Breast Augmentation Revision can lift the breasts back onto their Breast Implant after postpartum sagging causes them to fall down.

Breast Augmentation Revision can lift the breasts back onto their Breast Implant after postpartum sagging causes them to fall down.

The photo on the left shows the result that pregnancy can have on otherwise perfectly fine Breast Augmentation. The breast tissue, in front of the implant, responds naturally by enlarging for lactation. Once breast feeding stops, the breast tissue atrophies, leaving loose saggy skin. This would happen with or without a Breast Implant, but in this case with Breast Implants, the breasts have fallen off their implants. After a Breast Lift and Breast Implant Replacement, a much perkier result is obtained.

Capsular Contracture Can Happen Too

Most Breast Implants remain soft and mobile; however, when the pocket around the implant shrinks, the result can be a firm breast, that often rides up. The good news is the tightness can be released.

Capsular Contracture release can improve the feel and location of the Breast Implant.

Capsular Contracture release can improve the feel and location of the Breast Implant.

The Capsular Contracture Release Before and After Pictures above show how elevated breast implant malposition can be corrected by removing or expanding the tight Breast Implant Capsule.

Sometimes Enough is Too Much

Sometimes Breast Implant Malposition is the result of too big an implant and too little support. The woman below had Breast Augmentation with a Breast Lift. Unfortunately, her Breast Implant was too heavy for her skin. The result was bottomed out breasts and an angry scar.

Heavy Breast Implants can stretch out the breasts and cause bottoming out. Downsizing and a Breast Lift with Scar Revision can often help.

Heavy Breast Implants can stretch out the breasts and cause bottoming out. Downsizing and a Breast Lift with Scar Revision can often help.

In the Breast Augmentation Revision Before and After Photos above, the angry scar was revised, the breast was lifted again and a smaller Breast Implant was selected. The result is a superior shape, contour and feel. While there can be no guarantees in life, the chances of bottoming-out again are reduced by the reduced weight of the new implants.

Botched Breast Implants Can Be Unbotched

If you are unhappy with your Breast Augmentation, you don’t have to go to Beverly Hills and visit the Botched doctors for help. The San Francisco Bay Area is not only the site of the first Plastic Surgery training program west of the Mississippi, it remains home to two of the most competitive plastic surgery programs in the United States. You have many Board Certified Plastic Surgeons to choose from.

About The Author

With 20 years of experience with Breast Augmentation and Breast Augmentation Revision, Dr. Joseph Mele is a Board Certified Plastic Surgeon with the ability to get results. If you would like to schedule a personal consultation, give his Walnut Creek Plastic Surgery office a call at (925) 943-6353.

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Male Breast Reduction San Francisco Bay Area Gynecomastia

Posted February 08, 2014 in Breast Reduction, Breast Reduction (Men), Home, Videos

Gynecomastia can be a source of embarrassment for men both in and out of clothing. Over developed breasts can be obvious through a shirt, so men with Gynecomastia avoid tight shirts and often wear multiple layers to obscure the appearance of their enlarged breasts.

Causes of Gynecomastia

The are many reasons for Gynecomastia. The most common reason is natural hormonal changes. This can be seen in newborns, adolescents and men. Newborn Gynecomastia usually resolves within two to three weeks after birth, as the influence of the mother’s estrogen wanes. Adolescent Gynecomastia is very common, but also can resolve in one to two years, as surges in hormones seen with puberty level off. Adult Gynecomastia can either be unresolved adolescent gynecomastia, or may develop later in life. According to the Mayo Clinic, Gynecomastia peaks between the ages of 50 to 80, and at least 1 in 4 men are affected.

Gynecomastia Video – Male Breast Reduction

The Gynecomastia Video below was made for KRON4’s Body Beautiful television show. This segment focuses on the latest treatments available for Male Breast Enlargement. Options like Liposuction and Surgical Excision are discussed and illustrated with multiple Gynecomastia Before and After Pictures.

The (415) number displayed during the video was only for the live broadcast. If you have questions about Male Breast Reduction, or would like to come to my office for a private consultation about Gynecomastia Reduction, call (925) 943-6353, or use the contact form in the column on the left. Other postings on Gynecomastia are available by clicking Breast Reduction (Men) under “Categories” to the left.

Male Breast Reduction Video from KRON4

Medications and Gynecomastia

Many common medications are linked to the development of Gynecomastia including:

  • Anti-androgens like flutamide, finasteride (Proscar, Propecia) and spironolactone (Aldactone)
  • Anabolic steroids and androgens
  • AIDS antiretroviral therapy (HAART) especially Efavirenz (Sustiva)
  • Anti-anxiety medications like diazepam (Valium)
  • Tricyclic antidepressants
  • Some Antibiotics
  • Ulcer medications like cimetidine (Tagamet)
  • Chemotherapy, especially for Prostate Cancer
  • Heart medications like digoxin (Lanoxin) and calcium channel blockers
  • Alcohol
  • Amphetamines
  • Marijuana
  • Heroin
  • Methadone

Other Health Conditions

Other Medical Conditions can also contribute to the development of Gynecomastia including:

  • Hypogonadism (Klinefelter syndrome or pituitary insufficiency)
  • Obesity
  • Tumors of the testes, adrenal glands or pituitary gland
  • Hyperthyroidism
  • Kidney failure
  • Liver failure and cirrhosis
  • Malnutrition
  • Aging

More Gynecomastia Treatment Information

More Gynecomastia Information is available on the San Francisco Plastic Surgery Blog and my other web sites; however, if you want specific information, a private consultation is the best way to get it. Call (925) 943-6353, or use the contact form in the column on the left.

Other postings on Gynecomastia are available by clicking Breast Reduction (Men) under “Categories” to the left, and by visiting DrMele.com’s Gynecomastia Page or SanFrancisco Breast’s Gynecomastia Page.

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Breast Implant Capsules – Capsulotomy, Capsulectomy and Capsulorrhaphy

Posted November 06, 2011 in Breast Asymmetry, Breast Augmentation, Breast Implant Revision Surgery, Home

Vostok 3KA-2 space capsule - 1961

On April 12, 1961, Soviet cosmonaut, Yuri Gagarin, used a space capsule like this to become the first human in orbit. That same year, the first breast implant was developed by American plastic surgeons Thomas Cronin and Frank Gerow.

Breast implant capsules have a bad reputation. Normally, they are only discussed when they are causing problems like capsular contracture or breast implant malposition. However, like a space capsule, the breast implant capsule provides protection, and without breast implant capsules, there would be no breast augmentation.

What is a breast implant capsule?

Whenever a breast implant is used for breast augmentation, your body makes an encapsulating sheet of scar that lines the breast implant’s pocket. This normally thin, soft scar is called the “capsule”, and it is incredibly important in maintaining your breasts’ enhancement.

Have you ever wondered how breast implants stay in place?

The capsule is responsible for keeping the breast implants in the proper position beneath the breasts. It forms in just a few weeks after breast augmentation surgery and keeps the breast implants from freely sliding around. Optimal breast implant position is a combination of careful placement during surgery and a proper capsule. The capsule will quickly line the surgical pocket and provide a smooth, strong interface between the breast implant and the soft tissues of the chest. By reinforcing the pocket, the capsule helps to maintain optimal breast implant placement.

The capsule protects the breast implant.

Not only does the capsule help keep the breast implant in position, it also protects the implant. The interior of the capsule is smooth and allows for nearly frictionless movement within its boundaries. The outer layers of the capsule provide enhanced vascular circulation and helps protect the breast implant from infection.

When good capsules go bad.

So what can go wrong with breast implant capsules? The perfect capsule is firm enough to maintain proper breast implant positioning, but soft enough to not be felt. Problems occur at the extremes, so like Goldilocks the capsule needs to be just right, not too hard and not too soft.

Too soft

When the Breast Implant Capsule is too soft, it does not provide enough support for the implant. Gravity pulls the implants down when standing or to the side when laying down. The larger the breast implants, the greater the force. Stomach sleeping also pushes the implants apart. A healthy capsule can resist the tendency toward Breast Implant Malposition, but a good bra helps too.

Treatment for implant malposition can include a capsulorrhaphy, to tighten the capsule, and close off the areas where the implant should not be going. If an overly large breast implant in compounding the problem, a smaller implant can help reduce recurrence. The use of an acellular dermal matrix (ADM) has also become more popular as a way to line, reinforce and thicken the capsule.

Too hard

When the Breast Implant Capsule is too hard, it can compress the implants, and cause Capsular Contracture. Capsular contracture can also result in breast implant malposition. If the capsule is tight only on one side, it will push the breast implant toward the soft side. If the capsule is tight all the way around, it can make the implant feel hard.

Treatment for capsular contracture includes capsulectomy, removing the thickened capsule, and capsulotomy, incising the capsule to allow it to expand. Both these techniques are performed in the operating room. An older, non-operative technique called closed capsulotomy was a way to split the capsule without surgery by forcefully compressing the implant. This has been largely abandoned as it has less predictable results, may lead to uncontrolled bleeding or implant rupture, and violates most breast implant warranties.

Just Right

The most common types of capsules are grade I followed by grade II. Grade I capsules are soft on not detectable from the outside, Grade II capsules feel firmer, but are not tight enough to cause visual changes. Both usually provide adequate support to allow the breast to age naturally, securely on the chest. If you are considering breast augmentation, or you have breast implants and are considering breast implant revision surgery, give me a call at (925) 943-6353 or contact my Walnut Creek Plastic Surgery Office using the contact form in the left column.

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Breast Augmentation and Breast Implant Revision San Francisco Bay Area: 3 of 4

Posted October 22, 2011 in Breast Asymmetry, Breast Augmentation, Breast Implant Revision Surgery, Capsular Contracture, Home, Videos

Breast Augmentation remains one of the procedures that I perform most frequently. Whether you’ve always had small breast and want them larger, or you had larger breast and want them back, Breast Augmentation can help you achieve your goals.

Breast Implant Revision Surgery is performed to improve the results of Breast Augmentation. While Breast Augmentation is both safe and effective, our bodies change as we age. Breasts naturally change size and shape over time, and this happens even after breast augmentation. Changes can certainly be exacerbate by pregnancy and changes in weight, but most of the time the changes are gradual and sneak-up on us.

What’s New in Breast Implants and Breast Augmentation?

If you are considering Breast Augmentation or Breast Implant Revision surgery, you should know that new breast implants are available and more are on the horizon. New techniques are also being developed to help make your Breast Enhancement simpler, safer, more predictable and easier overall. Be certain to seek a Board Certified Plastic Surgeon for all your Cosmetic Breast Surgery needs.

To check your plastic surgeon’s credentials click here -> Is Your Plastic Surgeon Board Certified?

San Francisco Bay Area Breast Augmentation

Below is part three of four of my Breast Implant Revision Video that appeared on KRON4’s Body Beautiful. Options in Breast Augmentation, Breast Implants and Breast Augmentation Maintenance are reviewed. The television show was broadcast live, so viewers could call in during the broadcast to have their questions answered. The (415) number shown in the video was only for the show; however, 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. If you prefer, you may also use the contact form on the left.

San Francisco Bay Area Breast Implant & Breast Augmentation Revision Video

San Francisco Bay Area Breast Implant Revision Questions

This Breast Augmentation, Breast Implant Revision Surgery video includes:

  • The Breast Implants currently available
    • Saline Breast Implants – Natrelle (Allergan) and Mentor (J&J)
    • Silicone Gel Breast Implants (Natrelle and Memory-Gel)
    • Soft-Solid Silicone Breast Implants (GummiBear Implants)
      • Natrelle 410’s*
      • Mentor Contour Profile Gel (CPG)*
      • *The 3 yr and 5 yr data for the 410’s and CPG breast implants surpasses that of the breast implants that are already approved in this country. Why are they not approved? Only your FDA knows for sure.
  • Breast implant deflation
  • What are the signs and symptoms associated with a leaking breast implant?
  • How to check for a breast implant leak
  • How long do Breast implants last?
  • How are breast augmentation and breast lifts combined?

Breast Augmentation and Breast Implants Revision Resources

You are viewing number three of four Breast Implants Revision Video segments from Dr. Mele’s recent Body Beautiful television appearance. Here are links to the other segments:

Additional Web Links about Breast Augmentation and Breast Implant Revision Surgery are also available here:

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Tubular Breasts and Plastic Surgery – Walnut Creek, San Francisco East Bay Area

Posted February 16, 2011 in Areolar Reduction, Breast Asymmetry, Breast Augmentation, Breast Lift (Mastopexy), Home, Tubular Breasts

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.

Tubular Breast Augmentation

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.

Tubular Breast Augmentation Lift

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.

Information on Tubular Breasts

More information on tubular breasts is available on the breast abnormalities page of my specialty breast site under Congenital Abnormalities – Tuberous or Tubular Breasts, and the Snoopy Nose Deformity. Tubular Breast Augmentation Before and After Pictures are also available in my main web site. The best information, however, is only available in person. If you would like to schedule a consultation appointment in my Walnut Creek Cosmetic Surgery office, please give me a call at (925) 943-6353, or use the contact form in the column to the left.

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Bay Area Breast Implants – Bay Area Breast Augmentation – Part 2

Posted January 04, 2011 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Capsular Contracture, Home, Videos

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

This segment of video from KRON4’s Body Beautiful, includes more information about cosmetic breast surgery. Breast augmentation, breast implant revision (capsular contracture) and breast reduction surgery before and after pictures are included, to help illustrate what can be accomplished.

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
  • My new breast web site – SanFranciscoBreast.com
  • Reduction Mammoplasty (Female Breast Reduction) before and after pictures
  • Cosmetic breast augmentation (Breast implants) before and after pictures
  • Cosmetic breast augmentation revision for capsular contracture (Breast implant revison surgery) before and after pictures
  • The common reasons for breast implant revision surgery
  • The common reasons for breast implant failure
  • Should breast implants be replaced every ten years? (Also covered here: Routine breast implant replacement)

Finding the Right Breast Augmentation Surgeon

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

This is part 2 of 4 in a video series on aesthetic breast surgery in the San Francisco Bay Area. Additional segments can be found here:
Bay Area Breast Implants – Bay Area Breast Augmentation – Part 1 of 4
Bay Area Breast Implants – Bay Area Breast Augmentation – Part 2 of 4 (You are here)
Bay Area Breast Implants – Bay Area Breast Augmentation – Part 3 of 4
Bay Area Breast Implants – Bay Area Breast Augmentation – Part 4 of 4

Additional information on cosmetic breast enhancement procedures is available on my main Walnut Creek Plastic Surgery website and on my specialty breast site: San Francisco Breast.

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