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:

• Breast Augmentation

  • Breast Augmentation
  • Breast Implant Options
  • Breast Implant Placement
  • Breast Implant Care

• Breast Augmentation Lift

  • Breast Augmentation Lift
  • Breast Aug Lift Indications
  • Breast Aug Lift Types

• Breast Augmentation Revision

  • Breast Augmentation Revision
  • Changing Implant Size
  • Breast Implant Deflation
  • Capsular Contracture
  • Breast Implant Malposition
  • Breast Implant Rippling
  • Breast Implant Infections

• Breast Lift

  • Breast Lift
  • Breast Lift Types
  • Areola Reduction

• Breast Reduction

  • Breast Reduction (Female)
  • Breast Reduction Indications
  • Breast Reduction Types

• Gynecomastia Reduction – Breast Reduction for Men

  • Breast Reduction (Male)
  • Gynecomastia Types
  • Gynecomastia Surgery

• Specialty Breast Procedures – Correction of Other Breast Abnormalities

  • Specialty Breast Procedures
  • Inverted Nipple Correction
  • Nipple Reduction
  • Areola Reduction
  • Nipple Reconstruction
  • Areola Reconstruction
  • Congenital Abnormalities
  • Tubular Breasts
  • Breast Health

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:

• Breast Augmentation

  • Breast Augmentation
  • Breast Implant Options
  • Breast Implant Placement
  • Breast Implant Care

• Breast Augmentation Lift

  • Breast Augmentation Lift
  • Breast Aug Lift Indications
  • Breast Aug Lift Types

• Breast Augmentation Revision

  • Breast Augmentation Revision
  • Changing Implant Size
  • Breast Implant Deflation
  • Capsular Contracture
  • Breast Implant Malposition
  • Breast Implant Rippling
  • Breast Implant Infections

• Breast Lift

  • Breast Lift
  • Breast Lift Types
  • Areola Reduction

• Breast Reduction

  • Breast Reduction (Female)
  • Breast Reduction Indications
  • Breast Reduction Types

• Gynecomastia Reduction – Breast Reduction for Men

  • Breast Reduction (Male)
  • Gynecomastia Types
  • Gynecomastia Surgery

• Specialty Breast Procedures – Correction of Other Breast Abnormalities

  • Specialty Breast Procedures
  • Inverted Nipple Correction
  • Nipple Reduction
  • Areola Reduction
  • Nipple Reconstruction
  • Areola Reconstruction
  • Congenital Abnormalities
  • Tubular Breasts
  • Breast Health

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.

• Breast implant size – Perhaps the most common reason for breast implant revision surgery. The breast implant and pocket may both be fine, but there is a desire to change the size of the breast augmentation. By far, the most common change is to place larger breast implants, but reducing breast implant size and correcting asymmetry for size also are included in this category.
• Breast implant leak – Failure of the implant, and loss of the filling volume is another common reason for breast implant revision. Saline filled breast implants rapidly lose volume and it is clear that there is a problem. Silicone gel filled breast implants may require an MRI to determine if there is a leak. Regardless of the type of implant, if there is a leak, it needs to be replaced.
• Pocket problems – The pocket around the implant is normally lined with a thin soft scar. When the scar becomes too thick or too tight this is called capsular contracture. In its advanced stages, capsular contracture can lead to a firm, tight, immobile breast, which in severe cases becomes painful. On the other hand, if the scar is too soft and loose, the implants can move too much. This can lead to implants that are bottoming out (too low) or the implants may fall to the side when laying down (like natural large breast do).

Here is another example of breast augmentation revision surgery bay area. This patient presented to my Walnut Creek plastic surgery office. Overall, she was happy that she had breast implants, but she had several aspects that she wanted improved.

• Her bra would ride up onto the lower pole of her breast with exercise.
• Her implants had bottomed out.
• Her breast implants were asymmetric (more bottoming on the right).
• Her implants were a little small still.
• Her nipples were too prominent, noticed more after her primary breast augmentation.
• Her nipples were asymmetric.

The following procedures were discussed:

• Capsulorrhaphy – literally means capsule tightening. The lower pole of the capsule is closed to lift the implant higher on the chest. Capsulorrhaphy is also performed to move implants out of the armpits. Larger implants and weaker soft tissues increase the risk of implant malposition, and recurrence of the problem.
• Creation of an New Inframammary Fold (IMF) – This is a difficult procedure to get right, and it is worth finding a Board Certified Plastic Surgeon who has experience with this type of correction. The IMF is purposefully formed slightly higher than the desired result as there is almost always some stretching again after surgery. This procedure and capsulorrhaphy can both improve asymmetry. A defined IMF is important to keep the bra in the correct position and to allow the bra to support the breast properly.
• Breast Implant Exchange – Whenever breast augmentation revision is performed, it is worth considering whether to replace the implants. Implant volumes are most commonly increased during breast revision surgery. Sometimes the volumes are reduced and sometimes the volumes are adjusted to help compensate for asymmetry. The implants can also be exchanged between saline and silicone gel. As is often the case, a slightly larger implant was desired. Larger implants can increase the risk of bottoming out. Smaller implants will increase the reliability of the capsulorrhaphy and IMF repairs. Smaller implants are lighter, and less weight means a better chance for long term correction.
• Nipple Reduction – Generous nipples can be reduced in size. The scar lies in the crease at the base of the nipple and is very difficult to see.
• Periareaolar Breast Lift – The periareolar scar can be used to move the nipple/areaolar complex (nipple and the dark skin around it) in any direction. As with a breast lift, the scar goes around the areola. In this case, the right nipple is significantly higher than the left; however, since the patient was not really bothered by her nipple position, it was not fixed.

Breast Augmentation Revision with Nipple Reduction - Before (left) and After (right)

The previous implants were removed, a capsulorraphy was performed, additional work was done internally to form a new IMF, and new implants where placed via a periareolar scar (from 4 to 8 o’clock). The volume was increased from 300 to 350 cc’s using saline filled implants. In addition, the nipples were reduced with an incision that runs around its base. The nipple is still high on the right, and could be improved by further raising the breast implants. However, for the sake of the left breast, it is better to keep the implants in their current position. While this leaves the right nipple high, it avoids creating a low (sagging looking) nipple on the left.

Notice the improvement of the angle at the bottom of the breasts. It is no surprise that the bra was ridding up onto the breasts before surgery. After recreation of the IMF, it is higher, smooth and well defined.

In my San Francisco Bay Area (Walnut Creek) cosmetic plastic surgery practice, I measure the differences between the breasts both subjectively and objectively every day. Small differences frequently go unnoticed. Often, asymmetry is first noted in the consultation for breast augmentation. When the difference is obvious, however, breast asymmetry can be the driving force toward seeking consultation with a Board Certified Plastic Surgeon.

This post is focussed primarily on areola asymmetry (the darker skin around the nipple) and nipple asymmetry (the raised part in the middle). Look for a post on breast asymmetry (the breast mound itself), including breast implant asymmetry, in the very near future.

One of the most common nipple asymmetries is caused by inversion (retraction) of the nipples. Inverted nipples can occur on one or both sides. Inverted nipples and even bifid (split or duplicated) nipples can be treated with minor surgery.

Before correction the nipple and part of the areola are hidden.

Inverted nipples are caused by short mammary ducts that pull the nipple inside the breast tissue. In the most pronounced forms even the areola maybe hidden. The scar for inverted nipple correction is normally hidden in the fold beneath the nipple. Since correction involves releasing the tight ducts, correction may interfere with the ability to breast feed, and this should be discussed with your plastic surgeon prior to surgery.

After correction the relatively large nipple can now be seen.

The size and shape of the nipple can also be adjusted.

Close-up of breast showing appearance of nipple enlargement after pregnancy.

Overly large nipples can be reduced in length and girth. In general, it is easier to reduce a large nipple than to enlarge a small one. Nipple reconstruction is performed after a mastectomy when the nipple is absent. With nipple reconstruction, especially when the breast has received radiation, the most difficult aspect is creating and maintaining nipple projection.

Close-up of breast showing appearance of nipple after nipple reduction.

There are times when the nipples are normally formed, but their location on the breast is asymmetric or they are just too low. Modest changes in nipple location can be improved with a periareolar approach. Several centimeters of motion can be safely accomplished with this method. The same periareolar technique can also be used for areolar reduction or to correct the overly full areola, as seen with a tubular breast deformity.

Larger asymmetries may require surgery similar to a breast lift. Formal breast lifts allow the larger movement of the nipples, and reshaping of the entire breast mound. See the previous San Francisco Plastic Surgery Blog posting by clicking here Breast Mound Asymmetry San Francisco: Breast Mound, Breast Implants. There are many types of lifts, and each has its own pros and cons. The art of Plastic Surgery is choosing the best approach for each individual San Francisco breast asymmetry patient. This will be the topic of a future posting.