How to Choose Breast Implants

Posted June 03, 2018 in Breast Augmentation, Home, Mommy Makeover

One of the most common questions Plastic Surgeons get is,”How do I choose the best breast implants?” While more often than not, this is in reference to size, there are multiple aspects to consider. The most important thing to remember is that you are not on your own. Your plastic surgeon should have a wealth of experience in this area, and they can help simplify and reassure you in your selection.

Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure.

Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure.

In my San Francisco Plastic Surgery office I depend on my patients to provide me with a clear idea of the size they want, and they depend on me to help them select the details that are most likely to give them a happy result. Let’s review some of the details.

Breast Implant Size

The amount of augmentation is determined by the volume of the breast implants. If you are looking for a particular cup size, the amount of volume needed will depend on many factors including:

  • The amount of breast volume you have before augmentation
  • Which bra you wear – Each manufacturer has a different definition of cup size.
  • The fullness you wish to achieve
  • The tightness of your chest skin and muscles
  • The shape of your breasts
  • The width of your chest

For the best results, do your pre-breast augmentation homework. Buy a bra the size you want to be. Stuff it. Wear it. Try it with different clothes. The clearer your goal, the easier it will be to communicate to your Plastic Surgeon and to achieve your ideal breasts.

Breast Implant Profile

Choosing the right size for you is the most important aspect of Breast Augmentation.

Choosing the right size for you is the most important aspect of Breast Augmentation.

Size matters, but so does shape. If you are trying to make a statement with your breasts, larger, high-profile breast implants will fill the breasts maximally. If you are considering proportionate breast augmentation, moderate profile breast implants may be more to your liking. If you are a marathon runner looking for a B-cup, low profile implants may provide enough augmentation to the breasts’ foundation to give you the shapelier breasts you desire.

Breast Implant Filling

Breast implants are filled with two materials: Saline and Silicone. While the majority of breast augmentation performed today is with smooth round silicone breast implants, sometimes, saline is a better answer. It is important to choose an experienced Board Certified Plastic Surgeon who can evaluate these options and help you determine what is most likely to work best for your goals.

Breast Implant Placement

The best breast augmentation is achieved by selecting breast implants that are proportionate to the chest.

The best breast augmentation is achieved by selecting breast implants that are proportionate to the chest.

Breast Implants can be placed in front of or behind the pectoralis major muscles. There are advantages and disadvantages to both positions. It is important that you know the differences and have guidance to select the placement which works best for you.

FDA Approved Breast Implants

There are currently three FDA approved Breast Implant manufacturers in the US. They provide many variations of sizes, shapes, filler and textures. While there are still some options that are not available, the options we have make it difficult to justify using a non-FDA approved breast implant. You should know exactly which implants your surgeon plans to use, and you should receive a card identifying those breast implants after your procedure. This is very important for warranty enforcement, breast implant replacement and for future breast implant maintenance.

Help Choosing Your Breast Implants

If you are considering Breast Augmentation, call my Walnut Creek Plastic Surgery office at (925) 943-6353, and schedule a private, confidential consultation appointment. I will go over your goals, your options and will use my greater than 20 years of experience to help you choose a plan that is best suited to your needs.

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Post-Bariatric Plastic Surgery Video – SF Bay Area

Posted April 22, 2018 in Arm Lift (Brachioplasty), Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Home, Lower Body Lift (Belt Lipectomy), Mommy Makeover, Post-Bariatric Surgery (After Weight Loss), Tummy Tuck (Abdominoplasty), Videos

Post-Weight Loss Plastic Surgery Video

Massive weight loss will shrink our volume, but does not reliably shrink our skin. In the before and after pictures above, breast volume is restored with breast implants. Sagging breast skin is tightened with a breast lift.  Excess abdominal skin is removed, and the belly bulge caused by stretched out abdominal muscles is flattened by tightening the muscle sheath.

Massive weight loss will shrink our volume, but does not reliably shrink our skin. In the before and after pictures above, breast volume is restored with breast implants. Sagging breast skin is tightened with a breast lift. Excess abdominal skin is removed, and the belly bulge caused by stretched out abdominal muscles, is flattened by tightening the muscle sheath.

Post-Bariatric Plastic Surgery is Plastic Surgery after Massive Weight Loss. Whether this is after a lifestyle change or after Bariatric Surgery, the amount of skin that persists after weight loss is often large and frustrating. This Post-Weight Loss Plastic Surgery Video reviews several of the most common treatments including: Lower Body Lifts, Tummy Tucks, Breast Augmentation, Breast Lifts and Arm Lifts. The results of Post-Bariatric Plastic Surgery are illustrated and narrated in this video with before and after pictures, which describe and demonstrate what Board Certified Plastic Surgeons can do for the skin excess that often occurs after weight loss.

Post-Bariatric Plastic Surgery Video

Extremity Tightening Procedures

The majority of skin tightening procedures performed after weight loss are for the trunk; however, the face, arms and legs can also develop excess skin. Face Lifts (Rhytidectomy), Arm Lifts (Brachioplasty) and Thigh Lifts can help with excess skin on the face/neck, upper arm and thighs. Below is an example of an arm lift.

Brachioplasty literally means arm changing. An arm lift can change the way an arm looks, feels and fits into sleeves.

Brachioplasty literally means arm changing. An arm lift can change the way an arm looks, feels and fits into sleeves.

Brachioplasty changes the arm by removing the excess skin that often hangs off the upper arm after weight loss. The skin is removed from the lower border of the upper arm, leaving a scar along the bottom of the arm. This is the only procedure that can remove large amounts of excess skin.

Post Bariatric Plastic Surgery Consultations

As an active member of the American Society of Bariatric Plastic Surgeons, post bariatric plastic surgery is an area in which I specialize.

The American Society of Bariatric Plastic Surgeons was formed by Board Certified Plastic Surgeons specializing in skin tightening after massive weight loss.

The American Society of Bariatric Plastic Surgeons was formed by Board Certified Plastic Surgeons specializing in skin tightening after massive weight loss.

When searching for an experienced post-weight loss plastic surgeon, be certain to look for a Board Certified Plastic Surgeon who is a Member of the American Society of Plastic Surgeons. Additionally, members of the American Society for Aesthetic Plastic Surgery specialize in the cosmetic side of plastic surgery, and members of the American Society of Bariatric Plastic Surgeons demonstrate additional dedication to the cosmetic side of post-bariatric plastic surgery.

If you are in the San Francisco Bay Area and want to learn more about your skin reduction options after weight loss, call (925) 943-6353, to schedule your private consultation appointment.

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Breast Augmentation and Breast Lifts Combined – SF Bay Area

Posted April 09, 2018 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Home, Post-Bariatric Surgery (After Weight Loss), Videos

Aesthetic Breast Surgery

Breast Augmentation Lift combines the Breast Enlargement of Breast Augmentation with the firming and shaping abilities of a Breast Lift.

Breast Augmentation Lift combines the Breast Enlargement of Breast Augmentation with the firming and shaping abilities of a Breast Lift.

The desire for the Best Breast can be divided into two areas: The best size and the best shape. This Breast Augmentation and Breast Lift Video discusses combining a breast lift with a breast implant. The procedure allows your plastic surgeon to maximize your results when both shape and size need modification.

Breast Augmentation Lift Video (Mastopexy Augmentation)

This Body Beautiful video segment from the San Francisco Bay Area’s News Station, KRON 4, reviews Breast Lifts combined with Breast Implants and illustrates the benefits of Augmentation Mastopexy with numerous Breast Aug Lift Before and After Photos.

Breast Size

The ideal breast size varies from patient to patient, and it is important to recognize that the more you do your homework in determining what size makes you happy, the easier it will be for your plastic surgeon to give you the result you desire. Most patients request a cup size in the C plus to D minus range, but you should try it out at home, first.

Buy a bra the size you feel you want to be and stuff it. Ziplock bags filled with rice are a simple way to adjust your breast volume. Try it with different clothing to see how you like it. Do your normal activities, and see how it works. Also, think about your overall body size and your activity level. Marathon runners often go smaller, to avoid the added weight and momentum.

Breast size is determined by the volume of breast tissue you have now, plus the volume of the breast implant. When you have a good shape, Breast Augmentation alone is used to enlarge the breasts to the desired size. For most women this is the procedure of choice. When the breasts are saggy, asymmetrical or tubular, a breast lift may be recommended to improve the overall esthetic of the breasts.

Breast Augmentation Lift Before and After Pictures

Deflated, post child birth or post weight loss breasts can be lifted, tightened and enlarged with the breast enhancing Mastopexy Augmentation. Larger lifts require longer scars. In this case, the healing vertical scar is seen on the lower pole of the breast. After this breast augmentation mastopexy, the breasts are fuller, firmer and lifted.

Deflated, post child birth or post weight loss breasts can be lifted, tightened and enlarged with the breast enhancing Mastopexy Augmentation. Larger lifts require longer scars. In this case, the healing vertical scar is seen on the lower pole of the breast. After this breast augmentation mastopexy, the breasts are fuller, firmer and lifted.

Breast Shape

The ideal breast shape also varies from patient to patient. Most patients desire perky, teardrop shaped breasts. A Breast Lift reshapes the breasts by removing excess skin, lifting and firming the breast mound. When the upper pole of the breast is empty, a breast implant is used to add volume. A Breast Implant can balance the upper and lower halves of the breast, or it can enlarge the entire breast.

Breast Lifts come in many sizes. The most common are periareolar (around the areola/nipple), vertical (lollipop) and inverted T (anchor or keyhole). The amount of lifting needed determines the type of lift recommended. It is always desirable to choose the smallest lift expected to work. Smaller lifts come with shorter scars, but they lift less. Be sure to consult a Board Certified Plastic Surgeon near you to learn what is recommended for your particular needs.

Breast Augmentation Lift Consultations

When considering Breast Augmentation, with or without a Breast Lift, be certain to consult an experienced Board Certified Plastic Surgeon. They can explain your options and select the procedure most likely to get you the results you want in the safest and most predictable manner. Call (925) 943-6353 and schedule a personalized consultation appointment, today.

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Questions For Your Cosmetic Surgeon – Experience

Posted February 04, 2018 in About Dr. Mele, Home, Patient Safety

Experience shapes training into even better results. Ask your Board Certified Plastic Surgeon about their experience.

Experience shapes training into even better results. Ask your Board Certified Plastic Surgeon about their experience.

It is important to have all the information before deciding on a Cosmetic Plastic Surgery procedure. This post reviews question two of the five questions you should always ask before having Elective Cosmetic Surgery. The five questions are:

How Often Do You Perform The Procedure?

How often do you perform the procedure? This question gets to your surgeon’s experience. Excellent Training is a must and was reviewed in the previous post. What happens after training is equally important. You want a Cosmetic Surgeon who actively practices the procedure they are doing for you. Someone who has the skills and good judgement, specific to your needs.

Last year, almost two-million cosmetic plastic surgery procedure were performed by eight-thousand US based Board Certified Plastic Surgeons. This is an average of 225 operations per surgeon. This is a good number to have in mind when we are evaluating how many times a surgeon performs a certain procedure each year. Some surgeons do 100 operations a year, some do 500. Some surgeons operate fast than others. Some work three days a week, some work six. Specialists will do a higher percentage of a certain procedure, and necessarily fewer other procedures.

How To Measure Experience

Quantity and quality do not always correlate. There is a quantity with above which quality suffers. There are also some very busy, below average ability surgeons. They may have slick advertising campaigns. They may always be offering the absolute latest technology. They may provide cut-rate surgery costs. Unfortunately, often by corners are being cut behind the curtain. Buyer beware.

Two simple ways to measure experience are years in practice and a clean record with the medical board. Both are easily checked online, and these should always be checked. For your convenience, I have links for checking Board Certification and standing with the California Medical Board at the bottom of the San Francisco Plastic Surgery Blog’s American Board of Plastic Surgery Page.

How Many Procedures Are Enough?

How often your plastic surgeon does a particular procedure is a gauge of experience. But, how many procedures are enough? The answer varies.

Surgical statistics for each year are available  on the ASPS and ASAPS web sites. Knowing how common a procedure is will help you determine how many procedures a year are reasonable.

Surgical statistics for each year are available on the ASPS and ASAPS web sites. Knowing how common a procedure is will help you determine how many procedures a year are reasonable.

Numbers go up depending on the popularity safety and reliability of the procedure, and there is regional variation. On the other hand, Plastic Surgeons with more skills, better judgement and more experience will require lower numbers to maintain their skills. If a surgeons only does a certain procedure, you should expect them to do a larger volume of that procedure. Unfortunately, there is no guarantee that a surgeon is better, just because they do, or claims to do, more procedures. Numbers are just one way to measure experience, but in general, more is better.

Procedure Popularity

Some procedures are more popular than others, so higher numbers are expected for procedures like Breast Augmentation and Liposuction, and lower numbers are expected for less common procedures like Buccal Fat Pad Reduction and Lower Body Lifts. Dividing the number of procedures performed in the US by the number of plastic surgeons in the US gives us a rough average for each procedure. By the nature of an average, half the plastic surgeons in the US will do less than the average number of procedures. This does not necessarily mean they are worse at it.

Here is an example. If 300,000 Breast Augmentations are performed in one year, and there are 8000 Plastic Surgeons in the US, the average is 300,000 divided by 8,000 or 37 Breast Augmentations per Plastic Surgeon. In other words, the average US Plastic Surgeon would be expected to do about 37 Breast Augmentations a year or about three a month.

Breast Augmentation is often the most frequently performed Cosmetic Plastic Surgery procedure performed in the US. Other very popular procedures include: Eyelid Surgery, Liposuction and Nose Reshaping. Each of these are performed approximately 200,000 times a year or twice a month for the average Plastic Surgeon.

Facelifts, Tummy Tucks and Breast Lifts are at a frequency of 100,000 a year or a once a month average. Gynecomastia Reduction (Male Breast Reduction) is performed about 25,000 times a year in the US, or 3 operations a year for the average Plastic Surgeon. Arm Lifts have a lower frequency. Fewer than 18,000 Arm Lifts are performed each year, which works out to two a year on average. Thigh Lifts are performed even less frequently, so the average is about one a year. Buccal Fat Pad Reduction is even less common. It’s all relative.

Some Procedures Work Better Than Others

Some procedures work better than others. These tend not to be the latest and greatest procedures. The most reliable procedures are tried and true and tend to be mainstream general plastic surgery procedures. Surgeons with good judgement will do more of these general plastic surgery procedures and fewer very specialized niche procedures. You should expect your surgeon to do more “full” procedures than “mini” procedures. I prefer using the smallest hammer that will get the job done; however, mini procedures do less. To get a good result from a mini procedure, you need to have a mini problem. If your surgeon is only doing mini procedures, this is a red flag.

When Is The Last Time You Did This Procedure?

The question, “How often do you perform a procedure?”, is really two questions in one. “How many procedures do you do?” and “How recently have performed the procedure?” Two questions which combine to give insight into how familiar your plastic surgeon is with your procedure. Someone who has done 50 procedures ten years ago, may not be as qualified as someone who performed 50 procedures in the last year. So you might want to ask a follow-up question about the last time your surgeon performed the procedure you are interested in.

The Shape Of The Practice

The popularity of Cosmetic Surgery varies by country. While South Korea, Greece and Italy beat the US by surgeries per capita, the column to the far right shows that no country does more Cosmetic Surgery than the US.

The popularity of Cosmetic Surgery varies by country. While South Korea, Greece and Italy beat the US by surgeries per capita, the column to the far right shows that no country does more Cosmetic Surgery than the US.

As practices are busier, the number of procedures performed goes up. Hopefully, they are busier because they are doing a better job. Additionally, as surgeons specialize, they limit the number of other procedures they perform. Moreover, they should be expected to be doing more procedure in their area of specialization.

Specialists

Specialization is good. It allows a surgeon to focus on a particular area of interest. I am Board Certified in General Surgery and Plastic Surgery. I am trained in many procedures, but I choose to specialize in Cosmetic Plastic Surgery. The majority of my practice is Cosmetic Plastic Surgery. I had excellent training, but I have learned more in my 20 plus years of practice than I learned during my many years of training. Moreover, being a Cosmetic Plastic Surgeon was a goal I set before beginning my training. This goal shaped the entire course of my training as well as the types of procedures I perform on a daily basis.

Super-Specialists

There is an expression which goes: When all you have is a hammer, the entire world looks like a nail. Be a little cautious of super-specialists. Most good super-specialists are well rounded surgeons who still do other procedures. On the other hand, there are some super-specialists who have only learned one way to do a procedure. They may lack the training, experience or ability to offer you alternatives that may actually work better.

The Life-style Lift company is a good example. The company specialized in facial rejuvenation. They promised a bargain basement, one hour fix, under local anesthesia, with minimal downtime. Essentially, they did a mini-facelift on everyone they met. Unfortunately, the downside to this one-size-fits-all solution was not explained. Risks were minimized and outcomes not maximized. They even employed Debbie Boone as their cheerful spokeswoman. She promised a low cost, low downtime solution wrapped in slick advertising and misleading before and after pictures. The company had many complaints, many lawsuits and was fined by multiple states for false advertising and unethical behavior. Lifestyle Lift is now bankrupt, but not before giving many patients, and plastic surgery, a black-eye.

The Only One

Be even more cautious of experts claiming to be the only one performing a certain procedure. Good procedures are like wildfires; they spread quickly. Fat grafting to the Buttocks, better known as the Brazilian Butt Lift, was unheard of in the US in 2000. It has been the fastest growing procedure for several years running. The number of Brazilian Butt Lifts performed increased from 3000 to 30000 procedures per year over the last five years. It has expanded quickly because it solves a problem better than the previous operations. It is by no means a perfect operation, but it is a good operation, that works better than the alternatives (Buttocks Implants). When something works better, word spreads quickly.

Good procedures are very unlikely to remain in the hands of a single surgeon. Most plastic surgeons share their good ideas at our annual meetings. This is done not for personal financial gain, but for the good of the profession. The American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) have both stated that trying to patent or restrict the distribution of a medical procedure is unethical and grounds for expulsion. Sharing is caring, even for medical professionals.

Cross-over Procedures

Many plastic surgery procedures are similar. In some ways, Tummy Tucks, Arm Lifts and Thigh Lifts are the same procedure. The require similar skill set. This means there is some cross-over experience between these three procedures. What I learn through experience with common procedures, like Tummy Tucks, can help me achieve better results with less common procedures, like Arm Lifts and visa versa.

There Is No Magic Number

While a greater number of cases implies more experience, there is no number that can absolutely guarantee your results. Some people learn faster than others. This is true for doctors, too, so the number of repetitions needed to be safe and effective with a procedure will vary from doctor to doctor. Good training should make a surgeon safe, while experience makes them more effective. You want to choose a Cosmetic Surgeon who is both qualified and experienced.

We are fortunate. The San Francisco Bay Area is home to some of the best plastic surgery training centers in the world. We have many qualified and experienced Board Certified Plastic Surgeons to choose from. If you are interested in any of the procedures mentioned above, or elsewhere on the San Francisco Plastic Surgery Blog, call (925) 943-6353 today, and schedule a private consultation appointment to learn more.

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BIA-ALCL January 2018 Breast Implant Associated Lymphoma Update

Posted January 13, 2018 in Home, Patient Safety

Through the years, I have posted several updates on the rare, but very treatable, Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) on the San Francisco Plastic Surgery Blog. As of January 4, 2018, a pivotal new study was released in JAMA Oncology.

An advanced case of BIA-ALCL. Arrows on this MRI point to white patches of increased fluid around the tumor cells.

An advanced case of BIA-ALCL. Arrows on this MRI point to white patches of increased fluid around the tumor cells.

What Is The Risk of BIA-ALCL in Women With Breast Implants?

The article, available on-line, is titled, “Breast Implants and the Risk of Anaplastic Large-Cell Lymphoma in the Breast.” The key question which the authors tried to answer is, “What are the relative and absolute risks of breast anaplastic large-cell lymphoma (ALCL) in women with breast implants?”

To properly frame the answer obtained, it is important to note that BIA-ALCL is not breast cancer. However, the relative risk of BIA-ALCL compared to the risk of breast cancer is often used to give proper reference to how rare BIA-ALCL is.

What Was Found – The Absolute Numbers

The study utilized the Netherlands’ Nationwide Network and Registry of Histo- and Cytopathology (PALGA). Over the 27 years, the study identified 32 patients with primary breast ALCL with a breast implants. Overall, 782 female patients were diagnosed with a non-Hodgkin lymphoma (NHL) of the breast in the Netherlands during 1990 to 2016. 43 primary breast-ALCL cases were confirmed. The median age of the 43 patients with breast-ALCL was 59 years. 32 of these patients had ipsilateral (same sided) breast implants, compared with 1 among 146 women with other primary breast lymphomas (OR, 421.8; 95% CI, 52.6-3385.2).

Other Associations With BIA-ALCL

BIA-ALCL seems to form on the surface of textured breast implants. The cells can also be found in the fluid  that accumulates around the breast implant. The bacteria that form a biofilm around the textured implants have been associated with this tumor.

BIA-ALCL seems to form on the surface of textured breast implants. The cells can also be found in the fluid that accumulates around the breast implant. The bacteria that form a biofilm around the textured implants have been associated with this tumor.

BIA-ALCL is associated with textured breast implants. Out of 109,448 breast implants sold in the Netherlands, 49,109 were textured (P < 0.01). This means of the breast implants sold in the Netherlands, and presumably used, 45% are textured. In this study, however, 23 of 28 patients diagnosis with BIA-ALCL had textured breast implants at the time of their diagnosis or 82%. So the actual number of BIA-ALCL cases associated with textured implants was almost twice what would be expected if BIA-ALCL occurred at the same rate in textured and smooth breast implants. Even more importantly, in this study, it was unknown if the patients with smooth implants had previously had textured breast implants, but more on that below.

Textured Breast Implants & BIA-ALCL

The Plastic Surgery Foundation has the most complete and largest database of BIA-ALCL cases. As of December 1, 2017, of the 183 unique reported cases in the PROFILE database, every patient has had a textured breast implant prior to their diagnosis. Even women who had smooth breast implants at the time of their BIA-ALCL diagnosis, had previously had either a textured breast implant or a textured tissue expander prior to receiving their smooth breast implants.

Comparisons With Breast Cancer

If you live to 80 years of age, your risk of developing breast cancer is 1:8. If you have breast implants, your risk of developing BIA-ALCL ranges from 1:1000 to 1:30,000 for women with textured breast implants, depending on which epidemiological study you read. In 2018, about 40,920 women in the U.S. are expected to die from breast cancer. World wide there have been 17 deaths from BIA-ALCL over the 56 years that breast implants have been available. Like breast cancer, early diagnosis is the key to a cure. Unlike breast cancer, BIA-ALCL is very treatable.

The Signs of BIA-ALCL

Current treatment of BIA-ALCL is usually curative, but depends on early diagnosis and appropriate treatment.

Current treatment of BIA-ALCL is usually curative, but depends on early diagnosis and appropriate treatment.

Although it is unlikely that a woman with breast implants will ever have to deal with BIA-ALCL, it is important to know the symptoms and seek care if they develop. When BIA-ALCL is confined to the capsule, removing the breast implants and capsules has been curative for every patient to date. The majority of early stage patients require no additional treatment. Chemotherapy is required for unresectable disease to metastasis.

Delaying or declining treatment is not advisable. Analysis of the known deaths from BIA-ALCL revealed that patients either received radiation (x-ray therapy) or chemotherapy alone, died of the treatment itself, had incomplete surgical resection or had distant metastasis. All cases of BIA-ALCL should be reported to the PROFILE registry.

BIA-ALCL usually presents as unilateral (one-sided) swelling of the breasts, an average of 8-9 years after the insertion of textured breast implants (range 2-28 years reported). This can occur even if the breast implants have been replaced with smooth breast implants. Fluid around a textured breast implant is not usually due to BIA-ALCL, but it can be sent for analysis when the conditions are suspicious. BIA-ALCL can also present as a lump in the breast or in the armpit like breast cancer does.

Risk Factors

The FDA does not recommend any additional screening or treatment for BIA-ALCL. BIA-ALCL is extremely rare, and it is impossible to predict who will develop it, but there are 4 identified risk factors: TIMD

  1. T – Textured Breast Implants – There have been no reported smooth-walled device cases at this time.
  2. I – Inflammation – Chronic inflammation has been implicated. Certain bacteria in the biofilm that forms around breast implants have been associated with an increased risk of BIA-ALCL.
  3. M – Mutations – There may be a link with genetic mutations in JAK1 and STAT3. Further research is necessary.
  4. D – Duration of Augmentation – Presentation is usually 8-9 years after textured breast implant insertion.

What To Do If You Suspect You Have BIA-ALCL

Get checked out. See your primary medical doctor or your plastic surgeon. Get an updated medical history and physical examination. If enough fluid is present around the breast implant, a sample can be sent for analysis. 2-3 tablespoons are required for cytology and CD30 immunohistochemisty to rule out BIA-ALCL. Mammograms are not useful. PET/CT scans are used for staging.

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Mommy Makeover Before and After Video – SF Bay Area

Posted December 23, 2017 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Home, Mommy Makeover, Tummy Tuck (Abdominoplasty), Videos

The combination of Breast and Belly Enhancement has been coined the Mommy Makeover. Since the breasts and belly often change after childbirth, the combination is most often performed for mommies. Children, however, are not a prerequisite as any weight gain and loss can cause similar changes.

Mommy Makeovers After Weight Loss

Mommy Makeovers can be performed after weight loss, too.

Mommy Makeovers can be performed after weight loss, too.

The combination of breast and belly rejuvenation is frequently requested after bariatric surgery or larger weight loss after diet and exercise. As with pregnancy, both areas stretch with weight gain, and then deflate and often sag after the weight is lost, taking the shine off all the hard work. The Mommy Makeover procedure can enhance the breast and the belly in a single operation. The Mommy Makeover Video below shows additional examples.

Mommy Makeover Video (Breast and Belly Enhancement)

This Mommy Makeover video narrates several Mommy Makeover Before and After Pictures and provides additional information on the Mommy Makeover procedure including options and recovery.

Mommy Makeover Results Last

This mommy has been shown here before. She is maintaining her healthy lifestyle and her beautiful results.

This mommy has been shown here before. She is maintaining her healthy lifestyle and her beautiful results.

You can expect your Mommy Makeover to last. With proper maintenance, the procedure is very effective at improving body contours long term. If you are planning to have children, it is recommended to have them before the Mommy Makeover.

Mommy Makeover With A Brazilian Butt Lift

The Mommy Makeover can also be combined with the Brazilian Buttocks Lift.

The Mommy Makeover can also be combined with the Brazilian Buttocks Lift.

For selected patients, the Mommy Makeover can be combined with fat grafting to the buttocks, aka the Brazilian Buttocks Lift. The upside is added shape to the buttocks by grafting fat from the belly and back that would usually be discarded during the tummy tuck. The downside is trying to avoid sitting/laying on the fat grafts while recovering. Sometimes separating the procedures is recommended.

Mommy Makeover Consultations

To schedule your personal Mommy Makeover Consultation, tailored to your specific needs, call (925) 943-6353. As a Board Certified Plastic Surgeon, I offer a wide range of options for both breast enhancement and tummy tightening. Check out the San Francisco Plastic Surgery Blog and my main websites for more information. If you have a question, just ask via the contact forms available on this and all our webpages.

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Breast Augmentation With Breast Implants Bay Area

Posted December 16, 2017 in Breast Augmentation, Home, Mommy Makeover, Videos

Breast Implants can enlarge and enhance the shape of a woman's breasts.

Breast Implants can enlarge and enhance the shape of a woman’s breasts.

Breast Augmentation remains one of the most requested Cosmetic Plastic Surgery procedures year after year. My San Francisco Bay Area Breast Augmentation patients are no exception. Whether breast shape or volume has become a problem postpartum, after weight loss or if you have always had small breast, Breast Implants may be the answer you are looking for.

Breast Augmentation Before and After Pictures

Breast Implants can put the stuffing back into deflated breasts.

Breast Implants can put the stuffing back into deflated breasts.

This week I discussed Breast Augmentation on the SF Bay Area’s New Station, KRON 4, with host Janelle Marie. The video segment below includes information about Breast Implants and how they are used. In it, I narrate multiple Breast Implant Before and After Pictures of my actual patients.

Breast Augmentation Video (Breast Implants)

Breast Augmentation Explained

Breast Augmentation with Breast Implants has been around for over 50 years. The procedure involves creating a pocket for the Breast Implant behind your breast tissue to augment the breasts. This enhances both the size and shape of the breasts. More information is available here on the San Francisco Plastic Surgery Blog, by selecting “Breast Augmentation” under the “Search By Category” heading in the sidebar. There is also information about Breast Augmentation Lifts, Breast Implant Selection, Breast Implant Revision, Breast Implant Removal and a wide variety of other cosmetic breast, face and body procedures.

The best breast augmentation is achieved by selecting breast implants that are proportionate to the chest.

The best breast augmentation is achieved by selecting breast implants that are proportionate to the chest.

Breast Augmentation Consultations

If you are considering Breast Enhancement Surgery, call (925) 943-6353, today, and schedule a personal consultation appointment, tailored to your goals. We are conveniently located in the East San Francisco Bay Area city of Walnut Creek, CA.

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Cup sizes and CCs – SF Bay Breast Augmentation

Posted November 19, 2017 in Breast Augmentation, Home

How many ccs in a c-cup? This is a question I hear every day. The question is simple; however, the answer is complicated. I will try to explain in today’s San Francisco Plastic Surgery Blog post.

In 1937, Warner introduced its Alphabet Bra with four cup sizes (A, B, C and D)

In 1937, Warner introduced its Alphabet Bra with four cup sizes (A, B, C and D)

Math is Beautiful

Volume of a hemisphere

Please explain how this equation answers the question,”How many ccs are there in a C-cup?”

If you are still reading this, I will explain. The equation above is the approximate volume of a breast, given its radius (r). The volume of the breast is directly related to its radius cubed. In other words, if you double the radius of the breast, this will increase the volume eight-fold.

The upside to using an equation is that equations are 100% objective. Measuring the base width of the breast gives us the radius, and via the equation the volume. The beauty of mathematics is that there is a defined answer. The downside is that even this simplified equation is hard to relate to for most people. Additionally, the actual volume will be less than calculated, because breasts are not perfect hemispheres. At least they should not be, but this segues nicely in the subjective side of the C-cup.

Objective vs. Subjective

At the latest American Society for Aesthetic Plastic Surgeon (ASAPS) meeting, a company was offering a high-tech laser scanner that can be used to measure the exact contours of a patient’s body. If plastic surgery were 100% objective, this would be great; however, even though we can measure and calculate volumes with great precision, what exactly a C-cup represents is subjective. It depends on each patients experience, body shape and even the brand of the bra worn.

Bras were much pointier in the past.

Bras were much pointier in the past.

It is estimated that 75-80% of women wear the “wrong” bra size. My grandmother was a corsetiere. She sold lingerie at I. Magnin’s in Walnut Creek until the day it closed. She fitted women for bras, and even for prosthetics after a mastectomy. She had a loyal following, because she could find the right size for each customer and each manufacturer, and she confirmed that most women wear the wrong bra size. On the other hand, we wear what is comfortable.

Why Women Wear the Wrong Size Bra

Bra researchers have studied what size bras women wear and have documented through the years that most women do not wear the size bra for which they measure. Moreover, two trends are consistent. Women with smaller breast tend to wear bras which are too large, and women with larger breast tend to wear bras which are too small. Oprah Winfrey had an entire show dedicated to this, so it must be true. I think it’s an extension of the saying, “The grass is always greener on the other side of the hill.” In this case, the hill is a C-cup.

Inflatable cup sizes.

Inflatable cup sizes.

To add to the confusion, boutiques that tailor their products to younger/thinner women tend to inflate the cup size for a given volume. The best example is Victoria’s Secret. It is no secret that if you wear a C-cup in VS, you likely wear a B-cup in other mainstream bra manufacturers like Warner’s and Bali. This brand specific sizing, and often style specific sizing, leads to further confusion over what a C-cup really represents. There is no industry standard for bra sizing, so if you wear a 34C from company A, a 34C from company B may not fit.

Cup Volumes And Band Size

Cup volumes are also dependent in band size. The measurement under the breasts, the size of the chest without including the breasts, determines the band size. A larger chest means a larger band size. In the US, the measurement is made in inches, and then 4 or 5 is added to this to get to an even number. Other countries simply use the closest even number, so it is important to know the method of sizing.

Measurements are made around and below the bust for bra fittings.

Measurements are made around and below the bust for bra fittings.

When measuring around the breasts, each increase of one inch equals and increase in one cup size. Again, there are variations, some countries use 2 cm and others may use 3 cm. Since is takes more volume to increase an inch around a larger chest, cup volumes increase, for a given letter size, as the band size increases. For example, the cup volume of a 34C is 25% larger than that for a 32C and 23% smaller than that for a 36C.

So How Many CCs Are There In A C-Cup?

Bra sizing can be frustrating and confusing, and this is why it is hard to promise a certain cup size after Breast Augmentation. As it was so eloquently put by a presenter at the ASAPS annual meeting, “If a patient wants a guarantee for a specific cup size, I tell her I can, if I get to buy the bra.”

The simple answer: Objectively: When we do the math using the most commonly used US system of bra measurement, a 34C cup is 480ccs.

The real answer: Subjectively: It depends. It depends on many factors including:

  • Who’s C-cup you wear. A pretty, cleavage enhancing, Victoria’s Secret bra may only hold half the volume calculated above. Some of the cup size is filled with padding, and the wire length may be reduced to force the breasts together.
  • How you like your bra to fit. You can wear a cup size larger if you are smaller, or wear a tighter band size to support larger breasts. Research shows most women do.
  • Skin tightness. Tighter, higher breasts fit into a bra differently than deflated, lower breasts. Larger natural breasts do not fill the upper portion of the cup without support, while larger implants do.

How To Choose The Best CCs For Your Breast Augmentation?

This is a question that is asked every five minutes on the Internet, if not more frequently. The best way is to:

  • Seek guidance from a Board Certified Plastic Surgeon who is experienced and fully trained in Breast Augmentation.
  • Be honest with yourself, your goals and your surgeon.
  • Do your homework. Buy a bra that is the size you want, the band number should be the same, and stuff it. Ziplock bags filled with (uncooked) rice is a simple way to vary the size and try on different looks. Be sure to use different clothes too, to see how your look changes. This short post is as true today as the day it was published: How to Choose the Correct Breast Implants: Size.

Also remember, there is no perfect answer. Your ideal size may change from day-to-day, and through the years. So the goal should be to find your comfort zone and aim for the center of it. Additionally, breasts change. They can change with normal monthly cycles. Breast size and shape morph as we age, have children and gain/lose weight.

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Breast Implant Revision SF Bay Area

Posted September 25, 2017 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Home, Videos

Breast Augmentation with Breast Implants remains the most popular cosmetic plastic surgery. Three to four-hundred-thousand women have Breast Augmentation each year in the US alone. It is the safest and most effective means of enlarging the breasts available, but even FDA approved devices, like Breast Implants, need touch-ups from time-to-time.

Do I Need Breast Implant Revision Surgery?

The following Breast Implant Revision Surgery Video originally aired on the San Francisco Bay Area‘s news Station, KRON 4. It reviews Breast Augmentation Revision Options and describes some of the most common breast augmentation revisions. Multiple before and after pictures are included as examples.

Breast Augmentation Revision Surgery Video

Breast Implant Deflation

The introductory photo for the video above shows deflation of this patient’s left breast implant. For Saline Breast Implants, loss of the breast implant’s shell integrity results in complete deflation and loss of breast augmentation. Replacement of a deflated breast implant can be done with minimal downtime. It is also a good time to consider if your breast implants are the right size, profile or style (saline vs silicone), as there is no better time to replace both implants. In situations like the above, it is extremely helpful if you know what type and size of breast implants you have.

Breast Implant Revision – Bigger

The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.

The most common reason for Breast Augmentation Revisions is to go bigger. This is especially common after pregnancy with preexisting breast implants as shown above.

The above Breast Implant Revision Before and After Pictures show two common reasons for revision. The first, and the most common, is to go larger. The second, and often seen after pregnancy with preexisting breast implants, is to correct breast tissue sagging off the breast implants.

This patient has already had a Breast Augmentation Mastopexy, also known as a breast lift, using breast implants for additional volume. The larger the preexisting breast tissue volume, the more likely the breast is to sag. This is true with or without breast implants. She desired larger breasts and a perkier appearance. A larger Breast Implant provides both additional volume and support for her breasts.

Breast Implant Revision – Smaller

The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.

The above Breast Augmentation Revision pictures demonstrate the correction of bottoming out.

Sometimes, the breast implants are too large to be supported. The before picture, in the above Breast Augmentation Revision Before and After Pictures, demonstrates what happens when breast implants are too large, even with a breast lift. Over time, the Breast Implants have over-stretched the skin of the lower breast and moved down the chest. The previous breast lift (mastopexy) scar is red and irritated, and the nipple is riding high. This patient presented with a desire for correction of the shape of her breasts, and also wanted to be smaller.

The after photo shows the results after the mastopexy was revised and the breast implants were replaced with smaller, lower profile, Breast Implants. The mastopexy scar looks less irritated. The distance between the nipples and the bottom of the breast is reduced to normal. The new breast implants are smaller, but maintain the width of the breast to preserve cleavage.

Breast Implant Revision Surgery Consultations

With the popularity of Breast Implants it is not surprising that Breast Augmentation Revision Surgery has become its own specialty. If you have breast implants which are:

  • too small
  • too large
  • too high
  • too low
  • too close together
  • too far apart
  • too hard
  • deflated or leaking
  • not supporting your breast tissue

then give my San Francisco Bay Area Plastic Surgery Clinic a call at (925) 943-6353. With 20 years of experience, I will give you up-to-date options that are personalized to your unique situation. Previous operative reports and your before and after pictures help, so bring them with you, too.

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New Body Beautiful From Head to Tummy

Posted September 09, 2017 in Breast Augmentation, Breast Implant Revision Surgery, Breast Reduction, Breast Reduction (Men), Capsular Contracture, Ear Shaping (Otoplasty), Home, Tummy Tuck (Abdominoplasty)

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful - September 12, 2017, at Noon.

Dr. Mele discusses Cosmetic Plastic Surgery on Body Beautiful – September 12, 2017, at Noon.

Hey San Francisco Bay Area. Body Beautiful will be broadcast this Tuesday, September 12, at noon. You may not have noticed, but KRON 4 was acquired by Nexstar. The good news is that they have decided to continue Body Beautiful, so I’ve got new Plastic Surgery News to share with you.

Body Beautiful on KRON 4

KRON 4's Body Beautiful with Vicki Liviakis and yours truly on the San Francisco Bay Area's News Station.

KRON 4’s Body Beautiful with Vicki Liviakis and yours truly on the San Francisco Bay Area’s News Station.

I have been doing Body Beautiful live for the last 10 years. The original show was with host Vicki Liviakis, and we would take viewer calls live, on the air. It certainly added excitement. Since we were on the air live, even the “unusual” questions had to be answered.

The latest version of Body Beautiful with host Janelle Marie.

The latest version of Body Beautiful with host Janelle Marie.

Now Janelle Marie is the host, but the format remains the same. This week’s show was taped last week. Maybe KRON’s new management was a little nervous about an amateur, me, on the air live. But don’t worry, you can still submit questions for the show via email or the contact form here in the margin.

This Week’s Body Beautiful Discussion

This week’s show is dedicated to four Cosmetic Plastic Surgery Procedures:

The links above will take to more detailed information about these procedures.

Body Beautiful Airs Tuesday At Noon

Body Beautiful will be broadcast this Tuesday, September 12, at noon. Be sure to tune in or set your DVR. I you miss it, don’t worry. I will be posting the segments from the show here, and the San Francisco Plastic Surgery Blog and on my YouTube channel.

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