What Is Breast Augmentation?

Breast augmentation (augmentation mammoplasty) is a cosmetic surgical procedure designed to enhance the breasts’ size, shape, or symmetry. Sought by more and more women every day, it can result in a more flattering and better-proportioned figure, expand clothing options, and 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 choice 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 plastic surgeon Dr. Miguel Delgado will provide the necessary information to arrive at a thoughtful and thoroughly researched decision.

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 (results may vary)
Breast Lift Elevates sagging breasts and nipples Yes 7-10 days, no exercise for 4-6 weeks Long-lasting (results may vary)

Before & After

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Why Choose Breast Augmentation?

Common Complaints

  • The breasts are too small, which is the most common reason.
  • One of the breasts is significantly different from the other breast.
  • Weight loss has changed the shape and size of the breasts.
  • The breasts have become smaller and lost elasticity, common after pregnancy, breastfeeding, and aging.
  • There is a reluctance to wear a swimsuit or a tight-fitting garment.

A Personal Decision

A woman must be emotionally mature and fully understand her motivations for wanting breast augmentation. Breast enhancement surgery should be a personal decision and not one based on another person’s desires. Expectations need to be realistic, understanding that the procedure will significantly improve the breasts but not necessarily create perfection. It is very common that some women have loose breast skin from pregnancy, weight loss, or genetics. In some cases, breast implants will fill out the breasts and solve this problem, but a breast lift may need to be included in other cases. Breast lifts modify the skin superior to the areola, restoring a more youthful placement to the nipple on the breast.

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Options For Breast Implants

There is no “perfect” breast implant, as all breast devices have their advantages and disadvantages. There are essentially two breast implants used today: saline-filled and silicone-filled. Both have a pliable outer shell made of silicone. The contents within the cover are either saline (saltwater) or silicone gel. For saline implants, the silicone shell is filled with saline at the time of surgery.

The breast implant companies now offer various shapes and sizes to customize the fit for each woman’s body. Based on a woman’s anatomical dimensions, Dr. Delgado will advise an appropriate range of implant size and shape options.

Learn more about saline and silicone implants below:

Saline Breast Implants

Saline implants have been used for decades. They are safe and effective.

Advantages of saline breast implants:

  • 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.

Disadvantages of saline breast implants:

  • Saline implants are slightly firmer than silicone breast implants.
  • There is a chance for mild rippling or “scalloping” (of the bottom edge of the implant).
  • Saline implants are not ideal for thin women over the muscle due to more potential noticeable rippling.
Flowers

Silicone Breast Implants

Silicone implants have been approved for general usage since 2006. The restriction is that a woman must be at least 22 years of age. Also, it is suggested by the FDA that Magnetic Resonance Imaging (MRI) be done at the three-year mark after augmentation, and every two years after that, to rule out potential leakage. Dr. Delgado feels the patient should return for an exam at the three-year mark to determine if an MRI is warranted. If there are no complaints, and with a routine exam, then no test is needed. An individual approach should be customized for each patient.

Silicone breast implants have evolved into a safer product as a result of two significant 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 substantial or dense than 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.

Advantages of silicone breast implants:

  • They have a softer, more natural feel (the most significant advantage).
  • There are no wrinkles or “scalloping” of the edges; therefore, they can easily be used on top of the muscle.
  • As a general statement, women with saline breast implants, who then change over to silicone, prefer silicone breast implants for their more natural feel.

Disadvantages of silicone breast implants:

  • 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.

Breast Augmentation Surgery Documentary - Part 6

Breast Augmentation Surgery Documentary - Part 6

Form-Stable Gummy Bear Breast Implants

The new product on the market is the “Gummy Bear Implants.” The FDA has approved the three United States companies—Mentor, Allergan, and Sientra—to distribute these breast implants.

These implants’ goal is to replicate a natural breast in making them form-stable, heavier at the bottom, and shaped like a teardrop. The implant is firmer, and this is what holds the shape. If the breast implant is cut in half, it will keep the exact shape without spilling out of the implant shell. These reasons are why this type of breast implant is commonly called a “gummy bear implant.”

As with all breast implants, they have advantages and disadvantages. The obvious benefit is that it mimics the natural breast’s shape, giving more volume at the breast’s bottom. Because of the firmer silicone composition of this implant, it results in less wrinkling. Some women want to have a firmer breast. There 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 give plastic surgeons and their patients another option when considering breast augmentation.

Can Fat Transfer Be Used As An Alternative To Breast Implants?

Natural breast enhancement can be a great alternative to breast implants. The technology has significantly advanced to increase fat cell survival and breast skin expansion. Dr. Delgado performs this advanced breast augmentation procedure by taking fat from one part of the body and transferring it into the breast. Breast enhancement with fat injections provides two different techniques, liposuction from the abdomen or muffin top and breast enhancement.

The breast size can usually be increased by one cup size fat transfer to the breasts; however, the breast size can be much larger if the Brava® System is used. The Brava® System is a skin expansion device worn over the breast for about three weeks before treatment. 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 and post-mastectomy patients, and women who have had multiple complications with breast implants and prefer a more natural approach.

Dr. Delgado’s technique starts with harvesting the fat via liposuction from a location where ample tissue 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 approximately seven to ten days.

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Preparing For Breast Augmentation

A personal consultation is the first step for every patient considering breast augmentation surgery. The appointment can be scheduled at either Dr. Delgado’s San Francisco office or his Marin County office.

At this meeting, Dr. Delgado and the patient will discuss the patient’s concerns about her breasts’ appearance. The current anatomy of the chest and breasts will be assessed and contrasted to the patient’s goals. 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. The patient is provided with a booklet that supplies detailed pre-and post-operative instructions, including medications before surgery. 

Dr. Delgado understands and respects the courage it takes for a patient to come to him about changing something as personal as your body. 

— Janet S.

BREAST AUGMENTATION PROCEDURE DETAILS

Dr. Delgado performs breast augmentation at Marin Cosmetic Surgery Center, a private surgery suite located in his Marin County office on the Sutter Marin County Community Hospital campus. This private surgical facility allows him to offer his patients personal, concierge medical care while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.

Breast augmentation surgery is performed under general anesthesia. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers general anesthesia. Additionally, the anesthesiologist calls the patient the evening before surgery to review her medical history, confirm last-minute instructions, and answer any questions she may have regarding the anesthesia.

Breast implant surgery can be performed through one of four incisions. The two most common are the inframammary incision and the areola incision. The inframammary incision is made at the breast fold, whereas the areolar incision is made between the dark and light interface of the areola and breast skin. Of the two, Dr. Delgado prefers the inframammary incision, as it offers less risk of capsular contraction, areola irregularities over time, sensation issues, and internal breast tissue scarring.

The other two techniques—employed far less frequently—are the transaxillary method involving an incision made through the underarm region and the trans-umbilical breast augmentation (TUBA) approach involving an incision made through the belly button.

The TUBA approach is challenging and turns a moderately difficult procedure into a much more complicated one. The TUBA approach utilizes saline breast implants only, and when breast implant revision surgery is required in the future, an incision on the breast will be necessary.

Today, few plastic surgeons will augment breasts through the belly button. Because 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, beneath it, or in a dual plane position. Dr. Delgado typically prefers placement of the breast implants below the pectoralis muscle. This position provides a more natural look—especially in the breasts’ superior margins—and better protection and support for the breast implant. That said, some women have loose skin from childbirth, weight loss, or genetic predisposition. In this situation, the implants are best placed partially below the muscle with more breast skin exposed at the bottom. This dual-plane technique ensures that the loose skin is fully stretched over the breasts. However, if the breasts’ skin is very loose (ptosis), mastopexy may give the best results in conjunction with breast enlargement.

Once the breast implants are in place during surgery, the operating table is adjusted, so the 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—before closure. A multiple-layer closure is then performed, and a soft support bra with a front hook closure is placed.

Recovery

The first few hours after breast augmentation surgery are spent in the recovery room. When the patient is fully alert, she will be able to go home with a friend’s or family member’s assistance. It is essential 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 are 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 breast implants’ presence. This process takes a few days, and the prescription muscle relaxant is very helpful for this.

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 post-operative period, the patient is ideally seen three days after her surgery. The patient will be instructed in breast massage techniques to soften and relax the breast implant pocket at this visit. Ultimately, this massage regimen’s conscientious practice daily can 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.

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Will I Have Noticeable Breast Augmentation Scars?

All surgery will require an incision, which results in a scar. The final breast augmentation scar is impacted by the surgical technique, the patients’ genetics, and the body’s natural ability to heal.

Dr. Delgado prefers an inframammary incision for many reasons:

    • There is a reduced risk of capsular contraction.
    • The areola and breast tissue remain in their natural state.
    • This infra-mammary incision can be used for all future surgeries.
    • The incision can be hidden in the breast fold in many cases.

    Dr. Delgado uses meticulous wound closure and has a customized incision care program for an optimal outcome. The incision is generally easily concealed by a bra or bathing suit, and Dr. Delgado has very few, if any, issues with the final scar outcome.

    How Do I Choose A Breast Augmentation Surgeon?

    How to select a breast augmentation expert is a critically important question. It is essential to maximize your likelihood of receiving excellent care, safety, and ethical treatment. A successful outcome with your first surgery sets up for continued success in the future. These are some critical points:

    Patient Reviews

    What are patients saying about their breast augmentation experience? Patient reviews are now commonplace in our society, and we value their experience. However, everyone has a bad review here or there—but it is the doctors’ overall trend, which is essential. Also, it should be multiple reviews and on various platforms like Yelp and Realself, for example. You can also request to talk with patients who have had breast enhancement. Dr. Delgado offers this routinely.

    Before and After Photos

    The breast augmentation before and after photo gallery will show many of the surgeon’s patients’ aesthetic outcomes. Each surgeon is an artist with varying degrees of aesthetic expression in their work.

    Some doctors, like Dr. Delgado, prefer a more natural appearance that fits the patient’s body. Other surgeons may desire a larger breast size that makes a more significant impression. If the doctor’s aesthetics agree to you by reviewing their photo gallery, this is a good sign. A few photos are not enough. Dr. Delgado shows hundreds of photos.

    Board Certification

    Through the American Board of Plastic Surgery, board certification is the gold standard by which Plastic Surgeons are trained. This certification is a mandatory requirement. It does not guarantee that a board-certified surgeon will give you superior care but certifies that he has undergone exceptional training.

    Communication and Trust

    Communication and trust issues can not be overstated. Are you able to communicate your goals, and is your doctor listening to you? Do you trust that your physician and staff will be there to take care of you? You must have a very positive feeling about your surgeon and the team.

    Surgery Center

    Breast augmentation should be performed in a hospital or an accredited operating facility, such as AAAASF. This accreditation will ensure that the facility meets the proper standards and ethical guidelines.

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    FAQ

    How much does breast augmentation cost?

    How does breast augmentation affect future breastfeeding?

    Will nipple sensation be affected by breast augmentation?

    How will breast augmentation affect my annual mammogram?

    Is breast augmentation painful?

    Is breast augmentation safe?

    How long do breast implants last?

    Who is a good candidate for breast augmentation?

    How much does breast augmentation cost?

    The cost of breast augmentation is approximately $7,500–$9,700, depending on saline or silicone implants. This fee includes the surgeon’s fee, anesthesiologist’s fee, operating room expenses, support personnel, and the actual cost of the implants. If needed, financing is available.

    How does breast augmentation affect future breastfeeding?

    Breast augmentation does not affect the ability to breastfeed. Dr. Delgado has had many augmentation patients who later breastfed successfully. When performed correctly, the surgical procedure does not damage nor alter the milk ducts. Not all women can breastfeed, regardless of whether or not they have implants.

    Will nipple sensation be affected by breast augmentation?

    While there may be a loss of sensitivity following breast surgery, it is almost always temporary. Typically, breast sensation returns after the swelling subsides and healing is complete. Nevertheless, there is still a remote possibility for sensory nerve injury to occur. Breast augmentation could result in some degree of permanent loss of sensation in the nipple-areola complex.

    How will breast augmentation affect my annual mammogram?

    Mammograms can be safely and effectively performed on women who have breast implants. Breast implants do not hide or mask breast cancer. However, women with breast implants will need to have four extra pictures (two on each breast) in addition to the four standard images taken during a screening mammogram.

    Is breast augmentation painful?

    The discomfort after breast enlargement surgery is generally mild to moderate. Tenderness and soreness are 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.

    Is breast augmentation safe?

    As with any surgery, the risks of bleeding, infection, and adverse reactions related to anesthesia exist. Nevertheless, each year thousands of women undergo breast enlargement surgery and experience no complications at all. An experienced, fully certified, and licensed plastic surgery team reduces the frequency of complications. Marin Cosmetic Surgery Center operates with Dr. Delgado—a board-certified plastic surgeon—a board-certified anesthesiologist, registered nurses, and trained surgical technicians.

    How long do breast implants last?

    Whether saline or silicone, breast implants can last many years—but they will not last a lifetime. These are human-made devices that fatigue over time.

    Who is a good candidate for breast augmentation?

    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 U.S. Food & Drug Administration (FDA) and the plastic surgery community have done extensive research proving silicone implants’ safety. Studies now support that silicone implants match saline implants in terms of safety.

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