Breast Implant Options – What Are Your choices?

Posted July 29, 2019 in Breast Augmentation, Breast Implant Options, Home

Today, Breast Implants come in different shapes, sizes and materials. For experienced board certified plastic surgeons, these are exciting options that provide us with the opportunity to customize your look and maximize your results. However, for patients, too many options can sometimes lead to overload and confusion. Today’s post will help navigate through the alternatives available for breast augmentation. There is no substitute for an in-person consultation appointment with a Board Certified Plastic Surgeon. Until then, the following is a brief introduction to the currently available breast implant options to get you started on your way.

Breast Implant Fillers – Silicone Vs. Saline

Breast Augmentation Before and After - Front View

These breast augmentation before and after pictures show results using silicone gel breast implants. (Click image for uncensored view.)

All breast implants have silicone shells and are classified as either silicone gel or saline depending on the filler. The current Silicone Gel Breast Implants are more popular than saline because today’s Silicone Gel is highly cohesive. This extra high strength gel is safer and more predictable because it does not flow. It supports the shape of the breast implant shell while remaining soft to the touch. Consequently, silicone gel filled breast implants have a lower incidence of rippling when compared with saline. They are also available in a greater variety of sizes, shapes and profiles. Moreover, my patients who have had both silicone and saline filled breast implants, prefer the look and feel of silicone implants.

Saline Breast Implants are also excellent devices. Saline is water with 0.9% salt (NaCl) added to make the solution as salty as we are. It is the same fluid we administer intravenously for hydration during emergencies and as a delivery medium for medications during surgery. Saline breast implants also come in a variety of shapes, sizes and profiles, but they tend to be more palpable and have a higher incidence of rippling (visible wrinkling). An advantage of saline is that it is much simpler to tell when a saline breast implant deflates. If a hole develops in the implant’s shell, the saline empties quickly and completely. Conversely, highly cohesive gel, with is found inside silicone breast implants (gummy bear implants), maintains its shape and fullness, even when there is a hole in the shell.

Breast Implant Shape – Round Vs. Teardrop

The final shape of the augmented breast is determined to a greater extent by the shape of the natural breast than by the shape of the breast implant. Most women already have most of their breast tissue in the lower pole of their breasts. Thanks to gravity, the majority of the breast implants’s volume also fills the lower half of the breast, so round implants do not necessarily mean round breasts.

Unlike shaped implants, round implants are axially symmetrical. That means round breast implants can spin without affecting the shape of the breast. For shaped breast implants, rotation is a significant problem. To help prevent rotation, shaped implants have a textured surface. The rough surface attaches to the inside of the capsule like Velcro®, hopefully preventing rotation. Unfortunately, texturing may also increase the risk of rippling and double capsules.

Shaped implants may be beneficial after a mastectomy and in congenital cases when the breast does not fully develop. Any likely benefit needs to be evaluated against the risks on an individual basis. Texturing is discussed later in this article.

Breast Implant Profile – Low, Medium, High Vs. Extra High

Breast Augmentation before and after pictures - front view African-American woman

The above breast augmentation before and after pictures show breast augmentation with high profile silicone gel breast implants. (Click image for uncensored view.)

The greatest innovation in implant shape has been the introduction of multiple breast implant profiles. Selecting the best profile often causes confusion, but hopefully this will help simplify the selection process. High profiles have greater projection for a fixed diameter. That means for a fixed width, high profiles are rounder and fuller. This means they are larger and project out from the chest more. My patients all want rounder, fuller breasts, but unless they are looking for maximum size, not everyone is a good candidate for high profile breast implants.

It’s easier to consider profile in terms of the diameter of the implant rather than how round it is because the base diameter of your breasts are fixed. They can’t be changed. The base diameter is an objective dimension that is easily determined during your consultation appointment. All it takes is a tape measure. From this measurement, the optimal diameter of your breast implant is determined. If the implant is too wide, it sticks out too far under the armpits. If the implant is too narrow, the cleavage gap between the breast implants is increased. The breast implant diameter is very important, objective and easy to determine.

To determine the best profile, we need two pieces of information. One is the measured breast diameter. The other is your goal size – i.e. the size you would like to be after breast augmentation because this determines the volume required for you breast implants. The volume of your natural breast tissue plus the volume of the breast implant determines the final size of the breasts. In other words, the goal size minus your current breast size equals the volume of the required breast implant.

Since the goal size is subjective, it is worth doing some homework. A good way to try on different sizes is to fill Zip-Lock® bags with rice and place them inside the bra you would like to wear after augmentation. Often, patients bring their optimal rice bags with them to the office to convey their desired result. It can be very helpful. Once we have determined your goal size and the base diameter of the breast is measured, we can choose the profile that fits the bill. All measurements and profiles should be confirmed with in-person guidance from an experienced board certified plastic surgeon.

Breast Implant Size – Too Small, Too Large Vs. Just Right

Breast Augmentation Before and After - Front View

These breast augmentation before and after pictures show the front view for breast augmentation using saline breast implants. (Click image for uncensored view.)

Choosing the correct breast implant volume is the most difficult aspect of breast implant selection. Everyone wants to be big enough, but not too big. I’ve had it described in many ways from noticeable, but guys should still make eye contact, to celebrity but not porn star. It all very subjective. Your “ideal” may not be mine, or your friends, so you need to be honest with yourself. If you give your board certified plastic surgeon a good idea of your goal size is, you have a much better chance of being satisfied with your final result. Wearing padded bras, using rice bags, sizers or bringing pictures to your consultation appointment all aid in size determination. Once I know what size a patient wants, the rest is measuring and math, and I like math.

Breast Implant Texture – Smooth Vs. Textured

I have always been a fan of smooth breast implants, primarily because of the excellent results they provide for my patients. They are simple, predictable and reliable, and for most patients they feel softer yet still give a teardrop shaped result. For cases of recurrent capsular contracture or when shaped implants are indicated, then texturing may provide an advantage, but recently texturing has been associated with an additional risk.

Textured Breast Implants have been in the news a lot lately, and in the future, some texturing may no longer be an option. Just this week, Allergan® voluntarily recalled its Biocell® textured breast implants from the world market. Biocell® was the most aggressive texturing and has an increased association with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Of the 573 cases of BIA-ALCL, 481 are reported to have Allergan® textured breast implants at the time of diagnosis.

This may seem like a lot of BIA-ALCL cases; however, there are millions of breast implant patients. If you have textured breast implants, your risk of developing BIA-ALCL is 1 in 20,000 or 0.005%. If you have Biocell® textured breast implants, your risk of developing BIA-ALCL is 1 in 3345 or 0.02%. By comparison, the risk of developing breast cancer is one in eight or 12.5%. Biocell® textured implants manufactured by Allergan®, represent less than 5% of breast implants sold in the U.S. In fact, textured implants account for only 10% of all breast implants sold in the US.

It is important to note that Allergan smooth and Microcell® breast implants are not impacted by the recent recall. If you do have Allergan® Biocell® textured breast implants and have no symptoms, the FDA does not recommend the removal of these or other types of breast implants due to the low risk of developing BIA-ALCL. If you have any questions, talk to your health care provider. If you have breast swelling, especially if it is one sided, or any other symptoms of BIA-ALCL, it is important to seek prompt medical follow-up with a board certified plastic surgeon for further testing. Like most medical problems, early diagnosis is associated with increased cure rates.

Breast Implant Makers/Warranties – Allergan®, Mentor® Vs. Sientra®

Sientra®, Allergan®, Mentor® and Ideal® are the four FDA approved breast implant manufacturers in the United States. Sientra® manufactures their implants in the US and only makes silicone gel filled breast implants. Allergan® and Mentor® make both Silicone and Saline filled breast implants, and Ideal® makes only saline filled breast implants. These are the only FDA approved breast implant companies in the US.

All US manufacturers of Breast Implants have breast implant warranties. The details vary between companies. I try to keep the latest information on my website’s Breast Implant Warranties Page, but for the most accurate and up-to-date information, please check with your implant’s manufacturer.

Breast Augmentation Consultations

To schedule a personalized Breast Implant Consultation, call (925) 943-6353 today. An in-person consultation with a Board Certified Plastic Surgeon can help you focus on the options specific to your needs and can save you a lot of time when considering Breast Augmentation.

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Allergan® Voluntarily Removes All BioCell® Textured Breast Implants from World Markets

Posted July 24, 2019 in Breast Augmentation, Breast Cancer Awareness, Home

Today, Allergan® voluntarily withdrew all BioCell® Textured Breast Implants and Tissue Expanders from the world markets due to an association with breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).

Allergan Biocell textured breast implants

Allergan® Biocell® textured breast implants have the highest association of BIA-ALCL.

Textured Breast Implants and BIA-ALCL

I have been posting about an association of BIA-ALCL and textured breast implants for some time here on the San Francisco Plastic Surgery Blog. While many types of textured breast implants exist, a higher association of BIA-ALCL has been found with more aggressively textured breast implants. Allegan® has the most aggressively textured breast implants and thus the highest association with BIA-ALCL.

BioCell® Textured Breast Implants and BIA-ALCL

BioCell® textured surface (shell) is a unique surface used only by Allergan®. A detailed list of the specific BioCell® textured devices marketed in the U.S. that are recalled can be found at the end of this post.

The FDA’s analysis was attributed to a new worldwide reported total of 573 unique BIA-ALCL cases including 33 patient deaths. Of the 573 cases of BIA-ALCL, 481 are reported to have Allergan® textured breast implants at the time of diagnosis. In addition, 12 of 13 deaths occurring in patients with BIA-ALCL where the manufacturer was known occurred in patients implanted with an Allergan® textured breast implant at the time of their BIA-ALCL diagnosis. The manufacturer and/or texture is unknown for the remaining 20 reported deaths from BIA-ALCL.

The risk of BIA-ALCL with Allergan® BioCell® textured implants is approximately 6 times the risk of BIA-ALCL with textured implants from other U.S. manufacturers.

BIA-ALCL Is Not Breast Cancer

Early treatment is the key to the cure for BIA-ALCL as it is for any medical illness. When in doubt; check it out.

Early treatment is the key to the cure for BIA-ALCL as it is for any medical illness. When in doubt; check it out.

BIA-ALCL is a type of non-Hodgkin’s lymphoma (cancer of the immune system). In most cases, BIA-ALCL is found in the scar tissue and fluid near the implant, but in some cases, it can spread throughout the body. At this time, the overall incidence of developing BIA-ALCL is considered to be low; however, a BIA-ALCL diagnosis is serious and can lead to death, especially if not diagnosed early or promptly treated. In most patients, BIA-ALCL is treated successfully with surgery to remove the implant and the scar tissue surrounding the implant; however, some patients may require treatment with chemotherapy and/or radiation therapy.

BIA-ALCL Is Rare

It is important to understand how rare the occurrence is and put the numbers into perspective. Literature indicates the current lifetime risk is about 1 in 20,000 patients with textured implants. BioCell® has a 7x to 8x greater incidence of BIA-ALCL compared to all other manufacturers’ textures, including Sientra® Texture and Mentor® Siltex. Geographic regions also reported variable risks including: Australia 1 in 3,345 for BioCell® and 1 in 86,029 for Siltex. In 2018, over 400,000 women underwent breast augmentation and reconstruction with implants in the U.S. Here are some comparative rates from the Sientra website:

  • The average woman’s risk of developing breast cancer in her lifetime is 12.5%. This means that 1 out of 8 women may develop breast cancer in her lifetime.
  • The risk of developing recurrent breast cancer after mastectomy is 5-8%. This means that 5 to 8 out of 100 women may develop recurrent breast cancer after mastectomy.
  • The risk of capsular contracture through 10-years is ~14%. This means that 14 out of 100 patients may experience capsular contracture within 10 years after receiving implants.
  • The risk of breast implant rupture through 10-years is ~8%. This means that 8 out of 100 patients may experience implant rupture within 10 years after receiving implants.
  • The risk of developing BIA-ALCL from a textured breast implant is ~0.005%. This means that 1 out of 20,000 women with textured implants may develop BIA-ALCL.

FDA Is Not Recommending Removal Of Textured Implants

FDA Logo

To date, the FDA has not recommended removal of textured breast implants, including those with Allergan®‘s BioCell® texturing.

From the FDA website:

  • If you have no symptoms, we [the FDA] are not recommending the removal of these or other types of breast implants due to the low risk of developing BIA-ALCL.
  • Know the symptoms of BIA-ALCL – primarily persistent swelling or pain near the breast implant – and monitor the area around your breast implants for any changes.
  • Evaluation for BIA-ALCL typically involves a physical exam, imaging, and/or assessment of the fluid or tissue around the breast implant. It is important to undergo an evaluation to diagnose BIA-ALCL since a confirmed BIA-ALCL diagnosis may change the type of operation that should be performed.
  • Based on discussions with your healthcare provider, patients with confirmed BIA-ALCL should undergo implant removal and removal of the surrounding scar capsule, which is a more extensive operation than implant removal alone.
  • As with any implanted device, it is good to keep a record of the device manufacturer, unique device identifier, and implant model name. You may have received this information on a patient device card from your surgeon. If you would like to obtain any of this information, consider asking your surgeon or obtaining the record of your surgery (operative notes) from the facility where it was performed.
  • Understand that most cases of BIA-ALCL occur many years after breast implant placement
  • If you have any questions, talk to your healthcare provider.
  • The FDA understands that today’s action may cause concern to patients who have breast implants, especially those who know they have one of the listed Allergan® BioCell® model implants or may not know the implant’s manufacturer or model. The FDA continues to monitor and evaluate reports of adverse events in databases, including external patient registries, and in scientific literature for the incidence of BIA-ALCL across all breast implants and other devices intended for use in the breast. The FDA further notes that the macro-textured implants, like the BioCell® textured implants manufactured by Allergan®, represent less than 5% of breast implants sold here in the U.S. In fact, textured implants account for only 10% of all breast implants sold in the U.S. To fully understand your risk of developing BIA-ALCL, the FDA recommends that patients and healthcare providers follow the FDA’s recommendations stated above. More information about BIA-ALCL can be found on the Breast Implants webpage. Additionally, the FDA will continue to update the public about developments in this area.

List of Affected BioCell® Products

Allergan® Natrelle Textured Saline-Filled Breast Implants (formerly McGhan RTV Saline-Filled Mammary Implant) approved under P990074. The following are the textured styles:

  • Style 163 – BioCell® Textured Shaped Full Height, Full Projection Saline Breast Implants
  • Style 168 – BioCell® Textured Round Moderate Profile Saline Breast Implants, also referred to as 168MP (168 Moderate Profile)
  • Style 363 – BioCell® Textured Shaped Moderate Height, Full Projection Saline Breast Implants, Allergan® catalog includes 363LF, or 363 Low Height Full Projection
  • Style 468 – BioCell® Textured Shaped Full Height Moderate Projection Saline Breast Implants

Allergan® Natrelle Silicone-Filled Textured Breast Implants (formerly Inamed Silicone-Filled Breast Implants) approved under P020056. All the new Natrelle Inspira BioCell® textured breast implant style numbers start with “T”. If your Allergan® Natrelle Inspira breast implant style starts with “S”, they are smooth, and are not part of this withdrawal. The following are the textured styles:

  • Style 110 – BioCell® Textured Round Moderate Projection Gel Filled Breast Implants
  • Style 115 – BioCell® Textured Round Midrange Projection Gel Filled Breast Implants
  • Style 120 – BioCell® Textured Round High Projection Gel Filled Breast Implants
  • Style TRL – Natrelle Inspira BioCell® Textured Responsive Silicone-Filled Breast Implants
  • Style TRLP – Natrelle Inspira BioCell® Textured Responsive Silicone-Filled Breast Implants
  • Style TRM – Natrelle Inspira BioCell® Textured Responsive Silicone-Filled Breast Implants
  • Style TRF – Natrelle Inspira BioCell® Textured Responsive Silicone-Filled Breast Implants
  • Style TRX – Natrelle Inspira BioCell® Textured Responsive Silicone-Filled Breast Implants
  • Style TCL – Natrelle Inspira BioCell® Textured Cohesive Silicone-Filled Breast Implants
  • Style TCLP – Natrelle Inspira BioCell® Textured Cohesive Silicone-Filled Breast Implants
  • Style TCM – Natrelle Inspira BioCell® Textured Cohesive Silicone-Filled Breast Implants
  • Style TCF – Natrelle Inspira BioCell® Textured Cohesive Silicone-Filled Breast Implants
  • Style TCX – Natrelle Inspira BioCell® Textured Cohesive Silicone-Filled Breast Implants
  • Style TSL – Natrelle BioCell® Textured Soft Touch Silicone-Filled Breast Implants
  • Style TSLP – Natrelle BioCell® Textured Soft Touch Silicone-Filled Breast Implants
  • Style TSM – Natrelle BioCell® Textured Soft Touch Silicone-Filled Breast Implants
  • Style TSF – Natrelle BioCell® Textured Soft Touch Silicone-Filled Breast Implants
  • Style TSX – Natrelle BioCell® Textured Soft Touch Silicone-Filled Breast Implants

Natrelle 410 Highly Cohesive Anatomically Shaped Silicone Filled Breast Implants approved under P040046. All style 410 implants are BioCell® textured. The following are the textured styles:

  • Style 410FM
  • Style 410FF
  • Style 410MM
  • Style 410 MF
  • Style 410 FL
  • Style 410 ML
  • Style 410 LL
  • Style 410 LM
  • Style 410 LF
  • Style 410 FX
  • Style 410 MX
  • Style 410 LX

Allergan® tissue expanders for the breast that have BIOCELL texturing originally cleared as:

  • Natrelle 133 Plus Tissue Expander (K143354)
  • Natrelle 133 Tissue Expander with Suture Tabs (K102806)

What To Do?

If you don’t know what breast implants you have, find out. All my patients are given a card with their implant information to keep in a safe place. If your surgeon did not give you this information, or you can’t find it there are options. You can

  • call you surgeon’s office
  • contact the surgery center or hospital where you had surgery
  • contact the breast implant manufacturer

90% of the breast implants used in the U.S. are smooth and are not affected by this action. In my office, we have always preferred the results obtained with smooth breast implants. Less than 1% of the implants I have placed are textured, and not all of them are Allergan®. In fact, in my over 20 years of practice, I have removed more textured breast implants than I have placed. If you had your breast augmentation with me, and are wondering which implants you have, your breast implant card should state whether your implants are smooth or textures. If you don’t have your card, just give us a call and we will look it up.

If you have Allergan® BioCell® textured breast implants, don’t panic. Your risk of developing BIA-ALCL is still very low. If you are asymptomatic, the current recommendation is to leave them alone, and monitor for changes. If you have changes, do not delay in getting evaluated by your doctor. The most common presentation is an increase in size of one breast years after breast augmentation, usually due to a collection of fluid around the breast implant (seroma). While, most seromas are not due to BIA-ALCL, all should be investigated. If you have any concerns, contact your plastic surgeon for more detailed information.

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Breast Implant Revision Before and After Pictures – Capsular Contracture SF Bay Area

Posted July 22, 2019 in Breast Asymmetry, Breast Augmentation, Breast Implant Removal, Breast Implant Revision Surgery, Home

Breast Augmentation Revision for Capsular Contracture

Breast Augmentation Revision for Capsular Contracture. Notice the decreased volume, increased hardness and irritated red color in the before picture on the left. After release, the breast are softened and expanded. (To view uncensored before and after photos, click on the image.)

There are many different reasons for Breast Implant Revision Surgery. Possible causes include:

  • Capsular Contracture
  • Breast Implant Malposition:
    • Too high
    • Too Low (Bottoming out)
    • Too close (Symmastia, Uniboob, Bread loafing)
    • Too far apart (in the armpits)
  • Breast Implant Deflation
  • Breasts sagging off implants (Waterfall deformity)

Capsular Contracture

One of the most common reasons for Breast Implant Revision Surgery is Capsular Contracture. So what is the capsule and what is contracture?

When you have Breast Augmentation, a pocket is created for the breast implant behind the native breast tissue. As this pocket matures, your body creates a thin layer of scar around the breast implant. This scar pocket is called the capsule, and it is very important because the capsule holds the breast implant in place, preventing it from migrating. Capsular Contracture occurs when the scar lining the breast implant pocket contracts, squeezing and distorting the breast implant.

Breast Augmentation Revision for Capsular Contracture Unilateral

Capsular contracture often affects just one side. In the case above, the right breast implant is higher and tighter than the left before surgery. After surgery symmetry is restored.
(To view uncensored before and after photos, click on the image.)

The above patient has mild capsular contracture affecting only her right breast. She was able to compensate for the difference in upper pole fullness by tightening her left bra strap. During the Breast Augmentation Revision, a capsulotomy was performed to expand the right breast capsule and lower the right breast implant.

Grades of Capsular Contracture

A scar around the breast implant is normal. Without the scar pocket, the breast implant will bottom out and move to the sides. On the other hand, too much scar causes problems with implants riding too high or becoming too hard.

Capsular Contracture is normally classified into four grades (I-IV), but I like to add grade zero for malposition problems caused by not enough scar support.

  • Grade 0 – not enough support causing breast implant malposition
  • Grade I – normal soft
  • Grade II – firm but no visible distortion of breast shape
  • Grade III – hard causing visible distortion of the breast shape
  • Grade IV – like grade III but is also painful

Breast Augmentation Revision for Capsular Contracture Unilateral

Severe unilateral capsular contracture – The right breast so high that it would be hard to disguise in clothing. After treatment for capsular contracture, the breasts are much more even.
(To view uncensored before and after photos, click on the image.)

The patient above has severe contracture of the right breast, which was noticeable both in and out of clothing. A capsulectomy was performed to remove the previous capsule, expand the pocket, lower the breast implant and reset the formation of a new capsule. Now both her breasts are soft and even.

Breast Implant Revision

If you have Breast Implants but are unhappy with their size, placement or firmness, Breast Implant Revision is worth considering. To schedule a private consultation, call (925) 943-6353, today. Breast Implants have changed in the last few years, and there are new options available.

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Breast Augmentation Video | Walnut Creek | San Francisco Bay Area

Posted July 08, 2019 in Breast Augmentation, Home, Videos

Breast Augmentation Before and After Pictures

Breast Implants provide volume and shape for small or empty breasts.
(To view uncensored before and after photos, click on the image.)

Today’s Breast Augmentation Video includes multiple examples of Breast Augmentation Before and After Photos and reviews the indications, procedures and recovery after Breast Enlargement with Breast Implants.

Breast Augmentation Video (Breast Implants)

The following Breast Augmentation Video includes several examples of Breast Enlargement with Breast Implants. This video is a segment from KRON 4’s Body Beautiful and first aired on the San Francisco Bay Area’s News Station a few weeks ago. In this video, I review multiple Breast Augmentation Before and After Pictures and the photos provide narration for the indications, procedure and recovery of Cosmetic Breast Surgery.

Breast Augmentation for the Flat Chest

Breast Augmentation with Breast Implants Before and After Photos

Breast Implants can provide natural feminine contours, even when the chest is flat.
(To view uncensored before and after photos, click on the image.)

You might think the above result required Shaped Breast Implants, but this natural, teardrop-shaped result was achieved with smooth, round breast implants placed behind the pectoralis major muscle. If there is a situation where shaped implants might give a better result, it may be the flat chest with tight skin. The situation is found in young women who develop very little breast tissue and women who have had a mastectomy for breast cancer removal.

Unfortunately, shaped implants require texturing to help prevent rotation, and texturing comes with controversy and an increased risk of the rare development of BIA-ALCL. Moreover, despite texturing, shaped implants still rotate as often as 10% of the time. If smooth breast implants can give natural, teardrop-shaped results like the above, textured shaped implants might be relegated to reconstructive surgery only.

Breast Augmentation for Small Breasts

Breast Augmentation Before and After Pictures

Small breasts still maintain projection in the lower pole, so a round implant provides a natural teardrop-shaped result.
(To view uncensored before and after photos, click on the image.)

Small breasts usually have all the breast tissue in the lower pole of the breast. Like in the case above, Smooth Round Breast Implants behind the muscle were used to achieve a beautiful and natural shape. The majority of Breast Augmentation in situations where there is little natural breast tissue utilize Silicone Gel Breast Implants, because they feel more like breast tissue and have a lower incidence of rippling (visible wrinkling).

Breast Augmentation for Asymmetrical Breasts

Breast Asymmetry is normal. Breast are more like sisters than twins, and trying to make them look like twins poses many challenges. This is compounded by the fact that there are many factors which contribute to breast asymmetry. A few examples include the:

  • Size of the breasts
  • Shape of the breasts
  • Distribution of the breast tissue within the breast
  • Amount of breast skin
  • Location of the breasts on the chest
  • Nipple position on the breast mound
  • Location and definition of the inframammary folds
  • Shape of the under lying ribs
  • Shape and size of the chest wall muscles

Breast Implants can compensate for differences in volume but cannot compensate for any of the other common reasons for asymmetry. Asymmetry is normal, and improvement is likely. However, unless you are perfectly symmetrical before Breast Augmentation, expecting complete symmetry after surgery is unrealistic. So rather than correction of asymmetry, I call it improvement of asymmetry. Here is an example:

Breast Augmentation before and after pictures for Breast Asymmetry

Breast Asymmetry cannot be completely corrected; however, it can be improved with asymmetrical breast augmentation.
(To view uncensored before and after photos, click on the image.)

The Breast Augmentation Before and After Pictures above show breast enlargement with improvement of asymmetry. Before surgery the right breast was smaller and higher and the right nipple was higher and more medial. There were also significant asymmetries with the cleavage: the breast folds medially (in the middle) had different heights, shapes and depths of folding (definition). Additionally, the left cleavage is closer to the midline than the right. Careful selection of implant volumes, shapes and location of the breast implant placement can all help achieve reduction of the asymmetry. The after photos reveal better size equality, inframammary fold location, cleavage symmetry and nipple location. To see the nipples, and remove the black-out squares, click on the picture.

Breast Augmentation for Tubular Breasts

Tubular Breast Augmention Before and After Pictures

Breast Augmentation, often combined with a Breast Lift, are used to correct congenital breast deformities like Tubular Breasts.
(To view uncensored before and after photos, click on the image.)

Tubular Breasts, like normal breasts, come in different sizes and shapes. Often, one breast is more involved than the other, and the size of the breasts is quite different. The base of the breast is constricted and the breast tissue often herniates into the nipple areolar complex. The above example is of mild tubular breast deformity, with low-set nipples. Silicone Breast Implants were used to augment the breast volume and round out the disproportionately filled lower pole. A breast lift was needed to elevate the nipples to the front of the breasts. The breasts were transformed from a deflated, saggy appearance to the full, perky and aesthetically balanced shape you see above. Again to see the nipple location, click on the picture to remove the censoring black square.

Breast Implant Consultations

To learn more about Breast Augmentation, schedule an in-person consultation with a Board Certified Plastic Surgeon near you. If you are in Walnut Creek, or the San Francisco Bay Area, call (925) 943-6353 and schedule a private consultation, tailored to your needs.

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Breast Augmentation Before and Afters In The San Francisco Bay Area

Posted June 10, 2019 in Areolar Reduction, Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Home, Tubular Breasts

Year after year, Breast Augmentation remains the most popular cosmetic plastic surgery procedure in the United States. This is true in the San Francisco Bay Area also. Common reasons include congenitally small or misshapen breasts and changes in the breasts seen after weight loss, pregnancy and breastfeeding. Today, we will review a few examples.

Breast Implants For Breast Augmentation And Lifts

Breast Augmentation Lift for Tubular Breasts adds volume and improves the shape of the breasts.
(To view uncensored before and after photos, click on the image.)

Breast Implants are used for Breast Augmentation, either alone or in combination with a Breast Lift (Mastopexy) for Augmentation Mastopexy. The implants provide volume while the lift improves the shape, elevates the nipples and reduces skin redundancy.

The before and after pictures at the top of this post are of Breast Augmentation with a Breast Lift. In the above case, Augmentation Mastopexy was used to enlarge and reshape a congenital breast deformity named Tubular Breasts. In addition, Areola Reduction was included in the Mastopexy to prevent the areolae from expanding with the Breast Augmentation.

Breast Implants For Breast Augmentation

Breast Augmentation Before and After Pictures

Breast Augmentation Before and After Pictures: Breast Implants alone are enough to enlarge the breasts and improve their shape when we are starting with “normal” anatomy.
(To view uncensored before and after photos, click on the image.)

The above case in simpler than the first. In this case, the patient has normal anatomy. The nipples are in a more ideal location, the breast skin has good tone and there is no excess skin causing sagging. A lift was not needed, so straight-forward Breast Augmentation was performed via an incision under the breasts via the IMF (inframammary fold). The scar is hidden in the shadow under the breast.

Breast Implants For Asymmetrical Breast Augmentation

Breast Augmentation before and after pictures: Breast Implants areused to enlarge and improve breast asymmetry.

Breast Augmentation before and after pictures: Breast Implants are used to enlarge and improve breast asymmetry.
(To view uncensored before and after photos, click on the image.)

Asymmetry is as challenging as it is common. The third case is an example of Asymmetrical Breast Augmentation. The right breast is smaller and higher than the left breast. In these cases, a larger implant can be placed behind the smaller breast to balance the volume disparity. Additionally, the right IMF was lowered to match the left breast. The right nipple follows, to further improve symmetry. Larger asymmetry can sometimes require a Breast Lift or Breast Reduction on the larger size for the best results.

Breast Augmentation Consultations

As you can see from the examples above, breasts are like snowflakes; no two are exactly alike. In fact, a woman’s breasts are more like sisters than twins, and each requires careful individual evaluation. In the San Francisco Bay Area call (925) 943-6353, to schedule your personal Breast Augmentation Consultation. We have the experience, certifications and the latest technology in breast implants for you.

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Breast Augmentation With A Breast Lift (Video) – SF Bay Area

Posted April 15, 2019 in Breast Augmentation, Breast Augmentation Lift, Breast Lift (Mastopexy), Home, Tubular Breasts, Videos

Breast Augmentation with Breast Lift (Mastopexy Augmentation) and Tummy Tuck. Breast Enlargement when the breasts are sagging and the nipples are below the inframammary fold requires a Breast Lift to achieve an aesthetic result. The Tummy Tuck further enhances the breasts' proportion by flattening the belly.

Breast Augmentation with Breast Lift (Mastopexy Augmentation) and Tummy Tuck. Breast Enlargement when the breasts are sagging and the nipples are below the inframammary fold requires a Breast Lift to achieve an aesthetic result. The Tummy Tuck further enhances the breasts’ proportion by flattening the belly.

The Components Of Breast Enhancement

Breast Enhancement surgery has two aesthetic components: size and shape. Breast size is increased with Breast Augmentation and reduced with Breast Reduction. Breast shape is adjusted with the Breast Lift. There are many options for adjusting both size and shape, and today’s video is an introduction to the most versatile of all the Cosmetic Breast Enhancement procedures, Mastopexy Augmentation — the combination of Breast Augmentation and Breast Lift procedures.

Breast Augmentation With Breast Lift Video (Mastopexy Augmentation)

This Mastopexy Augmentation Video is from my Body Beautiful television show, originally broadcast on the San Francisco Bay Area’s News Station, KRON 4. It reviews the techniques and options available for different types of Breast Augmentation With Breast Lift.

Indications For A Breast Lift With Augmentation

The majority of Breast Augmentation patients do not need a lift, but here are 5 reasons why your Plastic Surgeon may be recommended adding a Breast Lift (Mastopexy) to Breast Augmentation:

  • Breast sagging (ptosis)
  • Low set nipples
  • Tubular breast deformity
  • Breast asymmetry
  • Disproportionately large areolae

Breast Augmentation Lift – When the breasts are close to the desired size, sometimes a Breast Lift alone is all that is needed to create youthful, perky breasts. If the upper pole is empty, a small implant can be used to  enhance the shape of the breasts by adding fullness to the bust line without over exaggerating the size.

Breast Augmentation Lift – When the breasts are close to the desired size, sometimes a Breast Lift alone is all that is needed to create youthful, perky breasts. If the upper pole is empty, a small implant can be used to enhance the shape of the breasts by adding fullness to the bust line without over exaggerating the size.

Mastopexy Augmentation Consultations

When considering Cosmetic Breast Surgery, be certain to select an experienced and Board Certified Plastic Surgeon. During your Breast Enhancement Consultation, your goals for both size and shape of the breasts should be discussed. If you are happy with the shape of your breasts, and are just looking for more volume, Breast Augmentation alone is likely the procedure of choice. If your size is good, but the shape is bothersome, a Breast Lift may be the best option to achieve your desired breast aesthetic. If your goal is to both augment and rejuvenate your breasts, the combination of Mastopexy Augmentation is often recommended and may be the best choice for you.

To schedule a personal consultation appointment in the San Francisco Bay Area call (925) 943-6353.

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Mommy Makeovers After Children (Video) | SF Bay Area

Posted April 08, 2019 in Breast Augmentation, Breast Lift (Mastopexy), Breast Reduction, Home, Liposuction, Mini Tummy Tuck (Mini Abdominoplasty), Mommy Makeover, Tummy Tuck (Abdominoplasty), Videos

Mommy Makeovers include breast and belly enhancement in one surgery.

Mommy Makeovers include breast and belly enhancement in one surgery.

No matter what shape you are in before childbirth, the postpartum physique is rarely an improvement. Pregnancy can wreak havoc on a woman’s body. Cosmetic Surgery Repairs after having children are done so frequently, there’s a name for it: Mommy Makeover. Today’s video is all about the Mommy Makeover, and its many variations.

Breast Augmentation and Tummy Tuck Video (Mommy Makeover)

This Mommy Makeover Video is from my Body Beautiful television show broadcasted on the San Francisco Bay Area’s News Station, KRON 4. It reviews the techniques and options available for different types of Mommy Makeovers.

What Is A Mommy Makeover?

The Mommy Makeover has two goals: to enhance the shape of the breasts and to flatten the belly. With pregnancy, the breasts enlarge and then often shrink and collapse. Breast Augmentation and Breast Lifting are used to enlarge and lift the breasts. On the other hand, if the breast remain too large after pregnancy, a Breast Reduction can be substituted to improve breast and body proportions. The differences and options for Breast Augmentation and Breast Lifts are discussed further here: Breast Augmentation or Breast Lift?

For the belly, a Tummy Tuck is the workhorse that dramatically improves the appearance of the abdomen by tightening the abdominal muscles and skin, and by removing excess fat. When abdominal laxity is confined to the area below the belly button, a Mini Tummy Tuck may be the procedure of choice to restore a pre-baby toned belly. Lastly, if the skin and muscle tone are good, but disproportionate fat is bothersome, Liposuction alone may be the answer. The differences between the procedures are discussed here: Liposuction or Tummy Tuck?

Mommy Makeover Consultations

If you are considering a Mommy Makeover, or its component cosmetic procedures, Breast Augmentation or Tummy Tuck, be certain to consult with an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353, and schedule a personal and private consultation appointment today.

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Mommy Makeovers – Breast and Belly Rejuvenation

Posted March 04, 2019 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Breast Reduction, Breast Reduction (Women), Home, Liposuction, Mommy Makeover, Tummy Tuck (Abdominoplasty)

Mommy Makeovers may include Breast Augmentation, Breast Lifts or Breast Reduction combined with a Tummy Tuck, Mini Tummy Tuck or just Liposuction, depending on the areas that need improvement and the patient’s wishes.

Mommy Makeovers may include Breast Augmentation, Breast Lifts or Breast Reduction combined with a Tummy Tuck, Mini Tummy Tuck or just Liposuction, depending on the areas that need improvement and the patient’s wishes.

There is no denying that breasts and bellies take a hit with pregnancy. Fortunately, there is a solution. Mommy Makeovers rejuvenate both the breasts and the belly, to help restore your pre-pregnancy body.

Mommy Makeover Options

The term Mommy Makeover comes from the frequently requested combination of cosmetic plastic surgery procedures used to restore a woman’s body after childbirth. The most common combination is Breast Augmentation with a Tummy Tuck, but variations are available when indicated.

Mommy Makeover Breast Options

The motivation for having a Mommy Makeover is the desire to restore the breasts and belly to their pre-pregnancy shape. For breast enhancement, the best procedure depends on how the breasts have changed:

  • Smaller Breast may benefit from Breast Augmentation.
  • Larger Breast may benefit from Breast Reduction.
  • Sagging breast may benefit from a Breast Lift.
  • Changes to the nipples and areolae can also be reversed.

Mommy Makeover Before and After Pictures

This Mommy Makeover included Breast Augmentation and a Tummy Tuck, the most common combination for restoring the body after childbirth.

This Mommy Makeover included Breast Augmentation and a Tummy Tuck, the most common combination for restoring the body after childbirth.

Mommy Makeover Belly Options

Just like with the breasts, there options are available for treating the belly, depending on each patient’s needs. While the most common surgery to restore a pre-baby belly is the Tummy Tuck, sometimes a smaller operation is the better choice. Regardless of the procedure used, the best results are obtained when your weight is optimal.

Common scenarios and treatment options include:

  • Loose abdominal skin and muscle laxity are treated with a Tummy Tuck (Abdominoplasty)
  • Loose skin and muscle laxity confined to the lower abdomen may respond to a Mini Tummy Tuck.
  • If the muscle and skin are tight, but disproportionate fat is present, Liposuction might be the best solution.
  • The abdominal fat, which is removed during the Mommy Makeover, is sometimes repurposed to enhance an atrophied bootie. Fat from the abdomen can often be transplanted to the buttocks as part of a Brazilian Buttocks Lift.

This Mommy Makeover combined a Breast Augmentation Lift with a Tummy Tuck and Liposuction.

This Mommy Makeover combined a Breast Augmentation Lift with a Tummy Tuck and Liposuction.

Mommy makeover Consultations

There are many treatment options for Mommy Makeovers, so it is necessary to have an experienced professional to guide your decision making. The Internet can give you an idea of what is possible; however, there is no substitute for an in-person consultation with an experienced Board Certified Plastic Surgeon.

If you have Mommy Makeover questions, call me at (925) 943-6353, and schedule a private consultation appointment. Your options will be discussed and your questions will be answered in a manner specific to your needs.

Coming Soon to a Station Near You

Stay tuned to the Bay Area’s News Station, KRON 4. Later this month, I will be starting my television show Body Beautiful with a segment dedicated exclusively to the Mommy Makeover, and more before and after pictures will be revealed.

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Saline Breast Implants – SF Bay Area Breast Aug Surgery

Posted February 11, 2019 in Breast Augmentation, Breast Implant Revision Surgery, Home

All breast Implants create larger breasts. While Silicone Breast Implants are more widely used, Saline Breast Implants still have a role to fill.

All breast Implants create larger breasts. While Silicone Breast Implants are more widely used, Saline Breast Implants still have a role to fill.

Over 90% of today’s Breast Augmentation patients choose Silicone Gel Breast Implants, but Saline Breast Implants still play a role in selected situations. Today, I review the pros and cons of Breast Augmentation with Saline Breast Implants.

Saline Breast Implant Cost Less

Saline Breast Implants cost less than Silicone Breast Implants. Since saline breast implants are easier to manufacture, they cost less. Also, saline breast implants are not pre-filled. The saline is actually inserted during surgery by your surgeon.

Saline Breast Implant Leak Detection

Saline is water with a little salt added to make it as salty as we are, about 0.9% NaCl.

Saline is water with a little salt added to make it as salty as we are, about 0.9% NaCl.

With Saline Breast Implants, leak detection is simple. When they leak, the slightly salty water inside escapes and is quickly absorbed by the body. The result is noticeable deflation, usually occurring overnight. Unlike Silicone Breast Implants, expensive diagnostic imaging, MRI is not needed. Saline Breast Implants are also easier to replace, because only the shell needs to be removed.

Saline Breast Implant Projection

Until recently, Saline Breast Implants provided more projection than silicone breast implants. When saline implants are filled, they become firmer and have more projection. For the same volume, Saline Breast Implants have about 10% more projection. Additionally, Silicone Breast Implants are flat on the back side, while Saline Breast Implants are convex.

Saline Breast Implants are convex on the back, so they give more projection than the flat-backed Silicone Breast Implants for the same volume.

Saline Breast Implants are convex on the back, so they give more projection than the flat-backed Silicone Breast Implants for the same volume.

Saline Breast Implant Incision Size

Saline Breast Implants are inserted empty, so the surgical incision is small. They can be collapsed and then filled after they are inserted by way of a filling tube. On the other hand, Silicone Breast Implants come pre-filled, thus they are bigger and require a larger incision for placement.

Saline Breast Implant Drawbacks

Saline Breast Implants feel firmer, tend to ripple (wrinkle) more and move differently than Silicone Breast Implants. For women going up one cup size, there may be enough native breast tissue to disguise the implant. However, for those going from an A-cup to a D-cup, the implant is more palpable, even when the Breast Implant is placed behind the muscle.

Breast Augmentation Consultation

The difference between Saline and Silicone Breast Implants is just one consideration before Breast Augmentation surgery. While the Internet can provide general information, consulting with an experienced, Board Certified Plastic Surgeon will help you translate which options will work best for you.

If you are in the San Francisco Bay Area, call (925) 943-6353 today, and schedule a private Breast Augmentation Consultation.

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Gummy-Bear Breast Implants Have Taken Over

Posted February 04, 2019 in Breast Augmentation, Home

Breast Augmentation before and after photos: Breast Augmentation remains one of the most popular cosmetic plastic surgery procedures. In the above photos, asymmetry, sagging and upper pole emptiness are corrected with Breast Implants.

Breast Augmentation before and after photos: Breast Augmentation remains one of the most popular cosmetic plastic surgery procedures. In the above photos, asymmetry, sagging and upper pole emptiness are corrected with Breast Implants.

Gummy-Bear Breast Implants have taken over as the implant of choice for Breast Augmentation. The vast majority of Breast Implants used in the US today are Silicone Gel filled, and almost all new Breast Implants are Gummy-Bear Breast Implants.

Gummy-Bear Breast Implants – What’s the Big Deal?

Gummy-Bear Breast Implants provide a soft, yet strong option for Breast Augmentation. To really appreciate the advantages that Gummy-Bear Breast Implants offer, it helps to know a little about the history of breast implants.

Brief History of Breast Implants

Since the beginning, Breast Implants have been filled with two materials: silicone and saline. Saline filled breast implants are silicone shells filled with water and a little salt to make the solution as salty as we are. Other than changes in shell shape, saline implants have remained the same throughout the years, and the saline filler has not changed at all. Their main advantages are easy detection of leaks and the fact that saline, like water, is quickly absorbed by the body, disappearing without a trace. Saline Breast Implants can provide more projection, and a rounder look than most silicone filled implants. However, saline filled breast implants tend to feel firm and show wrinkling more than silicone gel implants, especially when less breast tissue and thinner skin are present before Breast Augmentation.

Silicone gel filled breast implants have evolved over the last few decades. The latest options provide soft, strong implants filled with a cohesive, gummy-bear gel to reduce the possibility of gel migration.

Silicone gel filled breast implants have evolved over the last few decades. The latest options provide soft, strong implants filled with a cohesive, gummy-bear gel to reduce the possibility of gel migration.

Silicone Breast Implants, on the other hand, have evolved and improved during their almost 60 year history. The current gummy-bear silicone filled breast implants are considered fifth generation. Older versions were thinner, less cohesive, would bleed gel through the shell, tear easily and the thinner gel would migrate. In 1994, higher quality silicone, more cohesive gel and improvements in manufacturing have led to drastic reductions in gel bleed in intact implants, and reduction in gel migration in cases of breast implant rupture. The latest generation also use optimal gel fill to reduce wrinkling and a more cohesive gel to reduce gel migration to further enhance both cosmetic results and safety.

What Is A Gummy-Bear Breast Implant?

When discussing Gummy-Bear Breast Implants, the term “Gummy-Bear” refers to the filling in the center of the implant, not the shape. Gummy-bear candies are soft, and if you have ever bitten one in half, they are solid. Gummy-bear breast implants are similar. Unlike older silicone breast implants, if you cut a gummy-bear breast implant in half, it behaves like a solid and remains as two intact domes. Like the gummy-bear candy, the center does not flow. In my San Francisco Bay Area office I have a gummy-bear implant which I sliced in half years ago that has a cut surface which continues to remain smooth, flat and intact. The Gummy bear implants offer the safety and predictability that I want for my patients, with a softer result.

Gummy-Bear Breast Augmentation

If you are consulting for Breast Augmentation, be certain to ask your Board Certified Plastic Surgeon about breast implant options. Size, shape and filling all effect results. You don’t have to choose in the vacuum of the Internet. If you can provide your surgeon with your desired goal size, they will help you choose the best Breast Implant available to achieve your augmentation goals.

In the San Francisco Bay Area, if you are thinking about Breast Augmentation surgery, call (925) 943-6353 and schedule a personal consultation appointment. Whether you are interested in a primary Breast Augmentation or desire Breast Augmentation Revision, today’s new Breast Implants offer some never before available features.

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