breast augmentation

• breast augmentation
• breast lift (mastopexy)
• breast reduction
• gynecomastia
• revision breast surgery
• breast reconstruction (cancer)

Breast augmentation enhances breast shape and size, corrects a loss of volume after pregnancy and breast feeding, improves symmetry, and gives the breasts a small lift. I am a female plastic surgeon.  I focus on a natural aesthetic, which resonates with my Bay Area Palo Alto patient base.  I did an additional fellowship in breast surgery.  This is the single most common surgery I do.

First, I meet you in my Palo Alto office to discuss options. You will decide between using silicone “gel” implants or saline implants, placement of the implant in front of or behind the muscle, the incision site, and the size. I do a wide range of combinations, contouring each surgery to the individual patient.

saline vs. silicone implants

Until recently, the majority of my patients chose saline implants located behind the pectoral muscle. There are pros and cons to every choice.

Saline implants behind the muscle gives a natural look, helps reduce the risk of implant hardening, has little risk with deflation, and minimizes interference with breast examinations and mammography. The negative to saline is wrinkling or rippling, particularly with lower profile implants.  There are tricks we use to minimize this, but it can be an issue for women with thin tissue.

Silicone implants were reintroduced in November 2006 for breast augmentation patients. Silicone implants never fully left the market. They restricted our use to patients who qualified for a study, for which I was a member of Inamed and Mentor. The gel implants I use are the newest third generation of “cohesive gel” implants. The benefit of silicone implants is the feel.  They look the same as saline implants.  But when you feel the breast, particularly in a thin patient with little natural breast tissue, silicone implants feel more like fat and natural breast tissue.  The true downside is a higher risk of capsular contracture, ”turning hard.”

The media has liked the term “gummy bear” implant. The true gummy bear is a more cohesive gel implant, the style 410, which is still not available in the US. The 410 is a textured, shaped, firm implant.

As for how to choose, the look of saline and gel is similar. The difference is in the feel. Some women do not like the idea of silicone in their body.  I understand and for them saline implants are better.  For others, they need the breast to feel as “real” as possible. For them gels are better.  Again, I find silicone implants particularly useful for breast enhancement in thin patients, as they have higher risk for palpable rippling with a saline implant. This is a difficult decision for most patients. For additional information please see: www.natrelle.com/breast_augmentation.aspx and http://www.mentorcorp.com/.

incision locations

There are three different incisional approaches I use: the axilla (armpit,) periareolar (a small incision at the junction of the areola and breast skin), or inframammary (underneath the breast where an underwire goes). There are pros and cons to each, which I review during your consultation.  You can do an incision which preserves your ability to breast feed.  Sensation is affected more by what size you choose, not the location of your incision.

implant size

I like you to have a ballpark idea of cup size, but I find trying on sizing implants the most accurate way to choose the appropriate volume. You will try on sizing implants in my office.

I urge you not to focus on a certain cup size.  There is no standard for bra sizing. What is a 34C in one company, is not in another.  What you think is a 34C  may not be . Focus on liking what you see in the mirror with the sizers.

I recommend you get used to seeing yourself with breasts.  Many women have an initial shock when they see themselves with breasts. To help you pick a more accurate size and avoid the “I wish I would have gone a little bit bigger” phenomenon, stuff your bra for a while before surgery.  Padding your bra, inserts, the rice test: all are good ways to test out the new size.  Are you comfortable? How do you feel in your workout gear? work wear? picking up the kids? going for a run? out on a Saturday night?

Bring in form fitting tops to try on the sizers.  High crew necked shirts in light colors or a tight fitting turtleneck will make you look the largest. You need to be comfortable in all your clothes.

the consultation process

During your consultation in my office in Palo Alto, I meet with you personally. The choices in breast enhancement can be confusing. I strongly believe in education and will help you understand the pros and cons of gel versus saline implants, subglandular versus subpectoral placement, sizing, incision choices, and implant styles (low, medium, and high profile implants, shaped /anatomic implants versus round implants.) During my exam, I note differences between your breasts. Most women are asymmetric. Frequently the breasts have different sizes or positions. Nipples are at different heights. The rib cage may be asymmetric. It is important during breast enhancement we see these asymmetries and soften them, to try to make you more symmetric. There are breast shapes which require special techniques, particularly the tubular breast and constricted breast. During this initial exam, I have you try on implant sizers to help visualize the results and size, so bring a form-fitting top. Photos of breasts you consider attractive are useful.

choosing your surgeon

Again, breast augmentation is a surgery where choosing your surgeon is important. Make sure the surgeon is board certified by the American Board of Plastic Surgery, and you feel comfortable with them. Find out how often they do the procedure. Some of us did additional fellowship training specializing in breast surgery after our plastic surgical training. Most importantly, look at the photos. Every surgeon has an aesthetic, what they think is a “pretty breast.” Make sure you agree.

breast augmentation recovery

The cosmetic breast augmentation surgery is 1 ½ hours. Recovery time is one to two weeks.

Breast Augmentation Photo Gallery

Before and After Gallery