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.

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Breast Implant Options – What Are Your choices?

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

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

Breast Implant Fillers – Silicone Vs. Saline

Breast Augmentation Before and After - Front View

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

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

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

Breast Implant Shape – Round Vs. Teardrop

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

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

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

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

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

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

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

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

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

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

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

Breast Augmentation Before and After - Front View

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

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

Breast Implant Texture – Smooth Vs. Textured

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

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

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

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

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

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

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

Breast Augmentation Consultations

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

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

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

Breast Augmentation Revision for Capsular Contracture

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

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

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

Capsular Contracture

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

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

Breast Augmentation Revision for Capsular Contracture Unilateral

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

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

Grades of Capsular Contracture

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

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

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

Breast Augmentation Revision for Capsular Contracture Unilateral

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

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

Breast Implant Revision

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

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Breast Augmentation Video | Walnut Creek | San Francisco Bay Area

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

Breast Augmentation Before and After Pictures

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

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

Breast Augmentation Video (Breast Implants)

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

Breast Augmentation for the Flat Chest

Breast Augmentation with Breast Implants Before and After Photos

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

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

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

Breast Augmentation for Small Breasts

Breast Augmentation Before and After Pictures

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

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

Breast Augmentation for Asymmetrical Breasts

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

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

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

Breast Augmentation before and after pictures for Breast Asymmetry

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

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

Breast Augmentation for Tubular Breasts

Tubular Breast Augmention Before and After Pictures

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

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

Breast Implant Consultations

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

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Breast Augmentation Before and Afters In The San Francisco Bay Area

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

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

Breast Implants For Breast Augmentation And Lifts

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

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

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

Breast Implants For Breast Augmentation

Breast Augmentation Before and After Pictures

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

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

Breast Implants For Asymmetrical Breast Augmentation

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

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

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

Breast Augmentation Consultations

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

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

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

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

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

The Components Of Breast Enhancement

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

Breast Augmentation With Breast Lift Video (Mastopexy Augmentation)

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

Indications For A Breast Lift With Augmentation

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

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

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

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

Mastopexy Augmentation Consultations

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

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

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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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How to Choose Breast Implants

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

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

Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure.

Breast Augmentation remains the most popular Cosmetic Plastic Surgery procedure.

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

Breast Implant Size

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

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

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

Breast Implant Profile

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

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

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

Breast Implant Filling

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

Breast Implant Placement

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

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

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

FDA Approved Breast Implants

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

Help Choosing Your Breast Implants

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

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