Augmentation with implants CHOICES

What breast implant you choose is as unique as you are.  You can’t “shop” online and find a photo you like, because every person is different- how tall are you, your weight, your ribcage shape, how curvy are you. This is where I can really help you achieve your goals and educate you on the choices.

You will decide between using

  • silicone “gel” breast implants or saline breast implants,
  • profile of implant (low profile? high profile?)
  • cohesiveness of gel (which gives different amount of upper pole fullness and firmness to the implant)
  • placement of the implant in front of or behind the muscle,
  • the incision site,
  • do you need to do with a lift? and
  • the size.

I do a wide range of combinations, contouring each surgery to the individual patient.

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Extensively Trained in Breast Augmentation Surgery

It’s important to choose a surgeon who has been trained specifically in breast surgery, and one who has had plenty of experience performing breast augmentations. Dr. Greenberg has completed fellowship training in breast and cosmetic surgery, and has written numerous publications about breast surgery.

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I love my results and I feel that Dr. Greenberg achieved exactly what I was looking for. They fit my body very nicely and they look natural. – T.H., San Jose
*Individual results may vary
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Choosing Your Surgeon

Again, breast augmentation is a surgery where choosing your surgeon is important.  One of my patients said “Finding a surgeon is like dating. You need to find ‘the one.'”

  • 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.
  • Do you meet with the doctor or with other staff?
  • Most importantly, look at the photos. Every surgeon has an aesthetic, what they think is a “pretty breast.” Make sure you agree.

What is your aesthetic? How does the doctor help you pick size? profile? shape? I have you try on sizing implants and use Vectra 3D imaging, so you can visualize how it could look.

I focus as well on your breasts over time. Are you pre babies? After? What is a good long term plan with implants?  I have long term relationships with my patients.  I look at your results now and in the future.

What measures does your doctor take to prevent complications? One of the biggest issues with implants is capsular contracture, where the implants feel hard over time.  I do many things to prevent this from forming, including use of the Keller funnel.  (Please see my blogs on BIOFILM and the KELLER FUNNEL.)  I will educate you on all of this at your visit.

The Consultation ProcessEducation of all the choices

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 breast 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.  And I will do Vectra 3D imaging to help you visualize your results.

Breast Implant Choices Choices Choices Help!

Dr. Greenberg did a breast fellowship after her training at Stanford and has published on breast implant surgery.  She strongly recommends you meet with a board certified plastic surgeon to help you sift through all of these choices.  Her aesthetic is all about natural look and feel.

What are the choices?

As an extensively trained plastic surgeon, Dr. Greenberg will help you pick a shape and profile once I have seen your anatomy, know the volume you choose when trying on breast sizing implants, and understand how you want your breasts to look and feel.  This is part of why she meets with you directly for your consultation.  She will have you try on sizing implants to see what the change would look like.  She uses 3D Vectra imaging so you can get a picture of what your result may look like.

There are pros and cons to many of these issues, and Dr. Greenberg will go over all of these at your consultation.  Dr. Greenberg believes in science, and is constantly updating and improving her practices.  She has written over 600 blogs. Many of these topics are covered in some of her breast augmentation blogs as well.

saline vs. silicone implants

SALINE BREAST IMPLANTS:

  • Saline implants are frequently placed behind the muscle and give a natural look.  Other benefits are they have lower risk of implant hardening, equal risk of deflation (and if it leaks it is just salt water), and smaller scar.
  • The negative to saline is wrinkling or rippling, particularly with lower profile implants, and the feel is not as natural. There are tricks we use to minimize this, but it can be an issue for women with thin tissue.

SILICONE GEL BREAST 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, or “turning hard.”

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 these women saline implants are better. For others, they need the breast to feel as “real” as possible, so gels may be a better choice. Again, I find silicone implants particularly useful for breast enhancement in thin patients, as thin patients 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 and www.mentorcorp.com.

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, and the 3D Vectra photo imaging lets you see the potential results as well.

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.

At home the RICE TEST is also helpful.  The blog here shows you the conversion of rice to cc’s.

“They are absolutely perfect. I feel so much more comfortable, confident and beautiful and now it all beams through my body language.” – B.B., San Francisco
*Individual results may vary
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implant shape

There are two basic shapes of implant: round or anatomic.

ROUND: are the traditional implants, which still are the most used implant. They come in different profiles, widths, and projections. Round implants give a natural look and because there is no orientation “up” or “down,” they have movement in the pocket which gives them a very natural bounce and feel.

SHAPED: Also known as “teardrop” or “anatomic.” These are textured shaped implants. The media has liked the term “gummy bear” implant. (The true gummy bear is a more cohesive gel implant, the style 410, which is a shaped, form-stable implant.) Originally these implants were conceived to make the breast implant look more like a natural breast, though many studies have shown there is no shape advantage.

I did use this style for very specific patients- those with very thin tissue cover and certain ribcage shapes. Then a rare cancer called ALCL was associated with textured implants. Then Allergan removed their product from the market, so the style 410 is no longer available. The other brands Sientra and Mentor still have textured shaped implants on the market. I will review all of this with you at your consultation.

  • The style has benefits of less rippling, more shape (particularly for super thin patients or breast cancer patients), and less mobility, which is good for some ribcage shapes.
  • There are some negatives, such as size of incision, lack of movement, and firmness of implant.
  • Textured implants have been associated with the rare ALCL cancer. See the blogs on the subject HERE.

Again, we review this during your consultation process, where you can actually feel the different implants.

implant profile

There are many different profiles of implant within “round” or “shaped.” Within each of these categories, there are different choices for the same volume. In round we now have 5 profiles: super low profile, low profile, medium profile, high profile, and super high profile. These vary in width and projection, which gives a different look. For shaped implants we have different heights and projections. I will help you pick a shape and profile once I have seen your anatomy, know the volume you choose when trying on breast sizing implants, and understand how you want your breasts to look and feel.

capsular contracture & biofilm

One of the biggest negatives to implants is if they turn hard. If they do, it can be uncomfortable, look rigid and round, and cause asymmetry with your other breast. If your breast feels hard after implants it is not the implant. What happens is the capsule around the implant has thickened or contracted.

Whenever you put something foreign into your body, your body walls it off with a layer of scar tissue. This is a capsule. It does not exist right now. It forms as a reaction to your implant. Why would the capsule turn hard? There are many theories for why this happens, but the two leading theories are inflammation or a low grade infection called biofilm.

I believe in this, and I go to great lengths to minimize this risk. How the implant is prepared, skin prep, antibiotic use, incision placement, placement behind the muscle, use of the Keller Funnel® for inserting the implant, a “no touch” technique– all contribute to the health of your implant and minimizing your contracture risk. I will review all of this at your visit.

breast augmentation recovery

Breast augmentation surgery is painful for the first few days.  A typical post surgery course is:

  • Day of surgery: you go home after surgery.  You will likely sleep most of that day.
  • First 2-3 days after: You are resting- watching TV, reading books, sleeping.  These are the most painful days, but easily treated with medication.
  • One week out: You are usually off pain medication and can drive when you are pain free / off the medication.  Most people return to work (desk job, not active jobs).
  • Three weeks out: light activity.
  • Four weeks out: back to normal exercise.

GIVE YOURSELF TIME TO HEAL. Too many of my active overachieving Bay Area patients try to do too much too soon.  Your body needs time to heal.  Imagine you have a “sprained breast.”  Just like if you had a sprained ankle, you would not try to exercise or do too much until it healed for fear of aggravating it.  The biggest risk is delay in healing or having a bleed.

breast augmentation procedure

Breast augmentation surgery is an outpatient surgery.  The surgery itself is about 1 1/2 hours.

You arrive at the center, get checked in, are marked by me (just like in the TV shows), and then seen by anesthesia.  You are then taken back into the operating room where you breathe oxygen, are hooked up to monitors, and then gently fall asleep.  Next thing you know, your procedure is done.

The surgery is done under general anesthesia for your comfort and safety.  I use only board certified MD anesthesiologists.

implant scars

Scars.

I wish there were scarless surgery, but alas there is not.  Where can you put scars?

  • IMF (the inframammary fold, where your underwire would sit)
  • periareolar (at the color junction of the areola to the breast skin)
  • axilla (the armpit)
  • and more rare choices: through the belly button, through the nipple itself.

Why choose one over the other?

  • Risk of capsular contracture.
  • Visibility of scar.
  • Affect on breast feeding.
  • *Note: sensation has been found to be affected by how BIG you go, not where your scar is.

The scar with the lowest risk of capsular contracture is the IMF scar.

Breast lift with augmentation

To lift or not to lift?

Ah. This is a tricky one, and one which cannot be answered without seeing you.  Are you droopy or are you just deflated? How stretchy is your skin? How big do you want to go? How do you want your breasts to look? How much scar are you okay with?

I never know what I will see when I meet you for the first time.  Some women are easy augmentations- they have good skin tone, their breasts are not sagging.  They are a simple augmentation.

Some women are clearly in the “need a lift category.”  Their breasts droop.  If you can hold a pencil in the fold under your breast (the infamous pencil test); if your breasts lie against your upper abdomen; if your breasts are stretched out/ large areola/ floppy- then you likely need a lift.  Please see my page on the short scar lollipop breast lift.  I love it. The real question here is whether you need to add an implant.  Some women seek breast augmentation to try to avoid doing a lift.  Don’t go bigger than you want to be to avoid the lift- that leads to issues down the road, and most women regret that choice.  Also of note, know that implants and lifting is a tricky surgery, particularly if you have a fair amount of natural tissue.  See my blogs on the waterfall or snoopy deformity.With the lollipop lift I can usually get great shape WITHOUT an implant. So only do an implant if you need it for size.

And then there is the GRAY ZONE.  These are women who after augmentation will still likely be a little loose.  A “mature” breast if you will.  These are women who could go either way- do the lift, to get a perkier, more lifted breast, but with the scar of a lift OR they could just do an implant, but be slightly droopier, a more “mature” breast look which looks good in a bra, but will drop down when not in it.

Sometimes we don’t know what your breast will do until we are in surgery and I put in sizer implants and see the stretch and droop of the skin.  Your breast skin is like that baby jumper you hang in your doorway.  With no baby in (ie no weight pulling on it), it may look high.  But once you put a weight in there (ie the implant), how low will that skin go? how much will it stretch?

cost of breast augmentation

Costs of breast augmentation varies.  Our national society ASPS statistics for 2017 show the national average for breast augmentation procedure costs $3718.  This is just the surgeon fee, and does not include “operating room, anesthesia, and other expenses.”  Here in Silicon Valley, the price for a breast augmentation in Palo Alto usually is in the $6000 – $8000 range for a primary breast augmentation.  This number includes surgeon fee, implants, and operating room fee.  Every practice is different, and you should ask what is included / not included with that quote.

What causes the cost to vary?

Be careful with breast augmentation in particular, as it is a surgery which tends to attract cheaper procedures from people who call themselves “plastic surgeons,” who are not.  There are many nuances to breast augmentation, and real medical reasons to choose one implant type over another, scar position preference, and position in front of or behind the muscle.  Cheaper is not better.  I met a woman who had surgery locally who lost her implant through the skin following surgery and endured multiple surgeries to try to fix it. She was told she was “allergic” to her implant.  She was not.  Her “surgeon” was board certified by internal medicine, not surgery.