Gynecomastia Reduction – Male Breast Reduction | San Francisco Bay Area

Posted November 11, 2019 in Breast Reduction, Breast Reduction (Men), Home, Liposuction

Between men and women, the breasts are an area with significant aesthetic differences. For both sexes, shape trumps size. However, size is particularly important for the masculine chest. Male breast enlargement is a source of embarrassment and a common reason that men both young and old seek plastic surgery.

Gynecomastia Reduction - before and after pictures

Gynecomastia Reduction Before and After Pictures – The before picture on the left is of an adolescent male who experienced sudden and severe gynecomastia development while still attending high school. He was more comfortable and happy in the after photo on the right.

Gynecomastia Reduction Surgery is a relatively short outpatient surgical procedure. Also known as Male Breast Reduction, it is often performed for men whose breast tissue has grown too large, making them unhappy with the appearance of their chest.

The Ideal Male Chest

Gynecomastia Reduction before and after photos - Male Bodybuilder

Gynecomastia Reduction before and after photos – The above Male Bodybuilder has spent a lot of time developing and contouring his chest. Unfortunately, he had a small amount of gynecomastia causing puffiness behind his nipples, left greater than right. Gynecomastia reduction improved his symmetry and put the icing on this beefcake.

While a man’s chest is generally flatter than a woman’s, it is not flat. A certain amount of projection and curvature is masculine. On the other hand, too much projection is feminizing. This applies to both the chest mound and the nipples. The lateral aspect of the ideal masculine chest ends at the edge of the pectoralis major muscle. Unlike a woman’s breasts, the masculine chest does not have “side-boob”, and male nipples are smaller and flatter.

Gynecomastia Reduction before and after photos - body builder side view

Gynecomastia Reduction before and after photos – This is the same body builder seen above. On the side view, his puffy nipples due to gynecomastia are more easily seen. The after photos shows his improved appearance.

What Is Gynecomastia?

Gynecomastia is overdeveloped breast tissue in men. It can be a source of embarrassment both in and out of clothing. Even in clothing, an overdeveloped male chest can be hard to disguise. The majority of the breast tissue in a man is behind the nipple. Excess fullness in this area causes the areolae (the circles of colored skin around the nipple) to over project, making the nipples stick out. The more prominent the tissue, the harder it may be to participate in normal activities such as going to the beach or swimming. This is often referred to as “puffy nipples”.

What Is Gynecomastia Reduction?

Gynecomastia Reduction is an outpatient surgical procedure which removes disproportionate breast tissue and fat from the male chest. It is the most effective way to remove gynecomastia and masculinize the chest. Male Breast Reduction, whether for body builders and regular Joes, is one of the most satisfying services I provide every week as a Cosmetic Plastic SurgeonWalnut Creek Plastic Surgery practice.

Gynecomastia reduction with liposuction and direct excision - before and after photos

Gynecomastia reduction before and after photos: Even this hairy chest looked feminine in a shirt. A combination of Liposuction and direct excision was used to remove the excess breast tissue and masculinize this patient’s chest.

Gynecomastia Reduction is usually performed with a combination of Liposuction and direct excision of the excess breast tissue. This two-pronged approach allows for the removal of excess fat via small incisions in the armpits and removal of the firm, rubbery breast tissue from beneath the nipples via periareolar incisions. The incisions are usually discreet, but the results are clearly evident and very satisfying.

Gynecomastia Consultations

Gynecomastia Reduction Consultations should be sought from an experienced, Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353 for your private and personal consultation appointment. More details about the procedure are available here, on the San Francisco Plastic Surgery Blog, but for the best information, there is no substitute for an in-person evaluation.

Read More

Breast Revision Surgery Video

Posted November 04, 2019 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Revision Surgery, Home, Videos

Breast Augmentation remains one of the most frequently performed cosmetic plastic surgery operations. While the procedure remains the safest and most reliable means of Breast Enlargement, from time to time, patients may require Breast Augmentation Revision Surgery.

Saline Breast Implant Deflation Replacement Before and After Pictures

Saline Breast Implant Deflation Replacement Before and After Pictures

Saline Breast Implant Deflation Replacement Before and After Pictures – On the left, this patient’s saline breast implant has clearly deflated. On the right, after breast augmentation revision surgery, both breast implants were replaced and the breasts are now rejuvenated. A great time to consider changing the size, style or type of breast implant is when you need to replace a deflated device.

Breast Implant Revision Video Presentation

Today’s Plastic Surgery Video outlines several of the most common Breast Implant Revision Surgeries, and illustrates what is possible with numerous Breast Augmentation Revision Before and After Pictures. My segment segment first aired on, the San Francisco Bay Area’s news station KRON 4’s Body Beautiful. I have made numerous appearances during the show’s 12-years run, I have had the opportunity to inform millions of viewers about the pros and cons of Cosmetic Plastic Surgery.

Breast Revision Surgery Video Presentation as seen on KRON 4’s Body Beautiful

Breast Augmentation Revision Surgery

Breast Augmentation Revision Surgery for Capsular Contracture - Before and After Pictures

Breast Augmentation Revision Surgery for Capsular Contracture – Before and After Pictures show treatment of capsular contracture of this patient’s right breast implant. The results are improved symmetry, softness and patient satisfaction.

The majority of patients do not require revision surgery; however, Breast Implants are not considered lifetime devices. As such, they may require maintenance. The care of Breast Augmentation patients has become a specialty unto itself. Breast Augmentation Revision encompasses a variety of procedures including surgeries to adjust breast implant size, soften capsular contracture, reposition implants that have shifted and replace implants that have ruptured.

Breast Implant Revision Surgery for Symmastia - Before and After Pictures

Breast Implant Revision Surgery for Symmastia – Before and After Pictures. This patient developed symmastia, uni-boob or breast-loafing of her breast implants. Before correction, she had breast implant malposition with both symmastia and bottoming-out. After breast revision surgery, her breasts are separated and elevated to a more aesthetic position.

Breast Augmentation Revision Surgery Consultations

Breast Implant Revision is an important aspect of maintaining Breast Augmentation aesthetics. Like primary Breast Augmentation, careful attention to detail is necessary. If you are considering Breast Implant Revision surgery, be certain to consult with an experienced and Board Certified Plastic Surgeon. In the San Francisco Bay Area, call (925) 943-6353 to schedule your private consultation appointment.

Read More

Breast Cancer Awareness Means Men Too

Posted October 07, 2019 in Breast Cancer Awareness, Breast Reduction (Men), Home, Patient Safety

October is Breast Cancer Awareness Month.

October is Breast Cancer Awareness month, so check your breasts and follow-up with your healthcare provider for any abnormalities. Men get breast cancer too, so everyone needs to check. Getting started is simple and painless.

Breast Cancer Awareness

October is Breast Cancer Awareness Month. We all, women and men alike, need to take a few minutes to take care of ourselves. We have all heard the sound bites. One in eight women get breast cancer, and only 20% have a family history of breast cancer.

Breast Cancer in Men is rare. One in 1000 men will develop breast cancer, and less than 1% of all breast cancer cases develop in men. This may be because men have fewer breast cells and lower estrogen levels. On the other hand, early detection in men, while somewhat easier, is even more important than for women. Smaller breasts mean that the cancer cells can escape the breast faster and invade locally more quickly, especially when treatment is delayed by assuming men don’t get breast cancer.

According to the American Cancer Society, there will be about 3000 new cases of invasive breast cancer in men in the U.S. this year and about 500 men will die from the disease, and black men tend to have a worse prognosis.

Breast Cancer Detection

The most common presentation of Breast Cancer in men is a hard, painless lump underneath the nipple and areola. The lump can be fixed and it may be hard to determine the edges as the cancer invades the surrounding normal tissues. For 67-year-old Mathew Knowles, perhaps know better as Solange and Beyonce’s father, the first indication that something was wrong was when he and his wife noticed small dots of blood on his shirts and bedsheets.

Matthew Knowles, seen here with his daughter Beyonce, was recently diagnosed with breast cancer.

Matthew Knowles, seen here with his daughter Beyonce, was recently diagnosed with breast cancer.

Mister Knowles was on Good Morning America last Wednesday with host Michael Strahan, sharing his experiences and encouraging men and women to do their breast self-exams and get tested promptly. He had surgery at the end of July, and in his words is doing “really good.”

“I’m hoping by me coming here today, speaking out, letting folks know that you can survive this. But it has to be early detection. And I can’t overemphasize the word early,” he said. Well done Beyonce’s dad. Well done.

Breast Cancer Genetics

Although treatment outcomes are very similar to women at the same stage of detection, a man diagnosed with breast cancer should also consider seeing a genetics counselor for a consultation. If a man tests positive for a defective gene like BRCA1 or BRCA2, it can lead to a future diagnosis of breast cancer and his children have a 50% chance of carrying the gene. These statistics come from the National Breast Cancer Foundation.

KISS drummer Peter Criss is an outspoken advocate for male breast cancer awareness.

KISS drummer Peter Criss is an outspoken advocate for male breast cancer awareness. In his words, “You don’t need boobs to get breast cancer.”

Peter Criss found a lump in his left breast after a workout in 2007. The legendary KISS drummer survives after successful treatment, and he remains an outspoken advocate for male breast cancer awareness.

A male child of a man with breast cancer who inherits the defective BRCA2 gene has an approximately 6% chance of eventually developing breast cancer and just over 1% chance with BRCA1. A female child of a man with breast cancer who inherits the defective gene has a risk between 40% and 80% of eventually developing breast cancer. Men with a genetic predisposition to breast cancer are also at a higher risk of getting prostate cancer at a younger age.

Macho Men Get Breast Cancer Too

Richard Roundtree, the actor and model, exploded onto the big screen in 1971 as John Shaft, an action hero who took no guff. As an actor, Richard Roundtree’s Shaft is as macho as a man can be. He was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy. I am happy to report that he is alive and well at age 77. Early detection and treatment are key. I can dig it!.

Richard Roundtree was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy, and is alive and well at 77

Richard Roundtree was diagnosed with breast cancer in 1993 and underwent a double mastectomy and chemotherapy, and is alive and well at 77. According to the theme song, “Who’s the cat that won’t cop out when there’s danger all about?” Can ya dig it?

Rod Roddy, Come On Down

You may not recognize the name, but if you are old enough to remember Bob Barker on the Price is Right, you will remember Rod’s voice. As the hyper-energetic off-stage announcer he would call out an audience member’s name followed by one of the most iconic catchphrases to grace daytime game shows, “Come on down! You’re the next contestant on the Price is Right!” Even though the “Come on down,” was first uttered by Johnny Olson, Rod Roddy belted it out for 17 years, longer than any other announcer.

The Price is Right announcer Rod Roddy had both breast and colon cancer during his lifetime.

The Price is Right announcer Rod Roddy had both breast and colon cancer during his lifetime.

Breast cancer and colon cancer can travel together. On September 11, 2001, Mr. Roddy was diagnosed with colon cancer, and in 2002 had a recurrence. In March of 2003, he was diagnosed with Breast Cancer. In the last few years of his life, he became a spokesperson for early detection of cancer. In an interview with CBS, he said, “I could have prevented all this with a colonoscopy, and of course, that’s the campaign I’ve been on since I had the first surgery. To everybody out there, get a mammogram! It can happen to men, too.”

Breast Cancer and Politics

Edward William Brooke III was an American Republican politician. In 1966, he became the first African American popularly elected to the United States Senate, and he represented Massachusetts in the Senate for 12 years, from 1967 to 1979. In September 2002, he was diagnosed with breast cancer and assumed a national role in raising awareness of the disease among men.

In 1966, Edward Brooke became the first African-American elected to the US Senate. He is seen here with his mother after receiving the 1978 Man of the Year Award. In September of 2002, Senator Brooke was diagnosed with breast cancer. (AP)

In 1966, Edward Brooke became the first African-American elected to the US Senate. He is seen here with his mother after receiving the 1978 Man of the Year Award. In September of 2002, Senator Brooke was diagnosed with breast cancer. (AP)

Brooke experienced pain under his right nipple. Most breast cancer is painless, but pain harder to ignore than a lump. His first thought was that he had pulled a muscle from gardening, but it was more serious. It was breast cancer. He underwent a double mastectomy, and remained cancer free until his death in January 2015 at age 95.

You Better Check Yourself…

There are expected to be about 3000 new cases of male breast cancer diagnosed this year. For women it is closer to 300,000 cases, and, an estimated 42,000 women will die from breast cancer in the U.S.. The good news is that 62% of breast cancer cases are diagnosed early when they are still localized. In localized cases, the 5-year survival rate is 99%.

I tell all my patients, “If something doesn’t seem right; it might be wrong. Call me.” Early detection and intervention is key for all medical issues. It allows more options for treatment and better outcomes. There is little downside. If there’s nothing wrong, you wasted a little time to find out that you are alright, plus you get peace of mind. On the other hand, if you have a problem, treatment can begin. All breast lumps and bumps need to be evaluated by your physician in a timely fashion, so if you have a lump in your breast, contact your physician today.

Read More

Breast Augmentation Revision Surgery – SF Bay Area

Posted September 02, 2019 in Breast Asymmetry, Breast Augmentation, Breast Augmentation Lift, Breast Implant Removal, Breast Implant Revision Surgery, Breast Lift (Mastopexy), Capsular Contracture, Home

Breast Implant Revision Surgery is performed when there is a problem with the breast implants. Some problems are subjective, for example when the implants are judged to be too small or too large. Other problems are objective, such as issues with the breasts’ shape, firmness, symmetry or position. These are commonly associated with Capsular Contracture and breast implant malposition. A third group of breast implant problems require urgent attention, like infections or exposure of the breast implants.

Today’s post reviews Breast Revision Surgery and the treatment for some of the more common Breast Augmentation Problems.

Capsular Contracture Correction

Capsular Contracture occurs when the normal pocket that holds the breast implant in place becomes tight. It can be tight all around the implant causing firmness and a reduction in the apparent size of the implant(s), or it can be along one side, pushing the implant out of position, usually upward.

Breast Implant Revision for Capsular Contracture Before and After Pictures - Front View

These breast augmentation revision before and after pictures show grade III/IV capsular contracture of the right breast preoperatively, and the result of removing the tight capsule (capsulectomy) thus lowering the breast mound to match the left side. (Click image for uncensored view.)

In the Breast Implant Revision Before and After Pictures above, the right breast mound is significantly higher, and harder, than the normal appearing left breast mound (Grade III Capsular Contracture). This is a problem for the patient both in and out of clothing, and with time, the right breast has become tender (Grade IV Capsular Contracture).

This Breast Implant Malposition was treated with a complete capsulectomy, removal of the tight scar. The result is a softer breast, that is lowered back to its normal and symmetrical position. The areolae are also more symmetrical postoperatively. To see the nipple position, click or touch the picture above and the censoring will be removed. Tap again to replace it.

Symmastia Correction for Uniboob

Symmastia is a specific type of Breast Implant Malposition where the implant(s) move toward the midline. It is more common in women with tighter skin and larger, high profile breast implants. Just like raising the towers on the Golden Gate Bridge would raise the bridge’s cables across the mouth of the San Francisco Bay, the high profile breast implants have raised the skin across the sternum causing a Uniboob Deformity or “Bread Loafing”. In addition, this patient has “bottoming-out” of her breast implants, greater on her right side.

Breast Implant Revision for Symastia or Uniboob Before and After Pictures - Front View

These breast augmentation revision before and after pictures show symmastia of the breasts and bottoming out (right greater than left) preoperatively. The after photo shows the result of symmastia repair and breast implant replacement with smaller breast implants and raising of the inframammary folds (IMFs) thus getting rid of the uniboob bread-loafing of the implants in the midline. (Click image for uncensored view.)

The Symmastia Deformity was corrected by both repairing the damage and addressing the original problem to prevent recurrence. The damage was repaired by closing the original capsule medially, forming a pseudoneopocket in the correct anatomical position and reinforcing the repair. Since the original cause was breast implants too large for the chest, they were replaced with smaller implants. The after picture shows that the breasts have been elevated and separated into two separate breast mounds. Breast symmetry is improved and the reduction in breast implant size should help to maintain the superior cosmetic result.

Stage 1 – Breast Implant Removal for Impending Exposure

Breast Implant Exposure and Breast Implant Infections are emergencies, and require prompt surgical intervention. In the picture below, the square area at the base of her left breast is the lower edge of the breast implant which is about to erode through the breast skin. Once exposed, infection is inevitable, so the implant was removed promptly to prevent this eventuality.

Breast Implant Removal for impending breast implant exposure Before and After Pictures - Front View

These breast augmentation revision before and after pictures show stage one of treatment for breast implant exposure. Once an implant is exposed, it requires removal to prevent infection and sepsis. The after photo reveals that the left breast was smaller before breast augmentation, confirmed by the removal of a larger breast implant during surgery. (Click image for uncensored view.)

An inframammary incision was used to remove the breast implant, and the damaged skin at the base of the breast was also removed to allow for a secure closure. Her left breast implant was larger than the right, because her left breast was smaller than her right breast before Breast Augmentation. The size discrepancy is apparent in the after picture

Stage 2 – Breast Implant Replacement after Exposure

After breast implant infection or exposure, a minimum of three months is allowed to pass before replacing the breast implant. This is to reduce the risk of another infection. After three months, the patient returned to the operating room for delayed Breast Implant Replacement.

Breast Implant Replacement after breast implant exposure Before and After Pictures - Front View

These breast augmentation revision before and after pictures show stage two of treatment for breast implant exposure. After the breast implant is removed, and the site heals for several months, the breast implant can be replaced. The after photo shows the restoration of symmetrical breast mounds after Asymmetrical Breast Augmentation. (Click image for uncensored view.)

The before and after pictures above show the results of the second stage of reconstruction. The breast implants were replaced without complications, and the patient was happy to have her figure back.

Breast Augmentation Revision Consultations

If you are considering Breast Augmentation Revision be certain to consult with an experienced and Board Certified Plastic Surgeon in your area.

If you are in the San Francisco Bay Area, call (925) 943-6353, to schedule a private consultation appointment in my Walnut Creek, CA, plastic surgery office.

Read More

Breast Implant Removal in the San Francisco Bay Area

Posted August 26, 2019 in Breast Implant Removal, Breast Implant Revision Surgery, Home

Breast Implant Removal is performed for about 1% of all Breast Augmentation patients. It is not a common procedure. Often it is elective, but sometimes it is as necessary as it is unwanted.

Breast Implant Removal Before and After Pictures - Side View

These breast implant removal before and after pictures show the result of removing moderate sized breast implants from a woman with young, elastic skin. No lift was needed. (Click image for uncensored view.)

Why Breast Implants Are Removed

Breast Implant Removal is chosen for many reasons ranging from completely elective to emergency situations. Elective reasons include the desire to have smaller breast, anticipating pregnancy and breast feeding and even a desire to exchange the current breast implants for larger ones. Urgent situations include exposure and infection of the implants.

How Are Breast Implants Removed?

Breast Implant Removal With Breast Lift Before and After Pictures - Side View

These breast implant removal before and after pictures show the result of removing ptotic, “bottomed-out” breast implants with a Breast Lift performed at the same time. (Click image for uncensored view.)

Breast Implants are often removed during a relatively short outpatient procedure through the same incisions originally used to place them.

For Saline Breast Implants, after a small incision is made the implants are deflated and then removed. The empty shell allows removal through a smaller incision.

Silicone Breast Implants are not deflated prior to removal to avoid leaving silicone inside the breasts. If silicone breast implants are already ruptured, the capsule is often removed to contain the extravasated silicone and to prevent gel migration.

Breast Implant Removal Recovery

Breast Implant Removal Before and After Pictures - Side View

These breast implant removal before and after pictures show the result of removing large breast implants from breasts with less elastic skin. No lift was performed, so the skin sags after the loss of support previously provided by the breast implants. (Click image for uncensored view.)

Recovery after Elective Breast Implant Removal is normally just a few days. If a capsulectomy is performed, a drain is often placed, and it may take longer for the swelling to subside. Aesthetically, the appearance of the breasts continues to improve for several months as the skin recoils postoperatively.

BioCell® Textured Breast Implants

Since the recall of BioCell® Textured Breast Implants a few weeks ago, I have received several phone inquiries regarding breast implant removal. This textured surface is associated with a small risk of developing BIA-ALCL; however, the FDA’s current recommendation is to leave the implants in place and follow them clinically for signs and symptoms including enlargement due to fluid collections around the implants and swelling.

Despite the FDA’s current recommendations, some patients feel more comfortable having their BioCell® textured breast implants removed or replaced. Allergan® will provide smooth replacement implants at not charge (until July 24, 2021). Since the FDA does not recommend removal, there is no financial support available for the elective surgical removal of BioCell® textured breast implants.

Breast Implant Removal Consultations

If you are considering elective Breast Implant Removal, be certain to consult with an experienced and Board Certified Plastic Surgeon. In cases with larger implants and skin laxity, a Breast Lift may be recommended, either at the time of breast implant removal or staged after recovery.

An experienced plastic surgeon can discuss these and other options with you and offer personalized guidance during an in-person consultation appointment. To schedule a private consultation in our Walnut Creek plastic surgery office call (925) 943-6353.

Read More

Breast Reduction for Men (Gynecomastia Reduction) SF Bay Area

Posted August 19, 2019 in Breast Reduction, Breast Reduction (Men), Home

The medical term for Man Boobs is Gynecomastia. Since most men prefer to have a flat, masculine chest, Gynecomastia is usually problematic and a source of embarrassment. There are several methods of Gynecomastia Reduction, because gynecomastia presents in different ways.

What Is Gynecomastia?

Chest Reduction Before and After Pictures (Men)

Gynecomastia Reduction provides a more masculine contour both in and out of tight shirts.

Gynecomastia is the development of excessive, but normal breast tissue on the male chest. It is benign, firm and almost rubbery to the touch. It can be sensitive or painless, and it is located behind the nipple areolar complex. Development is usually bilateral and often asymmetrical.

Although rare, men account for 1% of all breast cancer patients, so hard, unilateral breast lumps need to be removed and sent to pathology for diagnosis.

How Is Gynecomastia Treated?

Male Breast Reduction Before and After Photos

For this adolescent male, gynecomastia reduction was a life changer. Male breast reduction surgery provided him with the mascline chest he desired.

Since Gynecomastia is benign, it does not have to be treated, but elective treatment is common, and the result is very satisfying. The typical reasons for treatment include discomfort and embarrassment due to obvious breast fullness both in and out of clothing.

Gynecomastia Treatment is surgical. Wearing compression shirts can help disguise male breast fullness in clothing, but they are hot, uncomfortable and minimally effective. There are no medications to shrink breast tissue, although some medications can cause male breast enlargement.

Gynecomastia Reduction Surgical Options

Gynecomastia Reduction for Puffy Nipples Before and After Pictures

Sometimes, gynecomastia reduction is all about the nipples. In this case, his puffy nipples are prominent and very noticeable even in clothing. Gynecomastia surgery allows the skin to tuck up against the muscle, relieving a source of embarrassment that had been present for this patient since puberty.

There are two main surgical options for reducing the male chest: Liposuction and Glandular Excision.

Liposuction is best for soft, global breast enlargement caused primarily by fatty tissue. The advantage of liposuction is small discrete scars that can be placed off the breasts. Excision, however, is required in the majority of Gynecomastia Cases.

Glandular Excision is performed to remove the firm, glandular tissue located beneath the nipples. Incisions are made along the lower aspect of the areolae for direct access to the surgical site.

Gynecomastia Reduction Consultations

Gynecomastia Reduction is one of the most common procedures I perform. If you are concerned with the appearance of your chest and would like to learn more about your options, call (925) 943-6353 today, to schedule a private and informative consultation appointment in my San Francisco Bay Area Plastic Surgery office.

Read More

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.

Read More

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.

Read More

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.

Read More

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.

Read More