Breast Augmentation Lifts – Breast Lifts with Implants – SF Bay Area

Posted June 17, 2017 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Home, Post-Bariatric Surgery (After Weight Loss), Videos

Breast Augmentation adds volume, while Breast Lifts reshape. What happens when you put them together? You get Cosmetic Plastic Surgery that can enhance both breast volume and shape.

Breast Augmentation adds volume, while Breast Lifts reshape. What happens when you put them together? You get Cosmetic Plastic Surgery that can enhance both breast volume and shape.

Total Breast Enhancement – Breast Aug and Breast Lift

Sometimes a Breast Implant or a Breast Lift alone is not enough to get the results we want. The combination of Breast Augmentation with a Breast Lift, or Augmentation Mastopexy, is used when breast sagging is combined with a loss of breast volume. Board Certified, San Francisco Bay Area Plastic Surgeon, Dr. Joseph Mele, discusses the nuances of Breast Augmentation Combined With Breast Lift on this episode of Body Beautiful, a live television show dedicated to the latest in Cosmetic Plastic Surgery news for the greater San Francisco Bay Area.

Breast Lift With Breast Implants Video

Combining Breast Lifts With Breast Implants

After pregnancy or significant weight loss, Breast Augmentation is combined with Breast Lifts as much as 40% of the time.

Breast Implants Make Breasts Larger

Everyone knows that Breast Implants make breasts bigger. It’s a simple concept. Adding volume behind the breast tissue, often behind the pectoralis muscle, enlarges the breasts you have. While the size of the breast changes, the shape does not. It simply inflates the skin you have.

Breast Lifts Make Breasts Perkier

Breast Lifts (Mastopexies), on the other had, are all about breast shape. Lifts do not make breasts bigger or smaller. Breast Lifts reshape the skin envelope. Mastopexies reposition the nipples/areolae into a more attractive position and reduce the amount of breast tissue that sags below the IMF (inframammary fold).

Breast Augmentation Lift Consultations

The subtleties of the procedures, whether considered separate or together, are beyond the scope of one San Francisco Plastic Surgery Blog post, though you will find other posts on the topic here and on my other web sites. But rather than learning everything there is to know about both, why not learn about the aspects of the procedure that apply to your body?

Breast Augmentation Lift Consultations are the best way, and really the only way, to get the information specific to your needs. They focus on your breasts and your goals. You won’t waste time learning about options that won’t do what you want, and you will learn what to expect from the procedures that are most likely to help you.

If you would like to schedule a personalized and private Breast Enhancement Consultation, call my office today at (925) 943-6353. Get specific information that is tailored to address your needs, not generic information meant for the masses.

Read More

Mommy Makeover Video SF Bay Area

Posted June 11, 2017 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Breast Reduction (Women), Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Tummy Tuck (Abdominoplasty), Videos

The Mommy Makeover combines the most common body shaping procedures into a single operation for maximum breast and belly shaping.

The Mommy Makeover combines the most common body shaping procedures, breast augmentation and tummy tuck, into one, maximum result, breast and belly shaper.

The Mommy Makeover is one of my favorite combos. The ability to reshape the damage done to a woman’s body after childbirth or weight loss, in a single operation, makes it one of the most satisfying Cosmetic Plastic Surgery procedures.

What Is A Mommy Makeover?

The Mommy Makeover is not a specific procedure, but rather the combination of breast and belly enhancement performed in a single operation. Breast Enhancement may include Breast Augmentation, Breast Lift, Breast Augmentation with a Lift or Breast Reduction. It all depends on what needs fixing. Belly Enhancement is usually a Tummy Tuck; however, for the patient who needs less, Mini Tummy Tucks or Liposuction may be the procedure of choice.

Mommy Makeover Video Presentation

Recently, I had the opportunity to discuss Mommy Makeovers with the San Francisco Bay Area television audience. Body Beautiful airs on KRON 4, the San Francisco Bay Area’s News Station. The Mommy Makeover features the best and the latest in Cosmetic Plastic Surgery. This week, the spotlight is on Mommy Makeovers.

Mommy Makeover Video

More About Mommy Makeovers

The Mommy Makeover Video segment featured above reviews many of the available options and outcomes of the procedure for several of my patients. Additional Mommy Makeover Videos are available here, on the San Francisco Plastic Surgery Blog, and on my main site’s Mommy Makeover Video Page.

Mommy Makeover Consultations

When you are considering a Mommy Makeover, be certain to consult with a Board Certified Plastic Surgeon. Call (925) 943-6353 today, to schedule a private, personalized Mommy Makeover consultation in our San Francisco Bay Area Plastic Surgery Clinic.

Read More

Breasts, Belly and Bootie Lifts – SF Bay Area Plastic Surgery

Posted June 04, 2017 in Areolar Reduction, Brazilian Butt Lift, Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Women), Butt Lifts, Fat Grafting, Home, Inverted Nipples, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Thigh Lifts (Thighplasty), Tummy Tuck (Abdominoplasty)

The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.

The Mommy Makeover is the most popular, and one of the most satisfying, combination cosmetic plastic surgery procedures. With the ability to reshape the breast and flatten the belly, the Mommy Makeover is the procedure of choice to rejuvenate the female form after pregnancy or weight loss.

This Wednesday, June 7, 2017, I will be on the San Francisco Bay Area’s News Station, KRON 4’s Body Beautiful. The show airs live at noon. As usual, the discussion is focussed on the latest Cosmetic Plastic Surgery News for the San Francisco Bay Area.

Body Beautiful Plastic Surgery Topics

This week’s half-hour television show discusses Cosmetic Plastic Surgery of the Body. Planned topics include:

Mommy Makeovers SF Bay Area

The Mommy Makeover Before and After Pictures that leads this post demonstrate the most popular combination cosmetic plastic surgery. By combining Breast Augmentation and Tummy Tucks, the two areas the often sag after pregnancy, the breasts and the belly, are both addressed. Of course, the procedures can be performed without having had children. The term Mommy Makeover was coined because of the frequent request from mommies to repair the damages of pregnancy on their breast and bellies. Another common situation in which Mommy Makeovers are performed is significant weight loss.

EDIT – The first Plastic Surgery Video segment on Mommy Makeovers is up and live right here: Mommy Makeover Video.

Breast Augmentation Mastopexy (Breast Implants with Breast Lifts)

Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.

Breast Augmentation remains the most popular single plastic surgery procedure. Breast implants can provide volume, and as many as 40% of patients also benefit from a breast lift. Breast lifts can improve breast shape in ways the Breast Augmentation alone cannot.

Breast Augmentation is still one of the most frequently performed cosmetic plastic surgery procedures, but what happens if the breasts are saggy, or the nipple is very low on the breasts? Breast Augmentation in these situations may provide larger breasts, but not necessarily perky ones. As many as 40% of Breast Augmentations combine some sort of Breast Lift. The most common reasons for this are low set nipples or saggy breasts due to excess skin.

Additional procedures can also be added to correct other breast problems, Fine details of the breasts that are often targeted for improvement are: Areola Reduction, the improvement of Breast Asymmetry, Breast Implant Revision for women who had Breast Implants before pregnancy and Inverted Nipple Repair. Breast Reduction, perhaps paradoxically, can also be combined with Breast Augmentation Mastopexy when heavy lower breast tissue is distorting the shape of the breasts.

Brazilian Buttocks Lift

The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.

The fastest growing procedure is the Brazilian Butt Lift. The procedure takes fat from areas where it is not desired and repurposes it, to enhance the shape of the buttocks.

A newer body procedure is allowing Board Certified Plastic Surgeons to shape an area that traditionally has been difficult. The Brazilian Buttock Lift (BBL), allows us to remove fat with Liposuction and reuse it to enhance the buttock contours. Pioneered by Brazilian Plastic Surgeon, Ivo Pitanguy, the procedure allows for customized augmentation of the buttocks, and shape that is more pleasing to the eye than Buttocks Implants can provide.

Thigh Lifts in the SF Bay Area

The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.

The Thigh Lift is used most often after weight loss. Excess skin and fat from the inner thigh is removed to reduce the size of the thighs and tighten the skin.

Thigh Lifts are one of the less frequently performed cosmetic plastic surgery procedures. The numbers have risen in response to Bariatric Surgery and the massive weight loss associated with it. As weight is lost, the thigh skin that is stretched during weight gain becomes loose. As the volume of the thigh decreases, so does the support that the extra fat provides the thigh skin. As a result, the skin can hang like drapery. The Thigh Lift removes this excess skin, and helps to tighten the thigh, especially the upper, inner thigh.

Watch Body Beautiful June 7, 2017, on KRON at Noon Wednesday

If you are interested in learning more about any of the above procedures, I have provided links in this post, and I encourage you to watch me live on KRON 4, this Wednesday at noon. Segments from the show will be posted here, on the San Francisco Plastic Surgery Blog, in the coming days. So if you miss the live show, you can still catch up here or on my local San Francisco Plastic Surgery Web Sites.

Internet education can be very helpful, and it is the goal of the San Francisco Plastic Surgery Blog; however, because information on the Internet is designed to apply to the general population, it is generic in nature. Medical advice cannot be giving without the personal contact that an in-person consultation appointment provides. To get “brand name” plastic surgery information, tailored to your specific needs, call my San Francisco Bay Area Plastic Surgery Clinic today, at (925) 943-6353, and schedule an appointment to get your personal, Board Certified Plastic Surgery information.

Read More

Mommy Makeovers San Francisco Bay Area

Posted May 21, 2017 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Women), Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Tummy Tuck (Abdominoplasty)

The most common Mommy Makeover combination is the one depicted above: Breast Augmentation and a Tummy Tuck. Breast Implants restore lost breast volume, while the Tummy Tuck flattens and tightens the abdominal wall.

The most common Mommy Makeover combination is the one depicted above: Breast Augmentation and a Tummy Tuck. Breast Implants restore the lost breast volume, while the Tummy Tuck flattens and tightens the abdominal wall.

Mommy Makeovers remain one of the most popular body shaping combinations for women. The combination of Breast Enhancement and Belly Embellishment is often performed after childbirth and/or weight loss, with the goal of reestablishing more shapely and youthful proportions. While Breast Augmentation with a Tummy Tuck is the most common combination, it is important to pick the procedures most appropriate to your needs. Below, I discuss the options for rejuvenation of the breasts and the belly.

Breast Enhancement

Breasts often change with pregnancy and breast feeding. Variations are common, but typically breasts increase with pregnancy and then end up smaller after lactation ceases. The problems come when the postpartum breasts are too small, too saggy or remain too large (less common but, can be just as annoying).

Breast atrophy after pregnancy is very common. Breast Implants can restore lost volume and restore the proportions that enhance the breasts' shape both in and out of clothing.

Breast atrophy after pregnancy is very common. Breast Implants can restore lost volume and restore the proportions that enhance the breasts’ shape both in and out of clothing.

It is best to wait at least three months after lactation ceases before having any breast procedure. This allows the breasts to settle down to a consistent shape, providing more predictable and safer surgery. Depending on your experience and goals, options for Breast Enhancement include:

Belly Embellishment

Bellies, too, get stretched out during pregnancy. Subsequent pregnancies tend to increase injury, especially if close together. Working out and abdominal exercises help, especially if you are in good shape before pregnancy and maintain a healthy weight during pregnancy. Even under the best circumstances, a big healthy baby can trump a flat healthy belly. The options for tummy rejuvenation include:

After pregnancy, or weight loss, the abdominal muscles, skin and fat can all be compromised. Fortunately, the Tummy Tuck can repair all three areas. Be certain to find a Board Certified Plastic Surgeon with experience for your belly rejuvenation.

After pregnancy or weight loss, the abdominal muscles, skin and fat can all be compromised. Fortunately, a Tummy Tuck repairs all three areas. An experienced Board Certified Plastic Surgeon is the best choice for your Mommy Makeover.

Liposuction can also be used in combination with either of the Tummy Tucks, and the fat removed with Liposuction can be repurposed to enhance other curves, like the buttocks when combined with a Brazilian Butt Lift. If you are wondering which procedure is best for you, an in-person consultation is the best way to find out. I have a page on my main website that explains some of the decision points when trying to decide: Liposuction or Tummy Tuck?

Mommy Makeover Consultations

To explore all your body rebuilding options, call (925) 943-6353, and schedule a personal consultation appointment in our San Francisco Bay Area plastic surgery clinic. A Board Certified Plastic Surgeon is your best guide for explaining what Cosmetic Plastic Surgery can offer. Since we offer a wide variety of procedures, we can offer you the best choices for your Mommy Makeover.

Read More

BIA-ALCL is Breast Implant Associated Anaplastic Large Cell Lymphoma

Posted April 09, 2017 in Home, Patient Safety

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Since the last BIA-ALCL update, all the plastic surgery societies and breast implant manufacturers have responded with information sheets. I am encouraged by the free flow of information within the Plastic Surgery profession and the industry that supports us.

ASAPS by the Numbers

The ASAPS has distributed a quick summary of the numbers related to BIA-ALCL. Here are a few.

How Many BIA-ALCL Cases Have Been reported?

Of the estimated 7 million women with breast implant throughout the world, 359 reports have been filed. Since the reports can be filed by patients, physicians or manufacturers, it’s important to note the MDRs (Medical Device Reports) are not individual cases, and multiple reports may be filed for a single case of BIA-ALCL. In contrast, there are currently 139 case reports of BIA-ALCL in the literature. It is also important to realize that this is a very small number in relation to the millions of breast implant patients. Lastly, the number is expected to rise because we are learning how better to identify and diagnose patients with the disease.

Smooth vs. Textured

Of the reported cases, over 90% occurred in patients who had textured implants at the time of their diagnosis. In the US database, there is a single case of a patient with smooth breast implants developing BI-ALCL; however, they had a textured tissue expander prior to the smooth breast implant placement. Unfortunately, the other 27 cases of BIA-ALCL reported in the world databases do not include past breast implant information, so while we can say that BI-ALCL is predominantly a problem with textured breast implants, it is unknown if a case has developed in a person who had exclusively smooth breast implants. Currently, 12.7% of US patients receive textured implants. This includes both textured round and all anatomically “shaped” breast implants, and includes both saline filled and silicone filled breast implants.

How Many BIA-ALCL Deaths Have Been Reported?

Of the 359 cases reported, 9 patients have died. Two patients died from stem cell transplants, one died from development of a second unrelated lymphoma, and 6 patients died from direct extension of the tumor. Early detection is key. Of the deaths, none of them received complete surgical excision at any point in their clinical history, none received targeted therapy, and most were significantly delayed in diagnosis or receiving any treatment (1-2 years from onset of symptoms). On the other hand, 93% of all patients are disease free at 3 years follow up. BIA-ALCL has an excellent prognosis when diagnosed early.

How Do We Diagnose BIA-ALCL?

Early diagnosis is key to successful treatment, so how do we accomplish this? Unilateral (one-sided) swelling or mass should lead to a thorough evaluation. This is common in the months following your breast augmentation. The possibility of BIA-ALCL should be considered in a patient with late onset, peri-implant seroma (fluid collection). The majority of patients present on average 8 years after implantation, but range extends from 2 to 28 years.

Ultrasound imaging followed by fine needle aspiration of seroma fluid should be obtained. Collected fresh seroma fluid should be sent to a qualified lab for immunohistochemistry testing for cluster of differentiation (CD30) testing.  Anaplastic Lymphocyte Kinase (ALK) testing of the seroma fluid can help differentiate BIA-ALCL from systemic forms of lymphoma that may appear in the breast.  

Current BIA-ALCL Treatment

Most patients with BIA-ALCL are cured by removal of the implant and capsule surrounding the implant, however a small number act more aggressively and may require additional treatments. For 2017, the National Comprehensive Cancer Network defines optimal treatment which is total capsulectomy and implant removal for the majority of patients with disease confined to the capsule (35% of patients) or a resectable mass (40% of patients). Advanced disease with lymph node metastasis (14% of patients) or organ metastasis (1% of patients) may require further treatment with chemotherapy using either CHOP anthracycline based-protocol or targeted therapy with brentuximab vedotin. Radiation therapy is only reserved for locally unresectable disease.

BIA-ALCL Perspective

BI-ALCL is not breast cancer. Here are some additional numbers, and some links, to keep the worry about BIA-ALCL in perspective:

Read More

2017 BI-ALCL Update (Breast Implant Associated – Anaplastic Large Cell Lymphoma)

Posted February 26, 2017 in Breast Augmentation, Home, Patient Safety

The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP.

The 2016 diagnostic algorithm for BI-ALCL, shown in the flowsheet above, is still the recommended treatment. If you experience breast implant enlargement, breast inflammation, breast pain, a breast lump, a breast sore or feel like there is fluid around your breast implant, follow up with your plastic surgeon or primary medical doctor ASAP. (Click image for larger view.)


It’s been about six months since the last San Francisco Plastic Surgery Blog ALCL update. Recently, more information on the subject has become available, and it is about to be published. Two articles stand out. The first is from the United States, and the second is a global review of what is known to date. Both were recently e-published, ahead of print, in the American Society of Plastic Surgeons’ (ASPS) journal, “Plastic and Reconstructive Surgery.” Here are the latest facts…

What is BI-ALCL?

ALCL Histology

Breast Implant Associated – Anaplastic Large Cell Lymphoma (BI-ALCL) is a T-cell lymphoma that arises around breast implants. It is an extremely rare tumor, which makes it difficult to study; however. earlier data suggests that it is primarily associated with textured breast implants.

The Latest Plastic Surgery News

The first article by Doren et al, entitled: United States Epidemiology of Breast Implant-Associated Anaplastic Large Cell Lymphoma, reviews all cases of Breast Implant-Associated Anaplastic Large Cell Lymphoma (BI-ALCL) in the United States since the first documented case in 1996 up to and including cases reported in 2015. The study is retrospective, so it is not an ideal study for determining the incidence of the disease; however, it’s the best guess we have to date, and the conclusions seem fair. Although rare, all cases of BI-ALCL with adequate history have involved a textured breast implant. The incidence and prevalence of BI-ALCL was determined based on a literature and institutional database review of BI-ALCL cases and textured breast implant sales figures from implant manufacturers’ annualized data.

2017 United States BI-ALCL Data

One hundred pathologically confirmed BI-ALCL cases were identified in the United States. Mean age at diagnosis was 53.2±12.3 years. Mean interval from implant placement to diagnosis was 10.7±4.6 years. Forty-nine patients had breast implants placed for cosmetic reasons, 44 for mastectomy reconstruction, and seven for unknown reasons. Assuming BI-ALCL occurs only in textured breast implants, the incidence rate is 2.03 per 1,000,000 person-years (203 per 100 million), which is 67.6 times higher than that of breast ALCL (3 per 100 million; p<0.001). Lifetime prevalence was 33 per million persons with textured breast implants.

2017 Global BI-ALCL Data

The second article by Srinivasa et al, entitled: Global Adverse Event Reports of Breast Implant-Associated ALCL: An International Review of 40 Government Authority Databases, reviews all federal database submissions relating to BI-ALCL in 37 countries representing the majority of breast implant markets worldwide with available adverse event reporting. Database queries were performed for Australia, Brazil, Canada, China, Columbia, Japan, Mexico, National Competent Authorities of the European Member States, New Zealand, South Korea, and United States. Demographics, device characteristics, pathology, treatment modalities, and outcomes were assessed when available.

The United States MAUDE database included 459 entries in total for the search terms “Anaplastic” and “ALCL” as of September 2015. Excluding for duplicate entries, the MAUDE database had 258 unique cases of BI-ALCL of which 130 had pathologic markers performed. Implant surface was textured significantly more than smooth (50% vs. 4.2%, p=0.0001). Treatment, when reported (n=136), included explantation (n=125, 91.9%), chemotherapy (n=42, 30.8%), radiation (n=25, 18.4%), and/or stem cell transplant (n=9, 6.6%), and 5 deaths were reported. For the 40 countries queried, 340 unique cases were reported for lymphoma associated with breast implants.

They concluded that worldwide federal reporting of BI-ALCL has significant limitations in providing data regarding clinical history, treatment, and oncologic follow up. Country-specific total implant and textured implant sales data is needed in order to determine critical incidence and prevalence analysis. Detailed BI-ALCL patient registries such as American Society of Plastic Surgeon’s PROFILE and centralized tissue banking are necessary in acquiring accurate complete data for sound decision making. The good news for American’s here is that the American Society of Plastic Surgeons are leading the way in accurate and appropriate reporting.

What To Do If You Think You Have BI-ALCL

The most common presentation of BI-ALCL is a collection of fluid that occurs around your breast implants years after surgery. BI-ALCL is not the most common cause of these late seromas, but sending a sample may be the fastest way to make the determination. Other presentations include a mass attached to the capsule, tumor erosion through the skin, regional lymph node involvement, or sometimes it is discovered during revision surgery. Risk estimates ranged from one in 500,000 to one in 3 million women with implants.

The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.

The typical presentation of ALCL is a large seroma (fluid collection) around the breast implant causing obvious enlargement and asymmetry of the breast augmentation.

If you suspect there is a problem with your Breast Implants, whether related to BI-ALCL or not, contact an experienced Board Certified Plastic Surgeon in your area. If your original Plastic Surgeon is still in practice near-by, this would be the best place to start. They have your clinical information, and a head start in the investigation. If you have moved, or your plastic surgeon has retired, try to get a copy of your medical records. This will help your new Plastic Surgeon get to the facts much faster.

Read More

Breast Augmentation and Pregnancy

Posted February 12, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Home, Mommy Makeover

Breast Augmentation and pregnancy, the combination is the source of many questions in my San Francisco Bay Area Plastic Surgery Clinic. The answers center around a few themes: timing, breast feeding and how breasts change.

Pregnancy brings many changes including changes to the breasts. If you are considering Breast Enlargement, or if you already have Breast Implants, and you are contemplating pregnancy, this post is for you.

Pregnancy brings many changes including changes to the breasts. If you are considering Breast Enlargement, or if you already have Breast Implants, and you are contemplating pregnancy, this post is for you.

Breast Augmentation and Pregnancy: Timing

If you are done having children, the timing is ideal. The dramatic changes that can occur with pregnancy and breast feeding are over, and the focus is on getting back the breasts you had, or the breasts you always wanted to have. Details like size and shape tend to change slowly with age, but may swing widely with pregnancy. Having this behind you is a big plus in the direction of predictability. Additionally, details like inverted nipples, enlarged nipples or enlarged areolae can also be addressed. The Mommy Makeover can also be discussed if your belly has been stretched and has not recovered to your satisfactionx.

If you are planning to have children whether to have Breast Augmentation now depends on how soon you plan to get pregnant. If you are actively trying to get pregnant, you should wait. Your breasts may change with pregnancy. The changes may be small or dramatic, there is no way to predict. Even from child to child, there may be variation. If you get Breast Implants, and then things change dramatically, Revision Breast Augmentation may be needed to restore the breasts’ volume or shape.

If you are planning to have children later, it may make sense to have Breast Augmentation now. If you consider the immediate gratification of the Breast Enlargement, and you feel you will have enough time to enjoy the results, before possibly needing a touch-up, then go for it. The decision is not purely black and white. Breast Augmentation Revision is not always needed after pregnancy, and Breast Implant Revision Surgery may be necessary, even without becoming pregnant.

Before: This young woman had Breast Augmentation before pregnancy. After two children, the skin of her breasts relaxed, dropping the breast tissue off her Breast Implants.  After: Her Breast Implants were exchanged to adjust volume and a Breast Lift was performed to reshape and rejuvenate her breasts.

Before: This young woman had Breast Augmentation before pregnancy. After two children, the skin of her breasts relaxed, dropping the breast tissue off her Breast Implants. After: Her Breast Implants were exchanged to adjust volume and a Breast Lift was performed to reshape and rejuvenate her breasts.

Breast Augmentation and Pregnancy: Breast Feeding

If you have Breast Implants, there is no reason not to breast feed normally. Breast Implants do not taint the milk, and in many cases, the advantage that breast milk gives your infant is significant. Breast Augmentation may decrease the absolute volume of milk produced. The exact mechanism is unknown, but the easiest way to think about it is that the breast may be tricked into thinking it is already full. The volume of the implant may inversely effect the breasts’ milk production. On the other hand, I have had many women who had Breast Augmentation in their twenties, who later went on to breast feed successfully.

If you are currently breast feeding, and wondering when you can have Breast Enhancement Surgery, it is recommended to wait until the milk has dried up for a minimum of three months. This allows the breasts to finish their post pregnancy changes, and decreases the risks of operating on a lactating breast. However, it is never too soon to have a consultation with a Board Certified Plastic Surgeon, and in the San Francisco Bay Area, there are many to choose from.

Sometimes Breast Augmentation alone is enough to rejuvenate the postpartum breasts, as demonstrated in the above Breast Augmentation before and after pictures.

Sometimes Breast Augmentation alone is enough to rejuvenate the postpartum breasts, as demonstrated in the above Breast Augmentation before and after pictures.

Breast Augmentation and Pregnancy: Breasts Change

We touched on this a little above, but breasts do change with pregnancy. Some change very little, some quite dramatically, and sometimes one changes more than the other. If your breasts change a little, then Breast Augmentation after pregnancy will be very similar to Breast Augmentation before surgery. On the other hand, if the breasts increase rapidly in size for lactation, and then shrink, often to a volume smaller than their original size, adjustments will be needed in your Breast Enhancement. These adjustments depend on the size and shape of your breasts.

Size is perhaps the easier of the two to understand. If breast lose volume, more stuffing is required to perk them back up to the desired size. In cases when the breasts enlarge, but do not shrink back down to the original size, it may be advantageous to have a Breast Reduction, especially when the sizes are uneven. When the breasts shrink too much, Breast Implants are used to restore volume and improve both the shape of the breasts and the fit of clothing.

The shape of the breasts is determined not just by their volume, but mostly by the breasts’ skin. When the volume of the breast shrinks, but the skin doesn’t, excess sagging occurs. Breast Augmentation alone may not be enough. A combination of Breast Augmentation and Breast Lift is needed in as many as 40% of women after pregnancy. The Breast Lift is used to reshape the breast and remove the skin excess, while Breast Implants can restore volume and increase the bust.

Breast Augmentation Consultations

If you are considering Breast Augmentation, give me a call at (925) 943-6353, and schedule a private, personalized consultation appointment. It is never too early to get the facts, and there is no better way to get a plan tailored to your needs than with an in-person consultation with an experienced, Board Certified Plastic Surgeon.

Read More

When Breast Augmentation Needs A Lift | SF Bay Area

Posted February 05, 2017 in Breast Augmentation, Breast Augmentation Lift, 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.

Read More

Mommy Makeover SF Bay Area

Posted December 26, 2016 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Breast Reduction, Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Tummy Tuck (Abdominoplasty), Videos

Every Mommy Makeover includes enhancement of both the belly and the breasts. The most common combination is Breast Augmentation with a Tummy Tuck (Abdominoplasty). However, other options include:

  • Breast Enhancement
    • Breast Lifts
    • Breast Implants with Breast Lift
    • Breast Reduction
  • Belly Enhancement
    • Liposuction
    • Mini Tummy Tucks
  • Other Body Enhancements
    • Brazilian Butt Lift
    • Lower Body Lift
    • Facial Enhancement

The combination best for you depends on what you need, tempered by safety and predictability.

Mommy Makeover Video Presentation

The television segment included below is all about Mommy Makeovers and includes many of the most popular variations. The Mommy Makeover Video includes Mommy Makeover Before and After Pictures that illustrate what the procedure has to offer.

The following video segment is from my latest appearance on the San Francisco Bay Area’s New Station, KRON 4. The show gives me the opportunity to talk about the latest Cosmetic Plastic Surgery News.

Mommy Makeover Video

Make Your Mommy Makeover Consultation Appointment

When considering a Mommy Makeover, be certain to find a Board Certified Plastic Surgeon in your area who has years of experience with the techniques currently available. If you are in the San Francisco Bay Area and would like to schedule a personalized appointment in my Walnut Creek Plastic Surgery clinic, give me a call today at (925) 943-6353.

Read More

Breast Augmentation Recovery – SF Bay Area

Posted November 07, 2016 in Breast Augmentation, Home

Breast Augmentation remains one of the most frequently requested Cosmetic Plastic Surgery procedures.

Breast Augmentation remains one of the most popular cosmetic plastic surgery procedures, but what is the recovery like after Breast Implants?

Breast Augmentation remains one of the most popular cosmetic plastic surgery procedures, but what is the recovery like after Breast Implants?

Breast Augmentation – The Procedure

Breast Augmentation is simple to understand. Breast Enlargement is performed by placing a Breast Implant behind the breast tissue to increase the breasts’ volume. Of course, there is more to it than that, and it is important to seek the advice of an experienced Board Certified Plastic Surgeon, before your Breast Enhancement Surgery.

Breast Implants are placed in the operating room, almost always under general anesthesia. This provides maximal safety and predictability of the operation, especially when Silicone Breast Implants are being placed behind the muscle, or when a Breast Lift is also being performed.

Breast Augmentation Recovery Time – The First 24 Hours

After the anesthetic is given, the next thing you will know, you will be in the Recovery Room. It feels instantaneous. Your breasts will be sore and many patients feel pressure, like an elephant is sitting on their chest. Pain is present, but should be manageable. Local anesthesia is frequently placed around the Breast Implants to help with the initial discomfort. Medications will be given intravenously to make you feel better. The primary goals are to allow you to wake-up and to reduce your discomfort.

At home, prescription pain medications are often used for the first few days. Acetaminophen (Tylenol) is also safe, because it does not increase the risk of bleeding like aspirin can. Acetaminophen should be taken instead of, not with, your prescription pain medication because most prescription pain medications already have acetaminophen in them, and too much, can cause liver damage.

RICE Therapy for the Breasts

Post-operative discomfort can also be helped with RICE. The acronym RICE stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

REST – Not overusing your chest muscles after surgery can speed your recovery. Your Plastic Surgeon should review what precautions to take after surgery. To read a copy of my Breast Implant Instruction Sheet, click the following: Post-Operative Breast Augmentation Instruction Sheet.

Ice is Nice: Ice provides natural pain relief with few side-effects.

Ice is Nice: Ice provides natural pain relief with few side-effects.

ICE – I cannot stress the importance of icing down after surgery. Like after any injury, ice can effectively decrease swelling and discomfort after surgery, often better than pain medication. Ice should not be applied directly to the skin, to avoid frostbite. A thin cloth should be placed between you and the ice, and the ice should be applied hourly for 15 minutes at a time.

COMPRESSION – The amount of compression will vary by Plastic Surgeon. Some surgeons recommend no support, while others bind the chest. Remember, your Plastic Surgeon will choose the method that works best for the surgery they perform. I prefer the combination of Bra and Band to keep the Breast Implants in their proper position, and to provide some post-operative support and comfort.

ELEVATION – Keeping the head elevated day and night the first few days after Breast Augmentation also helps reduce swelling and discomfort in the breasts. Sleeping on an extra pillow or two is all that is needed. If you are not used to sleeping on your back, a pillow behind the knees can help. It helps you maintain the correct position while you are sleeping and makes your back more comfortable.

Breast Implants have been an option for women with small breasts for over fifty years. During that time, the Breast Implants, the techniques and the recovery time have all improved.

Breast Implants have been an option for women with small breasts for over fifty years. During that time, the Breast Implants, the techniques and the recovery time have all improved.

Getting Back To Normal

After the first few days, your activities will begin to get back to normal. Most patients can drive by three or four days. However, if you are still sore or are taking pain medication, you should wait. By the end of the week, office work is usually doable. After two weeks, light physical activity is encouraged, and by six weeks, you should be able to return to all your usual activities.

It is also important to know that your results will vary. Good results and experiences are a product of teamwork. Choosing a Board Certified Plastic Surgeon who you are comfortable with is paramount. Doing the Breast Enhancement well is only part of my job, getting you through the recovery is equally as important to a good result.

Breast Augmentation Questions

If you have questions about Breast Augmentation, please call my San Francisco Bay Area Plastic Surgery Office today at (925) 943-6353, and schedule a private consultation appointment. While a lot of good Breast Augmentation information is available here, on the San Francisco Plastic Surgery Blog, and the links provided, an in-person consultation allows us to discuss the details specific to your Breast Enhancement.

Read More