Breast Augmentation Video | Walnut Creek | San Francisco Bay Area

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

Great 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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Abdominoplasty, Tummy Tucks, Mommy Makeover Videos – SF Bay Area

Posted June 24, 2019 in Brazilian Butt Lift, Breast Lift (Mastopexy), Fat Grafting, Home, Liposuction, Tummy Tuck (Abdominoplasty), Videos

Year after year, Tummy Tucks remain a top-ten Plastic Surgery procedure. Also known as Abdominoplasty, the procedure tightens and sculpts the abdomen on multiple levels. Tummy Tucks reverse and repair the damage to the abdominal wall caused by the overstretching of the skin and muscle that comes with weight gain and pregnancy. Damage that despite proper diet and exercise, often does not improve to the point of satisfaction. The result of Abdominoplasty is a flatter abdomen, and a more pleasing figure, boosting both self esteem and confidence.

Tummy Tuck Video (Abdominoplasty)

The following Tummy Tuck Video includes several examples of Abdominoplasty, after both weight loss and pregnancy. This segment is taken from the San Francisco Bay Area’s News Station, KRON 4’s Body Beautiful. In this video, I review Tummy Tuck Before and After Pictures and narrate the indications, procedure and recovery from Tummy Tuck Surgery.

Tummy Tuck With Brazilian Buttocks Lift

The Tummy Tuck may be combined with other procedures to enhance the results and keep the body in balance. The most common combination is Tummy Tuck plus Liposuction of the sides and back to improve the waist line all the way around. This is helpful when there is a disproportionate amount of fat causing a muffin top.

Today, fat is often transferred to provide volume in areas of deficit or areas that have atrophied. The most common area that fat is grafted to is the aging face. Fat Transplantation can reduce wrinkles and revitalize saggy cheeks by optimizing facial volume. Less common, but the fastest growing area for fat grafting is the buttocks, no pun intended. Fat Grafting to the Buttocks is also known as the Brazilian Butt Lift. The Tummy Tuck Before and After Photos below also include the results of liposuction and fat grafting to optimize body proportions.

Tummy Tuck with Brazilian Butt Lift Before and After pictures

Tummy Tuck with Brazilian Butt Lift Before and After pictures show: flattening of the tummy, improvement in abdominal muscle tone and perkier, rounder and more defined buttocks.

In the above case, a Tummy Tuck was used to tighten the abdominal muscles, reduce skin laxity and remove disproportionate abdominal wall fat. Liposuction was used to further enhance the results by removing disproportionate fat from the abdomen, waist, lower back and thighs. Normally, the fat removed by Liposuction is discarded; however, additional improvement in my patient’s body proportions was obtained by repurposing the fat to enhance the buttocks. A Brazilian Buttocks Lift was performed to create more shapely buttocks. For her, rounder, firmer buttocks were created, and the indentations on the outer aspect of the buttocks were corrected. Combining procedures repaired the postpartum damage improved her appearance in form-fitting clothes. She is happier and more confident with her new shape.

Tummy Tuck As Part Of A Mommy Makeover

Tummy Tucks are an important part of the Mommy Makeover, enhancement of both the breasts and the belly, frequently after pregnancy. The most common combination of procedures for Mommy Makeovers is Breast Augmentation with a Tummy Tuck; however, other procedures can be substituted as needed or desired. In the following case, Abdominoplasty was performed with a Breast Lift (Mastopexy), rather than Breast Augmentation, because she was already happy with the size of her breasts, but not the shape.

Mommy Makeover Before And After Pictures

Mommy Makeover Before And After Pictures – In this case, Abdominoplasty was combined with a Breast Lift to complete this Mommy Makeover. (To see the movement of the nipple in the uncensored photos, click this picture.)

The above Mommy Makeover Before and After Pictures reveal the results of combining Abdominoplasty with a Breast Lift. Prior to her Mastopexy, she was happy with the size of her breasts, and how they looked in a bra; however, the droopy appearance and downward pointing nipples were not acceptable. Breast Augmentation would have enlarged her breasts, but size was not the issue. Also Breast Augmentation alone would not correct the low nipple position, therefore a Breast Lift was the best option and the procedure of choice. An uncensored version of the before and after is available for viewing by clicking on the picture.

Abdominoplasty After Massive Weight Loss

After weight loss, especially massive weight loss, the abdominal wall is left lax and redundant. This is true at multiple levels of the abdominal wall including both the superficial skin and the deeper muscle and fascia layers. Abdominoplasty is uniquely appropriate for correcting both problems. A Tummy Tuck repairs the muscle by tightening the tough fascial case that encloses it, much like applying an internal corset. This flattens the abdominal wall’s foundation and supports the guts. Tummy Tucks also remove the excess skin and fat from the lower abdomen, thereby eliminating the redundant skin that impairs hygiene and blocks wearing clothing with a cinched waist.

Post Bariatric Plastic Surgery - Tummy Tuck Before and After Pictures

Post Bariatric Plastic Surgery – Tummy Tuck Before and After Pictures. Abdominoplasty was used to flatten the belly by tightening the muscles, removing the fat and reducing the redundant skin.

Abdominoplasty is often used after Bariatric Surgery to “clean-up” excess skin and complete the journey to a better body. It is normal to wait one year after Bariatric Surgery before having Plastic Surgery. Earlier surgery increases the risk of wound healing problems. By waiting for the body to recover nutritionally, we can enhance wound healing and achieve superior results.

Tummy Tuck Plastic Surgeon

If you’ve recently had a baby or lost weight and are contemplating plastic surgery to flatten your belly, you are going to want a Board Certified Plastic Surgeon for your procedure. Board Certified Plastic Surgeons are uniquely qualified due to their years of training and experience performing Cosmetic Plastic Surgery.

To find out more about Abdominoplasty, call me at (925) 943-6353. Each patient is unique in their needs and desires. In every case, both are considered when planning your specific procedure. Enter your questions in the contact form on this page, or for a faster response, give us a call and get answers now.

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Male Breast Reduction for Gynecomastia Video | SF Bay Area

Posted June 20, 2019 in Breast Asymmetry, Breast Reduction, Breast Reduction (Men), Home, Liposuction, Nipple Reduction, Tubular Breasts, Videos

Gynecomastia Reduction for male breast enlargement before and after pictures

Gynecomastia Reduction is performed for male breast enlargement. These before and after pictures show a reduction in breast projection on the oblique view.

Gynecomastia is the growth of excess breast tissue in the male chest. The resulting mass causes fullness, embarrassment and often tenderness, for men who develop what is colloquially known as “man boobs.” Gynecomastia Reduction removes the excess breast tissue and restores the masculine physique. This Gynecomastia Reduction Video illustrates and narrates several typical cases.

The Gynecomastia Reduction Before and After Pictures shown above and below are of the same patient. The oblique views (above) show the reduction in projection that Male Breast Reduction can achieve. The front view (below) reveals that more tissue was removed from the larger left side. The Gynecomastia Reduction improved his breast symmetry by equalizing his breast volume, reducing the size of his areolae and elevating the position of the left nipple. Areola Reduction and Nipple Reduction are separate procedures used to reduce the size of the areolae and nipples. In this case, these ancillary procedures were not necessary.

Before and after pictures of Gynecomastia Reduction for male breast enlargement.

Gynecomastia Reduction is performed for male breast enlargement. These before and after pictures show improved symmetry and reduction in breast and areolar size.

Gynecomastia Reduction Video

The following Gynecomastia Reduction Video reviews several typical Male Breast Reduction Surgeries, and narrates the indications, procedure and recovery. This video originally aired on the San Francisco Bay Area’s News Station, KRON 4.

Gynecomastia Reduction for Tubular Breasts

Tubular Breasts can occur in both men and women. For women, the goal of Tubular Breast Surgery is the creation of normally shaped and symmetrical breasts, For men, the goal is the same as with all Gynecomastia Reduction Surgery: the reduction and flattening of the chest.

Gynecomastia Reduction for Tubular Breasts before and after photos.

These before and after photos show how Gynecomastia Reduction can improve the appearance of Tubular Breasts for men.

Gynecomastia Reduction for Bodybuilders

Gynecomastia Reduction is particularly useful for the reduction of breast buds in bodybuilders. As they lean out for competition, the fat flattens; however, the gland does not. This causes increased projection of the nipple-areolar complex. These buds are distracting, and they lead to penalties during competition. Since Gynecomastia can occur with steroid use, removing the mass removes the stigmata.

Gynecomastia Reduction for Body Builders before and after photos

These Gynecomastia Reduction before and after photos show reduction of the glandular tissue under the nipples for a Bodybuilder.

Gynecomastia Reduction for Asymmetry

Most breasts are asymmetrical. For men this is usually subtle, but when Gynecomastia forms, the asymmetry can become quite pronounced. In the case below, the left breast is significantly larger than the right. Even in a dress shirt, the left breast protruded and was a source of embarrassment for my patient. Gynecomastia Reduction was performed on both sides, and more tissue was removed from the left to provide a flattened, masculine chest.

Before and after photos of Gynecomastia Reduction for the asymmetrical male chest.

Sometimes Gynecomastia occurs primarily on one side of the male chest. These before and after photos show the improvement of breast symmetry after Gynecomastia Reduction.

Consultations For Male Breast Reduction

If you are among the one-third of men who have persistent Gynecomastia after puberty, and would like to learn exactly what treatment options are available for you, call (925) 943-6353 today, and schedule a private consultation appointment in my San Francisco Bay Area Plastic Surgery office.

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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 – 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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BIA-ALCL Update 2019

Posted February 25, 2019 in Breast Augmentation, Home, Patient Safety

What we know about Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is evolving. We learn more as each new case is identified. Right now, there are just too few cases to know many of the specifics; however, today I will go over the data currently available.

ASPS and ASAPS summary of BIA-ALCL in 2019

ASPS and ASAPS summary of BIA-ALCL in 2019

Much of this information comes from the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS). Thanks to its members voluntarily reporting and collecting information on BIA-ALCL, these US based national plastic surgery organizations have the best database on BIA-ALCL in the world.

What is BIA-ALCL?

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and treatable type of T-cell lymphoma that can develop around breast implants. BIA-ALCL is not a cancer of the breast tissue itself. It is not breast cancer, but it is found in the breast, around the capsule which surrounds breast implants.

When Does It Present?

The time between breast implant insertion and diagnosis of BIA-ALCL varies greatly. It ranges from 9 months to 27 years, with an average delay in presentation of 9.2 years.

Who Gets BIA-ALCL?

Cases seem to be concentrated in patients who have, or who have had textured breast implants. It seems to be related to the aggressiveness of the texturing and has occurred in patients with both silicone and saline filled breast implants.

Early diagnosis and treatment are key to curing BIA-ALCL. When in doubt; check it out.

When in doubt; check it out. Early diagnosis and treatment are key to curing BIA-ALCL.

After reviewing all available case series, case reports, and registries, BIA-ALCL is more common with textured implants. Textured implants are used less frequently than smooth implants. Textured implants are also used more often for breast reconstruction after breast cancer, because shaped implants are more desirable in this population and texturing is used to reduce breast implant rotation for shaped implants.

To date, no cases of BIA-ALCL have been verified in patients who have had exclusively smooth breast implants. However, it is not possible to exclude the appearance of BIA-ALCL in association with smooth implants at this time. The FDA reports that they are aware of smooth breast implant only cases; however, they warn that this information is “unverified” and potentially “inaccurate.”

The association of BIA‐ALCL and textured implants may be related to the increased surface area of the texturing; however, this has not yet been definitively proven. The variation in surface texturing among breast implant manufacturers may mean there are variable risks for the development of BIA-ALCL.

How Does BIA-ALCL Present?

The majority of patients present years after their initial surgery with one breast gradually increasing in size. The increased size is from fluid, serum, collecting around the breast implant. This collection of fluid is called a seroma. Seromas are normal right after surgery; however these seromas appears later and are thus called a delayed seromas. A few patients have presented with different symptoms such as a mass, skin rash, fever and night sweats, and lymphadenopathy.

How Is The Diagnosis of BIA-ALCL Made?

BIA-ALCL usually presents as increased breast size due to fluid collecting around a textured breast implant.

BIA-ALCL usually presents as increased breast size due to fluid collecting around a textured breast implant.

Diagnosis is based on analysis of the fluid in the seroma. Most commonly, ultrasound‐guided fine needle aspiration of the peri-implant fluid is assessed with immunohistochemistry for CD30-positive large anaplastic T-cell lymphocytes.

How Is BIA-ALCL Worked Up?

PET‐CT is performed following a positive diagnosis. Mammograms are not helpful for evaluating lymphoma, but are important for the evaluation of breast cancer. Often, a multidisciplinary team approach including, when required, an oncological breast surgeon and an oncologist specializing in lymphoma.

How Is BIA-ALCL Treated?

The treatment of BIA-ALCL is evolving. In most cases, cure is obtained by removal of the breast implant and the capsule surrounding it. Incomplete capsular resection has been associated with both recurrence and significantly lower survival. Rarely, patients may present with a mass and have an increased risk of requiring radiotherapy and chemotherapy. Treatment approach should follow international guidelines established by the National Comprehensive Cancer Network (NCCN) for BIA-ALCL, available at nccn.org.

Current treatment recommendation is for bilateral complete capsulectomy and implant removal, as a small number of women have had contralateral disease found incidentally; however, it cannot be stressed enough that the treatment is still evolving, and each patient must be individually evaluated. If you suspect you have BIA-ALCL, do not delay, and contact your plastic surgeon or primary medical doctor immediately.

Summary Statement On BIA-ALCL From The ASPS

I have included below a statement released by the American Society of Plastic Surgeons (ASPS) this week. It summarizes well what we currently know about BIA-ALCL. The ASPS has also published an 2019 online BIA-ALCL summary.

“Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon type of lymphoma that can develop in the scar capsule near saline or silicone breast implants. This disease is currently being investigated as to its relationship with breast implants. The family of ALCL is a rare cancer of the immune system, which can occur anywhere in the body. Based on adverse event reports, the United States Food and Drug Administration (FDA) estimates the total number of cases of BIA-ALCL to be over 450 cases.”

“It has been noted that the majority of BIA-ALCL patients have a history of a textured-surface device. An exact single-number estimate of the risk for both textured and non-textured implants is not possible with the currently available data. Lifetime risk of BIA-ALCL has been estimated at 1:1,000 to 1: 30,000 for women with textured breast implants, and BIA-ALCL risk is currently under investigation. BIA-ALCL usually involves swelling of the breast at an average of 3 to 14 years after the initial breast implant operation. Most cases were cured by removal of the implant and the capsule surrounding the implant; however, rare cases have required chemotherapy and/or radiation therapy for treatment.”

“Patients with breast implants should be followed by a surgeon over time and seek professional care for implant-related symptoms such as pain, lumps, swelling, or asymmetry. Patients should monitor their breast implants with routine breast self-exams and follow standard medical recommendations for imaging (e.g. Mammography, Ultrasound, MRI). Abnormal screening results or implant-related symptoms may result in additional expenses for tests and/or procedures to properly diagnose and treat your condition. Tests and procedures could include but may not be limited to: obtaining breast fluid or tissue for pathology and laboratory evaluation, surgery to remove the scar capsule around the breast implant, implant removal, or implant replacement.”

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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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Silicone Breast Implant Warranty Comparisons

Posted January 28, 2019 in Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Breast Reconstruction, Home, Patient Safety

Breast Implant Warranty Coverage

Every few years, the US FDA approved breast implant manufacturers update their Breast Implant Warranties. While implant deflation has been covered for a long time, the warranties now include extended coverage for breast implant replacement and enhanced coverage for specific situations that may occur after Breast Augmentation with Silicone Gel Filled Breast Implants. Expanded coverage now includes Capsular Contracture, late seroma formation, double capsule formation and BIA-ALCL.

Below, I compare warranties offered by the three US breast implant brands: Allergan, Sientra and Mentor, in the three major areas of coverage: Capsular Contracture, Rupture and Seroma Formation. It is important to state that these are the current offerings, and that they may change without notification. You should check with the manufacturer directly for the latest warranty information. Additionally, newer coverage is limited to newer implants, so you need to know the manufacturer, type of implant and the date of your surgery in order to determine which warranty applies to your implants.

Capsular Contracture Coverage

The most common reason for Breast Augmentation Revision Surgery is Capsular Contracture. In the breast implant 10-year follow-up studies, occurrence rates ranged from 12% to 19% for the primary breast augmentation cohort. Breast Implant manufacturers have begun to include Capsular Contracture in their warranty programs.

Capsular Contracture is tightening of the scar pocket that holds the breast implant in place. In the left before-photo, Capsular Contracture elevates this patient's right breast implant and causes severe asymmetry. The right after-photo shows correction after capsule surgery and breast implant revision surgery. Now, Capsular Contracture is covered by all three US FDA approved manufacturers' warranties.

Capsular Contracture is tightening of the scar pocket that holds the breast implant in place. In the left before-photo, Capsular Contracture elevates this patient’s right breast implant and causes severe asymmetry. The right after-photo shows correction after capsule surgery and breast implant revision surgery. Capsular Contracture is now covered by all three US FDA approved manufacturers’ warranties.

Sientra currently offers the best free warranty for Capsular Contracture (grade III or IV). The latest Sientra Platinum20 Warranty offers twenty years of free implant replacement during surgery for Capsular Contracture along with $2000 of financial assistance if capsular contracture occurs in the first two years after surgery.

The Allergan ConfidencePlus Warranty was just updated and is a close second with ten years of free implant replacement during surgery for Capsular Contracture along with $2000 of financial assistance if capsular contracture occurs in the first two years after surgery.

The MentorPromise Warranty offers ten years of free implant replacement during surgery for Capsular Contracture, but no financial assistance. However, Mentor does offer an enhanced warranty. You need to pay $300 to Mentor at the time of your surgery to obtain the MentorPromise Enhanced Warranty. This includes ten years of free implant replacement during surgery for Capsular Contracture and $3500 of financial assistance but limits coverage to primary augmentation or primary reconstruction unless MemoryShape breast implants are utilized. Mentor currently lags, especially when comparing the free warranties; however, Mentor may update their warranty to more closely match their competitors as Allergan did when Sientra announced enhanced free coverage for capsular contracture.

Rupture Coverage

Breast Implant Rupture was the original coverage benefit for Breast Implant Warranties. It is a close second to Capsular Contracture as the reason for Breast Augmentation Revision Surgery. In the 10-year follow-up studies, rupture (deflation) rates range from 8% to 25%.

These Breast Implant Rupture Before and After photos illustrate a common case of Breast Implant Revision Surgery. The coverage is variable and depends on the manufacturer.

These Breast Implant Rupture Before and After photos illustrate a common case of Breast Implant Revision Surgery. The coverage is variable and depends on the manufacturer.

All three manufacturers provide free lifetime breast implant replacement on both sides and financial assistance for the revision surgery. Recently, Sientra increased the financial assistance offered, and it remains to be seen if the other manufactures will match them, as they often do.

The Sientra Platinum20 Warranty offers $5000 in financial assistance toward replacing the breast implants for up to 20 years after the original surgery. This is a recent change and is currently the best in the industry.

The Allergan ConfidencePlus Warranty offers $3500 in financial assistance toward replacing the breast implants for up to 10 years after the original surgery.

The MentorPromise Warranty also offers $3500 in financial assistance toward replacing the breast implants for up to 10 years after the original surgery. This is not increased in the MentorPromise Enhanced Warranty.

Late Seroma Coverage

As shaped implants became more popular, so did the problems associated with them. Shaped implants can rotate and “change” shape. To reduce this problem, shaped implants are textured. This can help prevent rotation and may also reduce the risk of capsular contracture; however, Textured Breast Implants also have unique problems: seromas (collections of fluid around implants), double capsules and possibly BIA-ALCL. Manufacturers have responded with late seroma coverage along with coverage for double capsules and BIA-ALCL diagnostic testing in their latest Breast Implant Warranties.

Seromas are collections of fluid. Small amounts of fluid around the breast implants is normal the first few days after surgery and resolves spontaneously. Seromas that appear years after surgery are not normal or common. The fluid will enlarge the effected breast, making it appear larger than its sister breast. It may present as the picture above shows, with the right breasts appearing larger than the left. There are many causes, most of them benign; however, all should be checked by your plastic surgeon. Breast implant warranties are starting to include testing and treatment for late seromas.

Seromas are collections of fluid. Small amounts of fluid around the breast implants is normal the first few days after surgery and resolves spontaneously. Seromas that appear years after surgery are not normal or common. The fluid will enlarge the effected breast, making it appear larger than its sister breast. It may present as the picture above shows, with the right breasts appearing larger than the left. There are many causes, most of them benign; however, all should be checked by your plastic surgeon. Breast implant warranties are starting to include testing and treatment for late seromas.

The Sientra Platinum20 Warranty provides twenty year coverage for breast implant replacement and $2000 in financial assistance should a double capsule or seroma form in the two years after surgery. They also provide CD30 panel testing for BIA-ALCL evaluation of late seroma fluid.

The Allergan ConfidencePlus Warranty also was recently updated to provide twenty year coverage for breast implant replacement and $2000 in financial assistance should a double capsule or seroma form in the two years after surgery. They also provide up to $7500 in financial assistance and implant replacement in cases of BIA-ALCL.

The MentorPromise Warranty offers ten year coverage for breast implant replacement and no financial assistance in cases of double capsule and seroma formation. However, Mentor does offer an enhanced warranty. You need to pay $300 to Mentor at the time of your surgery to obtain the MentorPromise Enhanced Warranty. This includes ten years of free implant replacement during surgery for Capsular Contracture and $3500 of financial assistance in the ten years after surgery. Like the Mentor Capsular contracture coverage, coverage is limited to primary augmentation or primary reconstruction unless MemoryShape breast implants are utilized. There is currently no coverage for BIA-ALCL testing.

Breast Augmentation and Breast Augmentation Revision

If you are considering Breast Augmentation or Breast Augmentation Revision, be certain to ask your Board Certified Plastic Surgeon about breast implant warranties. For revision surgery, bring as much information as possible about your current implants to your consultation appointment. The breast implant card given to you after surgery is very helpful as it provides the manufacturer, size, type of implant, and date of implantation.

There is much to know about Breast Implants and the procedures used to place and maintain them. It helps to have an experienced guide to answer your questions and provide expert guidance. For Breast Augmentation and Breast Augmentation Revision in the greater San Francisco Bay Area, call (925) 943-6353 today, to schedule a private consultation.

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