Breast Augmentation |Enhancement
Breast Augmentation is a procedure sought by more and more women every day. Advances in breast implant technology, as well as the surgical techniques to place them, have made breast enhancement a safe and popular cosmetic procedure. For these reason, it is the number one cosmetic surgery procedure performed in the United States.
Breast enlargement can result in a more flattering and better-proportioned figure. It can expand clothing options. It also has the potential to enhance a woman’s confidence and self-esteem.
The decision to have an augmentation mammoplasty is very personal. Each woman’s decision is unique and is based on her individual needs, wishes and expectations. A well-informed decision is critical since it may not be a one-time surgery. A consultation with Dr. Delgado will provide the necessary information to arrive at a decision that is both thoughtful and thoroughly researched.
|Procedure||What it does||Surgery||Recovery||Results|
|Breast Augmentation||Increases the size of the breasts with implants||Yes||2 weeks, no heavy lifting and exercise 3-4 weeks||Long-lasting*|
|Breast Lift||Elevates sagging breasts and nipples||Yes||7-10 days, no exercise for 4-6 weeks||Long-lasting*|
*Results may vary.
WHO IS A CANDIDATE?
Women who are 18-21 years of age are candidates for saline breast implants. Women who are 22 or older are eligible for either silicone or saline implants. The Food & Drug Administration (FDA) and the plastic surgery community have done extensive research proving the safety of silicone implants. Studies now support that silicone implants match saline implants in terms of safety.
There are many reasons or conditions to have breast enlargement. These are some of the more common:
- The breasts are too small, which is the most common reason.
- One of the breasts is significantly different from the other breast.
- The breasts have become smaller and lost elasticity; common after pregnancy and breastfeeding, but also a result of aging.
- Weight loss has changed the shape and size of the breasts.
- Reluctance to wear a swimsuit or a tight-fitting garment.
In addition, a woman must be emotionally mature and fully understand her motivations for wanting breast augmentation. This should be a personal decision and not one based on another person’s desires. Expectations need to be realistic, with the understanding that the procedure will bring great improvement, but not necessarily perfection.
Breast Implants in San Francisco
There is no ‘perfect’ breast implant. All breast devices have their advantages and disadvantages. There are essentially two used today: saline-filled and silicone-filled. Both have an outer pliable envelope, or shell, which is made of silicone. The contents of the shell are either saline (saltwater) or silicone gel. For saline implants, the silicone shell is filled with saline at the time of surgery. Saline implants have been used for decades: they are safe and effective.
The advantages of saline breast implants are:
- If a leak does occur, the saline (saltwater) is safely absorbed
- Saline breast implants are filled after insertion, therefore, more adjustments can be made for volume discrepancies
- In general, smaller incisions can be used
- Saline implants are less expensive
The disadvantages of saline breast implants:
- Slightly firmer than silicone breast implants
- Mild rippling or scalloping (of the bottom edge of the implant)
- In general, not ideal for over the muscle in small breasts, thin women, due to more potential obvious rippling
Silicone implants have been approved for general usage since November of 2006. The restriction is that a woman must be at least 22 years of age. In addition, it is suggested by the FDA, that a Magnetic Resonance Imaging (MRI) be done at the three-year mark after augmentation and every two years thereafter, to rule out potential leakage. Dr. Delgado feels that the patient should return for an exam at the three-year mark to determine if a MRI is warranted. If there are no complaints and with a normal exam, then, no test is really needed. This should be a customized approach for each patient.
Silicone breast implants have evolved into a safer product as a result of two major improvements. Today’s silicone breast implants have a much thicker outer shell and they contain a much more cohesive gel than earlier versions. The latter means that the silicone contents are more solid or viscous, as opposed to the more liquid versions of their predecessors. For example, if a modern silicone implant is cut with a pair of scissors and squeezed, the silicone material will go out and then retract back inward into the silicone shell.
The advantages of silicone breast implants are:
- A softer, more natural feel (the greatest advantage)
- No wrinkles or “scalloping” of the edges; therefore, they can easily be used on top of the muscle.
The disadvantages of silicone breast implants are:
- A leak or rupture may occur unknowingly
- Silicone implants are prefilled and, therefore, the size cannot be adjusted
- An MRI may be required in the future
- They are more expensive than saline implants
- A longer incision may be required
- As a general statement, women with saline breast implants, who then change over to silicone, do prefer the silicone breast implants for their more natural feel. The breast implant companies now offer a variety of shapes and sizes to customize the fit for each woman’s body. Based on a woman’s individual anatomical dimensions, Dr. Delgado will advise an appropriate range of options for the size and shape of implants.
- Breast implant surgery can be combined with other procedures such as facial surgery or body contouring.
- Both of the major breast implant companies, Allergan and Mentor, have warranties and extended warranties for implant failure.
The new product on the market is the “Gummy Bear Implants”. The Food and Drug Administration (FDA) has approved the three United States companies, Mentor, Allergan and Sientra to distribute these breast implants.
The goal of these implants is to replicates a real implant in making them form stable, heavier at the bottom and shaped like a tear drop. The implant is firmer and this is what holds the shape. If the breast implant is cut in half it will hold the exact shape without spilling out of the implant shell. This is why this type of breast implant is commonly called “gummy bear implants”.
As with all breast implants they have advantages and disadvantages. The obvious advantage is that it mimics the shape of the natural breast giving more volume at the bottom of the breast. Because of the composition of this implant it has firmer silicone that results in less wrinkling. Some women want to have a firmer breast. These are textured implants to hold the orientation.
The disadvantage is the potential for implant rotation which will cause the breast shape to distort. The incision needs to be larger to accommodate a firmer breast implant. Some women do not like the firmer consistency.
The bottom line is the form stable breast implants gives plastic surgeons and their patients another option when considering breast augmentation.
FAT TRANSFER PROVIDES ALTERNATIVE TO BREAST IMPLANTS.
Natural breast enhancement is a great alternative to breast implants. The technology has significantly advanced to increase fat cell survival and breast skin expansion. Dr. Delgado performs this advance breast enhancement procedure by taking fat from one part of the body and transferring it into the breast. This provides two different procedures, the liposuction from the abdomen or muffin top and breast enhancement.
The breast size can usually be increased by one-cup size. However, if the Brava System is used the breast size can be much larger. The Brava System is a skin expansion devise that is worn over the breast for about 3 weeks. The negative pressure of the device stretches the skin outward to accommodate more volume. The fat can then be injected into the expanded space.
The best candidates are women who; desire a fuller breast and do not wish to have breast implants, post mastectomy patients, and women who have had multiple complications with breast implants and desire a more natural approach.
Dr. Delgado’s technique starts with the harvesting of the fat from a location where fat is available. It is then put through a purification technique known as the “Coleman Technique” and injected into the breast to accomplish fullness. The process takes about three hours and the recovery is 7-10 days.
Dr. Miguel Delgado for a consultation
Before Breast Augmentation Surgery
PRIOR TO SURGERY
A personal consultation is the first step for every patient considering breast enhancement surgery. This appointment can be scheduled at either Dr. Delgado’s San Francisco office or his Marin County office near Santa Rosa.
At this meeting, Dr. Delgado and the patient will discuss the patient’s concerns about the appearance of her breasts. The current anatomy of the chest and breasts will be assessed and compared and contrasted to the goals the patient wishes to achieve. A physical examination will be done and the patient’s medical history reviewed to determine if it is a safe and appropriate option for her. If the patient is a good candidate, Dr. Delgado will explain:
- The pros and cons of saline implants versus silicone breast implants
- Various implant sizes and shapes
- Options for incision placement
- Implant placement (i.e. over or under the pectoralis muscle)
- Potential complications
The patient is provided with a booklet that supplies detailed pre- and post-operative instructions, including the use of medications prior to surgery. For example, it is required that aspirin and aspirin-containing products be discontinued, including anti-inflammatory products, two weeks before and two weeks after surgery, as these products have a negative effect on the patient’s clotting ability. The pre-operative instructions include a complete list of medications that could pose hazards for the patient and therefore, should be avoided. However, Tylenol (acetaminophen) can be safely taken during this time. However, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage.
Breast Augmentation Surgery
DAY OF SURGERY
Dr. Delgado performs augmentation mammoplasty at Marin Cosmetic Surgery Center, a private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before general anesthesia is given, demarcations of the breasts and chest are outlined using a surgical marking pen. This acts as a roadmap during surgery, allowing Dr. Delgado to make the appropriate adjustments for the gravitational changes that occur as a person moves from lying on the back (supine) to a sitting position, for example.
Breast implants can be placed through one of four incisions. The most common is the peri-areolar incision between the dark and light interface of the areola and paler breast skin. This incision gives an excellent cosmetic result. It can also be placed at the skin crease underneath the breast itself or through the underarm region, referred to as a trans axillary approach or lastly, through the navel (umbilicus or belly button), referred to as the TUBA (trans-umbilical breast augmentation) approach. The TUBA approach is a very difficult approach and turns a moderately difficult procedure into a much more complicated one. The TUBA approach utilizes normal saline breast implants only and when breast implant revision surgery is required in the future, then an incision on the breast will be required. Today, very few plastic surgeons will augment breasts through the belly button. Considering the fact that most patients will require more breast surgery in the future, a more direct approach is preferred.
Breast implants can be placed either on top of the pectoralis muscle or beneath it. Dr. Delgado prefers the peri-areolar approach and placement of the breast implants below the pectoralis muscle. The sub-pectoralis placement provides a more natural look, especially in the superior margins of the breasts and also better protection and support for the breast implant. During surgery, once the breast implants are in place, the operating table is adjusted so that patient is placed in an upright (sitting) position. This way, any necessary adjustments can be made to the breast implant placement or, in the case of saline breast implants, to size, prior to closure. A multiple-layer closure is performed. A soft support bra with front hook closure is placed. Often, a compression band with Velcro™ closure is also secured around the patient’s back and chest, compressing the upper part of the breasts. This ensures that the breast implants settle properly into the newly formed breast pockets.
Some women have loose breast skin from pregnancy, weight loss, or just genetics. In some cases, breast implants will fill out the breasts and solve this problem, but in other cases, a breast lift may need to be included. Breast lifts modify the skin superior to the areola, restoring a more youthful placement to the nipple in relation to the breast.
Breast implant surgery is performed under general anesthesia. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers general anesthesia. (See credentials for Randy Gaynor, MD on this website.). Additionally, the anesthesiologist calls the patient the evening before surgery to review his/her medical history, confirm last minute instructions and answer any questions he/she may have regarding the anesthesia.
After Breast Surgery
The first few hours after surgery are spent in the recovery room. When the patient is fully alert, she will be able to go home with the assistance of a friend or family member. It is important to sleep with the head and back elevated to reduce the swelling in the chest. Two days after surgery, the patient may remove the bra and any dressings to take a shower. The bra and, if used, the compression band, should be put back on immediately after showering. There will be instructions given for suture care.
The discomfort after surgery is mild to moderate. The pain and discomfort is more noticeable if the patient has had the breast implants placed underneath the muscle. These patients will notice more tenderness and fullness around the chest region until the muscles stretch and adjust to the presence of the breast implants. This process takes a few days and the prescription muscle relaxant is very helpful for this.
Regardless of the location of the implants, patients may choose to take pain medication to increase comfort levels during the first day or two. However, prescription pain medications are rarely needed by the third day after surgery. Occasionally, patients with a lower pain threshold may take pain medication for up to five days.
The recovery period is approximately two weeks in length. Once the bruising and tenderness are gone, the patient can return to normal activities. It is strongly recommended that patients avoid lifting anything of significant weight for at least two weeks following surgery. Most patients can drive a car and return to work and social activities within a week. However, strenuous exercise should be avoided for four to six weeks following surgery, as it can increase swelling and discomfort.
During this early postoperative period, the patient is ideally seen three days after her surgery. At this visit, the patient will be instructed in breast massage techniques to soften and relax the breast implant pocket. Ultimately, conscientious practice of this massage regimen on a daily basis will serve to reduce the risk of encapsulation in the future. About seven days after surgery, the sutures are removed. Subsequent appointments will be scheduled at two weeks, six weeks and three months.
For any of these post-operative appointments, the patient can be seen at either Dr. Delgado’s San Francisco office or his Marin County office.
BREAST AUGMENTATION RESULTS
Breast enlargement is a way to enhance the appearance of the breasts and often improve overall figure and body proportions as well. This can serve to boost a woman’s self-esteem and confidence. It is Dr. Delgado’s consultation style to invest significant time and effort preoperatively with a patient. In this way, he acquires sensitivity to a patient’s expectations and hopes and works with her to devise the plan most likely to ensure she will be satisfied with her results. At the same time, he employs his expertise from years of study and practice with breast surgery to assure that the result will be not only esthetically pleasing, but also appear very natural.
Risks and Complications
The most important concept to understand is that breast implant surgery is not a “one time procedure.” Over a lifetime, corrective surgery will be required for a variety of reasons. The most common reasons are capsular contracture, deflation or rupture of the breast implants, or post-pregnancy changes. In spite of this, it is one of the most popular cosmetic surgery procedures and patient satisfaction is extremely high.
Marin Cosmetic Surgery Center offers a highly trained plastic surgery team, which includes a board-certified anesthesiologist and experienced plastic surgery nurses and operating room technicians. This minimizes, but does not eliminate, the risks of this procedure. It is important to understand the risks, as well as benefits. Dr. Delgado and his staff, including the anesthesiologist, take time to carefully explain the risks associated with this surgery.
Capsular Contracture: The most common complication or adverse side effect of augmentation mammoplasty surgery is capsular contracture. During surgery, a pocket is created for the implant that is to some extent larger than the breast implant. During healing, a fibrous membrane called a capsule forms around the device. Under ideal circumstances, the pocket maintains its original dimensions and the breast implant rests inside, remaining soft and natural. However, for reasons still largely unknown, the scar capsule shrinks or contracts in some women and squeezes the implant, resulting in various degrees of firmness. This contraction can occur right after surgery or may not occur until many years later, and it may appear in one or both breasts. Current theories suggest that a very low-grade infection may trigger capsular contracture.
Capsular contraction is not a health risk, but it can detract from the quality of the result and cause discomfort, pain, or distortion of the breast contour. In cases of minor contraction, surgery may not be required. However, cases of very firm contraction can be relieved only by surgical intervention. Early capsular contracture can be treated with the asthma drug Singular. Dr. Delgado has seen some success with the use with early capsule formation.
Leakage or Rupture: Saline breast implants deflate either through a leak in the fluid import valve or through a break in the outer shell. Breast implant deflation or rupture can occur immediately or progressively over a period of days. Since saltwater is naturally present in the body, the saline will be absorbed by the body safely and ultimately voided. Deflated saline breast implants require additional surgery to remove and replace the implants.
If silicone breast implants have a leak or rupture, this is more difficult to identify. The leakage of silicone gel stays within the breast pocket, whereas the saltwater from saline breast implants is totally absorbed, leaving an obviously deflated breast pocket. Occasionally, the gel of the implant can escape the capsule (implant scar tissue) and irregularities can be felt around the outer shell of the implant. If this change is felt, it constitutes a problem that needs investigation. The FDA suggests that an MRI be done at three years and then every two years thereafter, in hopes of detecting a silent leak. Silent leaks can occur spontaneously and are often undetectable to the patient or plastic surgeon. If, a silicone leak is determined by an MRI or other test, the breast implant needs to be removed and replaced with a new breast implant.
Infection: Most infections resulting from surgery appear within a few days to two weeks after the operation. Generally, infections can be treated with antibiotics, but on rare occasions, the breast implants may need to be removed until the infection clears. All breast augmentation patients start oral antibiotics the night before surgery and continue to take these antibiotics for the week following the surgery as a prophylactic measure to avoid this complication. In addition, the patient receives an intravenous version of this antibiotic administered by the anesthesiologist during surgery and a special triple antibiotic irrigation is used during the placement of the implants into the breast pockets. Whenever implants are involved, the surgeon and his staff ensure that no pathogens are introduced by not touching the breast implant.
A new product on the market is the Keller Funnel, which the implant is placed into and squeezed through the funnel end. This allows a “no touch “ technique. Other precautions include, but are not limited to, double sterile gloves worn by the surgeon and the scrub technician and two applications of two different skin prep solutions applied by the RN, instead of the standard three applications of one solution. As a result of conscientious and skilled application of these special sterile techniques for implant surgeries, Marin Cosmetic Surgery Center boasts an exceptionally low incidence of infection since year 2001.
Hematoma: A hematoma is a collection of blood around the breast implant pocket. If a hematoma occurs, it usually occurs soon after the surgical procedure, within the first twenty-four to forty-eight hours. Small hematomas are absorbed by the body and can be unnoticed, but large ones need to be drained surgically in the operating room.
Changes in Nipple and Breast Sensation: Feeling in the nipples and breasts can increase or decrease after breast implant surgery. The range of changes varies from increased sensitivity to reduced sensation of the nipples or breasts following surgery. Changes in feeling are usually temporary and return after swelling dissipates. On rare occasions, sensation can be lost.
After your surgery, your surgeon will be giving you a card with the; type of implants, serial numbers and date of surgery. This information will be provided to Mentor, Inc. which is the breast implant company, on your behalf and it is very important that you keep this card in a safe place. If you ever have an issue with your implants, you will need this information to activate your warranty.
Mentor offers a very generous lifetime warranty on their implants. You can get detailed information on the warranty for your type of implants on their website, click here.
Basically what they offer for saline implants is:
- Lifetime product replacement
- For charges not covered by your insurance, financial assistance in the amount of $1200 toward cost of operating room, anesthesia and surgical charges, for 10 years from the date of implantation.
- For a reasonable fee of $100, within 45 days of implantation, the amount of assistance would be increased from $1200 to $2400.
For Memory Gel Round Implants on or after May 1, 2009, they offer a Premier Advantage Warranty that includes:
- Financial assistance of up to $3500 for charges not covered by your insurance, toward costs of operating room, anesthesia and surgical charges.
- Replacement implants.
For Memory Gel Implants prior to May 1, 2009, has the same extended warranty available as for the saline implants.
FREQUENTLY ASKED QUESTIONS
Who is a good candidate for breast enlargement surgery?
Once a woman reaches 18 years of age, she may be a good candidate for breast enlargement surgery. By age 18, the breasts have reached full development. Additionally, it is imperative that a woman be physically healthy and emotionally mature to make this magnitude of a decision, one that will impact the rest of her life. It is important to understand that this is not a one time surgery and others will be required in the future.
In general, a woman who chooses to have breast surgery does so to improve her self-image. The reason behind this decision can include:
- Her breasts did not develop to the size she desired.
- Her breasts are unequal in size or shape.
- Her breasts have lost volume and changed shape due to pregnancy, weight loss, or aging.
How do I know which breast implant size is right for me?
Dr. Delgado’s patients find a useful tool in the rice test for finding the right implant size. Uncooked rice is placed in a nylon stocking and tied into a knot. A woman can test out the sizes and weights of the various sizes by placing them in her bra with her own breasts.
A cup of dry rice represents 250 cc of volume. One may add to this volume in small increments to the desired size. One might try 1 cup, 1¼ cup, 1½ cup, 1¾ cups, et cetera, until the desired breast volume is achieved. Patients who have used this method have a high satisfaction rate with the implant size they ultimately chose. The implant company Mentor has developed a new tool. They have developed a system of shaped silicone implants to place in the bra. This is a great confirmation after the rice test is performed. Dr. Delgado offers this new breast-sizing tool to his patients.
There are three different diameters for the same volume implant: moderate, moderate plus and high profile implants. Dr. Delgado will show you these various styles of implants, explaining why one might be chosen over another and assist you with your final selection.
What type of breast implant should I choose?
In 1991, the FDA began restricting the use of silicone breast implants, based on safety concerns. This stemmed from claims that silicone breast implants could cause autoimmune diseases in some women. In November 2006, after extensive research, it was concluded that there was no scientific evidence to support this claim and silicone breast implants were approved for general use (with certain restrictions, including that the patient has to be at least 22 years of age).
How does having breast enlargement surgery affect future breastfeeding?
Will nipple sensation be affected by breast enhancement surgery?
How will breast enlargement surgery affect my annual mammogram?
How is the surgery performed?
Before anesthesia is given, the surgeon draws a surgical map on the breasts and chest using a specially designed felt tip marking pen. This provides points of reference for the surgeon throughout the surgical procedure.
Breast implants can be placed through one of four incision locations:
- Peri-areolar This incision is made on the border of where the darker skin of the areola meets the lighter skin of the breast. This is the approach Dr. Delgado uses most often because of its an excellent cosmetic result.
- Inframammary-fold Underneath the breast, hidden in the skin crease.
- Trans-axillary This incision is hidden in the underarm.
- Trans-umbilical The surgery is performed through an incision in the navel (belly button). This approach is uncommon as only saline implants can be used. Many plastic surgeons who used this method, in the past, have now abandoned this approach.
The breast implants can be placed either on top of the pectoralis muscle or below it. Dr. Delgado prefers to place the implants beneath the pectoralis muscle, because this method assures that the upper pole of the implants are not detectable which makes it look more natural.
During surgery, once the implants are in place, the patient is raised to a sitting position in order to assess the size, position and symmetry of the breasts.
A multiple layer closure is performed, closing the deeper tissue and finally the surface incision itself. A bra is placed and often a compression band is applied over the top of the breasts, as well. The compression band, which is worn only for a week or two, helps the breast implants to settle properly into the newly created pocket.
Some women have loose skin from childbirth, weight loss, or genetic predisposition. In these cases, the implants may be best placed partially under the muscle, above the nipple and partially above the muscle, below the nipple. This dual-plane technique ensures that the loose skin is fully stretched out over the breasts. However, if the skin of the breasts is very loose (ptosis), a breast lift in conjunction with breast enlargement may give the best results.
What can I expect after surgery?
The discomfort after breast enlargement surgery is mild to moderate. Tenderness and soreness is more noticeable if you have had your implants placed underneath the pectoralis muscle. You may want pain medication for the first day or two after your breast enlargement surgery. By the third day, you probably will no longer need it. However, if you tend to have a lower pain threshold than most people, you may still want pain medication for as long as five days post-op.
You should allow two weeks for your recovery and avoid heavy lifting of any kind during that time. Once the bruising and tenderness are gone, you can return to your normal activities. Most patients are able to drive and return to work or social activities after a week. You should abstain from strenuous exercise for three to four weeks after surgery, as this can cause the return of swelling and discomfort.
Are there any risks or complications?
Complications specific to breast enhancement include deflation or rupture of the breast implant.
Saline breast implants deflate when the saline solution leaks through a damaged valve or through a break in the implant’s shell. The implant deflation can occur immediately or progressively over a period of days. Since saltwater is naturally present in the body, leakage from a saline-filled implant will be safely absorbed. However, a deflated implant requires surgical removal and replacement with new implant.
The silicone implant can also develop a leak. This leak can be a silent leak that goes undetected. The silicone gel is not absorbed, but it stays in the pocket. Magnetic Resonance Imaging (MRI) is used to rule out whether a silicone implant has leaked or not. The Federal Drug Administration (FDA) suggests that a woman undergoing breast augmentation using silicone implants should have an MRI at three years and then every two years thereafter, to confirm that her implants are intact. Dr. Delgado feels that a discussion and a physical exam is the first step.
Breast contractures (advanced scar tissue around the breast implants) can occur over time. This problem is addressed with additional surgery to remove the fibrous capsule and replace the encapsulated implant with a new implant.
How much does breast augmentation cost?
What kind of results can I expect?
For the initial two weeks following surgery, the breasts are swollen with mild bruising, although this quickly dissipates. It takes approximately three to four months for the breasts to completely settle into their new shape and position.
Significant time and effort are invested preoperatively to select the best implant size and shape. This assures that each patient achieves an enhanced but natural appearance.