Breast Augmentation

Natrelle

San Francisco and Walnut Creek - Breast Augmentation Using Implants

We provide residents in the San Francisco and Walnut Creek area with quality breast augmentation services. If you've ever wished for a fuller, shapelier bust line, you are not alone. Breast implants have helped countless residents in and around San Francisco and Walnut Creek feel more beautiful, feminine and confident about their appearance.

At our Walnut Creek office we use several different breast augmentation techniques. After an in-depth consultation, Dr. Joseph Mele will recommend the technique that is most appropriate for you.

Breast Augmentation Procedure

When performing breast augmentation, Dr. Mele first makes a small incision either in the crease of the breast or along the edge of the areola. He then gently inserts saline or silicone gel implants beneath the pectoral muscles, which hold the breast implants firmly in place. Finally, the incision is carefully closed and stitched.

Breast augmentation is usually performed under general anesthesia. Many patients who come to our Walnut Creek facility choose to undergo breast augmentation in conjunction with other cosmetic surgery treatments such as tummy tuck, blepharoplasty, liposuction or rhinoplasty. If you are interested in breast implants and live in the San Francisco area, schedule an appointment with Dr. Mele at our Walnut Creek office today.

Click Here to Read Dr. Mele's Postoperative Instructions for Breast Augmentation

Click Here to Read About the On-Q PainBuster Pump Control Pump

Click Here to Read About the Accufuser Post-Op Pain Control Pump

Frequently Asked Breast Augmentation Questions

Am I a good candidate for breast augmentation?
Where is the incision?
Where is the implant placed?
What type of implant is right for me?
How do I know what size is right for me?
Does the surgery hurt?

Am I a good candidate for breast augmentation?

You may be a good candidate for breast implants at our San Francisco area office if you:

Are unhappy with the size, shape or appearance of your breasts.
Are over the age of 18.
Have realistic surgical expectations.
Are in good health.

Contact our Walnut Creek office near San Francisco to learn more about breast augmentation. We are always happy to answer questions from new and existing patients.

Where is the incision?

Dr. Mele uses the periareolar and inframammary incision approaches for the majority of his breast augmentation patients. Both approaches allow for the best direct view during surgery, increasing both predictability and safety of the procedure. They generally result in improved symmetry and discrete scars that are well tolerated by patients. The periareolar and inframammary approaches can be used for any type of breast revision surgery. This is not the case for the axillary and umbilical approaches.

Periareolar Incision Approach: With the increased use of saline-filled implants, the periareolar incision has become very popular. Since the saline implant can be inserted empty and filled after it is placed, a smaller incision is required. A discreet location for this smaller incision is at the junction of the areola and the skin surrounding it. In this location, the resultant scar is well-hidden after surgery. This incision also works well for women of color.
Inframammary Incision Approach: When the areola is too small or a larger incision is needed, the inframammary incision approach works well. When this approach is used, the incision is placed along the inframammary fold or IMF (the crease under the breast). Dr. Mele likes to make the incision slightly above the IMF so the scar will remain hidden if the patient's bikini top creeps up. One advantage of the IMF incision is that the milk ducts along the lower pole of the nipple are preserved in this approach. (See lactation and breast augmentation below.)
Axillary Incision Approach: With this approach, implants are placed through an incision in the axilla (armpit). This location is discreet; however, because it is farther away from the breast, it can make placement of the implants more difficult. Since the lowest portion of the pocket cannot be touched through the axillary incision, there is a slightly higher risk of breast implant asymmetry. There is also more post-operative pain and a slightly higher risk of a change in nipple sensation with this approach. Additionally, the scar may be more visible in clothing.
Umbilical Approach: The transumbilical approach (TUBA) involves making an incision above the belly button and placing the implants through a long tube into position under the breast. The main advantage is no scar on the breast; however, since the scar on the breast usually heals very well, this is a minimal advantage at best. Like the axillary incision, the incision is remote from the breast and there is less visualization and control of the operative site. Since the implant needs to be tunneled up to the breasts, this approach causes soreness in the upper abdomen that is not present with the traditional approach.

If you are having a breast lift with your augmentation, the incision used for the lift is usually sufficient for placing the implants.

Where is the implant placed?

Most breast implants are placed behind the pectoralis major muscle. This provides several advantages:

The muscle tapers the upper pole of the breast, allowing for a superior contour and a more natural teardrop shape. This works for round implants as well as shaped implants.
Placing the implant behind the muscle has historically decreased the risk of a tight scar around the implant, also called capsular contracture.
If the breast implant is placed behind the muscle, there is improved visualization of the breast tissue during mammography.
Decreased visibility and palpability of the implant.

Implants in front of the muscle have the following advantages:

Better fill of the loose skin. Sometimes this can eliminate the need for a breast lift.
Less movement of the implant with pectoralis major flexion.

What type of implant is right for me?

There are several options available for breast implants. The most frequently used breast implants in 2005 were smooth, round and saline filled.

Smooth vs. Textured -- Implants were originally silicone gel filled and had a higher incidence of hardening. Texturing was introduced to help keep the implants soft. With improvements implant shells and increased use of saline filled implants, this has become a less significant factor.
The most frequently used implants are smooth. They provide a softer, more mobile enhancement. Since smooth implants can rotate, only round implants are smooth. If placed behind the muscle, they still result in a tapered, teardrop shape.

Currently, texturing is used primarily to keep shaped implants in their proper orientation. Textured implants are used most frequently in breast reconstruction after a mastectomy. In this case, the chest wall is flat and augmentation requires greater volume in the lower pole to achieve a more natural appearance. The texturing on the implant provides a rough surface that attaches to surrounding tissue like Velcro®. This keeps the bigger end under the lower pole of the breast and usually prevents the breast implant from rotating. Disadvantages of texturing include increased rippling (wrinkling of the implant seen through the skin), increased firmness, increased leakage and prolonged postoperative swelling.
Round vs. Shaped -- When the implant is placed behind the muscle, all implants provide a teardrop shape. Because texturing is required for a shaped implant, the disadvantages of shaped implants include increased rippling (wrinkling of the implant seen through the skin), increased firmness, increased leakage and prolonged postoperative swelling. Some patients can receive benefits from a shaped implant that outweighs these disadvantages, but this needs to be determined on an individual basis. Most patients have better results with smooth round implants when saline filled implants are used. For gel filled implants, texturing may provide an additional benefit of decreased risk of capsular contracture. Recent improvements in the shell of these implants, however, may decrease the benefit of texturing.
Saline vs. Silicone filled -- All implant shells are made of silicone. It is an inert substance that is very well tolerated by the body. It is used for many types of implants, artificial joints and catheters that are permanently placed in the body. The difference between saline and silicone implants is the filler.

Silicone filled breast implant restrictions were largely removed in 2006. As a clinical investigator for both US silicone breast implant adjunct studies, Dr. Mele has provided appropriately selected patients the option of silicone filled breast implants for the duration of his practice. Sponsored by Allergan (formerly Inamed & McGhan) and Mentor, these clinical trials have shown that silicone filled breast implants are safe and effective. Current recommendations and restrictions include:

1) While saline implants are available for women age 18 years and older, silicone gel implants are only available for women age 22 and over.

2) To detect "silent" leaks in the implant an MRI of the breast is recommended at three years after the initial surgery and every two years after that.

3) Recommendations may change as long term data continues to be collected. To facilitate the collection of longer term data a patient registry has been established. Additionally, patients currently enrolled in the original ten year silicone breast implant adjunct studies will continued to be followed for an addiditional five years. In 2007, new ten year studies started looking at outcomes for both Saline filled breast implants and Silicone Gel filled breast implants. Dr. Mele is a primary investigator for all these studies to help insure that Breast Augmentation Surgery remains safe and effective.

4) Because of concerns with damaging the implants, silicone filled implants should not be placed transaxillary, transumbilically or with the TUBA technique.

When considering whether to proceed with breast augmentation it is import to discuss the risks, benefits, procedure, alternatives and recovery with a Board Certified Plastic Surgeon. Many of the risks associated with saline and silicone filled breast implants are similar; however, there are some differences between saline and silicone gel filled implants.

Future note: Some of the problems specific to silicone gel filled breast implants are linked to leakage. The "Gummi Bear," form stable implants are soft solids - more like Jello® than a liquid. The upside is, they can't leak, so MRI's may not be required. For reconstructive patients (after mastectomy) the implants can be made into a larger variety of shapes. While not usually a problem for patients under going breast reconstruction or a breast lift with their breast augmentation, the downside is these soft solid silicone breast implants require a larger incision for placement in the patient undergoing primary breast augmentation surgery.
Saline: The main advantage of saline implants is that patients experience fewer problems if they leak. The implant will still need to be replaced, but the saline, which is nothing more than salt water, can be quickly and safely absorbed into the body. Capsular contracture is less likely with saline implants, though this advantage has been narrowing with improvements in implant shells. Disadvantages include increased firmness to touch and increased rippling.
Silicone gel: Advantages of silicone gel include a softer augmentation resulting in a more natural feel and a lower incidence of rippling. Disadvantages include increased difficulty detecting leaks and more problems following a leak, since silicone gel does not get absorbed by the body. If a gel implant is found to have a leak, it will need to be replaced. Contracture rates are higher with silicone gel implants, but there has been a decrease in capsular contracture associated with silicone gel implants in recent years due to changes in the shell used to contain the gel.
Cohesive gel implants: These are a specific type of silicone gel filled implants. Silicone is a very versatile substance and can be free-flowing like water, soft like a stress squeeze ball, or hard like rubber. The next generation of implants, currently available in Europe, should soon be available in the US. These implants have a silicone shell, but contain a highly cohesive gel that is both soft and solid enough to be made into specific shapes. Sometimes referred to as "gummy-bear," "form stable," or "shape stable" implants, these implants may provide us some additional advantages for breast reconstruction. Advantages include softness to the touch comparable to gel implants, capsular contracture rates comparable to saline implants, reduced rippling, no leaking (they are solid) and the availability of various dimensions. Disadvantages include the need for a larger incision.

How do I know what size is right for me?

Size is the most subjective part of breast augmentation. Results are most natural when breast augmentation is kept proportional with the rest of a patient's frame. A specific result cannot be guaranteed, but some exercises will help to narrow the choices. No one method is ideal, but each can provide some benefit if used realistically.

Buy a bra the size you would like to be and fill it. You can use bra inserts, ziplock bags filled with rice, water balloons and even socks to try out different sizes. This can help identify the right size for you and let you try it out before making a final decision. If you bring this to your consultation appointment, it will help Dr. Mele understand your breast augmentation goals.
Pictures of your desired result can help in choosing the correct size implant. The shape of the breast, however, may not be the same and sometimes a breast lift can be helpful. If you have a picture of a chest that is close to what you desire, bring it with you to your consultation. This can provide a starting point for discussion and can help establish realistic expectations.
Before and after pictures can also be helpful. Dr. Mele keeps albums with before and after pictures in the consultation rooms to help narrow the range of choices and to demonstrate some common conditions that influence results. If you come across some before and after pictures you like, bring them with you so we can discuss them.

Does the surgery hurt?

The short answer is yes, but there are ways to make the procedure more tolerable. RICE therapy can be helpful - RICE stands for Rest, Ice, Compression and Elevation. Some details of post operative care can be found on the Breast Augmentation Postoperative Instruction Sheet. Many patients find icing the breasts works as well or better then pain medication.

Pain medications can be helpful. Some medications such as aspirin, ibuprofen (Motrin®, Advil®), and naprosyn (Aleve®) will make you bleed and should be avoided. Acetaminophen (Tylenol®) is okay, but should be avoided while taking most prescription pain medications. Most prescription pain medications already have acetaminophen (Tylenol®) in them and there is a possibility of overdosing and injuring your liver. Most herbal medications should be avoided the week before and after surgery, but Arnica Montana can help decrease swelling and pain after surgery. Information is available at the time of consultation.

Pain pumps can be helpful. These are medical devices that pump local anesthesia into the area around the implants. They decrease the pain by numbing the nerves that are irritated. A small catheter goes from the reservoir which regulates the flow of local anesthesia to the breast. Some pumps have a button that can be depressed to give a little extra medicine when it's needed. Most pumps last two days, and will help get you over the most difficult part of recovery. Most patients are moving well by the end of the week, and by two weeks, most postoperative restrictions are removed.