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Breast Augmentation

Breast Augmentation

Breast Augmentation in bay area

Breast Augmentation, or augmentation mammoplasty, is the most popular cosmetic surgery performed in the United States. Breast implants can help do more than just improve aesthetic appearances. Dr. Rex Moulton-Barrett offers breast augmentation with implants to help women achieve lasting self-esteem and positive self-images in the San Francisco Bay Area: Alameda and Brentwood. Over 280,000 women in the United States opted for breast augmentation surgery in 2015 of which 98% of women felt the results reached or exceeded their expectations.

Breast augmentation surgeries are increasingly popular, safe, effective, and successful in the United States. Dr. Moulton-Barrett as an experienced surgeon is here to help you address any concerns and achieve the results you deserve.

To learn how breast augmentation can improve your appearance, request a consultation with board-certified plastic surgeon Dr. Rex Moulton-Barrett.

Brief Guide to Breast Implants and Surgery in The United States

There are three basic types of implants commonly used in the United States. Each implant can be designed to individualized patient specifications after the initial consultation. Patients can opt for low profile widths, high profile widths, moderate profile widths, saline implants, silicone implants, or “gummy bear elastic” silicone implants. Some basic information about each type of implant is listed below:

1. Traditional Saline Implants

Saline implants are less expensive than silicone implants. Saline implants are also often recommended as they can be placed with a smaller incision near the armpit or areola. It is often suggested that patients use saline implants due to the decreased risk of scarring and nerve damage and damage to breast tissue. The implant can be placed unfilled, and only a one-inch incision can be placed around the areola for minimal visible scarring. The scar is difficult to notice, and the overall appearance of the breasts is dramatically improved. It is also recommended that patients detect any leaks before more advanced issues can arise. A small amount of saline can be safely absorbed by the body in the event a saline implant ruptures.

Before & After of Breast Augmentation

2. Structured ‘Ideal’ Saline Implants

In 2015 the FDA approved for clinical use a new type of smooth saline implant called the ‘Ideal’ implant. Unlike the traditional saline implant, it is composed of an inner and larger volume chamber of saline, which is filled from the back of the implant and a smaller and circumferential chamber which is filled from the front of the implant. The anterior chamber has up to 3 additional leaflet of sub-chambers ( called baffled shells ) like the layers of an onion, which have inter-communication channels to allow the saline to pass easily between them. The overall effect is that the implant behaves superior to a cohesive gel silicone implant in that the rippling is minimized, the implant holds it’s shape ( including maintaining a point at the front center ) and yet the back of the implant hugs the overlying curved chest wall closely. Unlike a silicone implant, the ideal implant can be inserted deflated and therefore through a smaller incision.

The company is based in Dallas, Texas and the implants are manufactured in southern California. The warranty is similar to the US vendors: a lifetime replacement for both implants, if there is a spontaneous rupture and during the first 10 years a financial aid payment of $2400 for the cost of surgical fees as a result of replacement. Similar to other saline implants, there is no reason to replace the ‘Ideal’ implant in the absence of a deflation. Finally, deflations are unlikely to involve both chambers, this means a deflation may be more subtle and not the devastating complete loss of breast projection which often occurs following a traditional single chamber implant deflation.

3. Sientra “Gummy Bear” Textured Gel Implants

Sientra implants were recently FDA approved for use in the United States. They have been used for breast augmentation surgery for the past 35 years by plastic surgeons in Brazil. These new implants use a textured gel for superior results. They are shaped to fit the patient’s body for optimal aesthetic results. The C3 program offers patients a free replacement implant if patients undergo capsular contracture surgery two years after the initial augmentation. The gel can be cut and contoured to provide more natural feel and aesthetic results. This type of implant can be especially effective for patients that have Pectus Excavatum as the implant can be formed to fit flush against the existing contours of the chest wall. Gummy bear gel implants provide more options for surgeons and patients to achieve desired results with minimal scarring.

Images of a Sientra silicone implant with cohesive gel which holds form after being cut in one half

Patient Gummy Bear ‘Sientra’ Implants Before and After Photos

Before & After of Breast Augmentation

Minimally Invasive Surgical Techniques

The placement of the implant is critical to achieving optimal results. Placement of the implant under the pectoral muscle can achieve a more natural look. However, placing the implant over the pectoral muscle can protect the implant and reduce the risk of capsular contracture. Scarring is typically minimal and can be easily hidden. A standard one-inch incision for saline implants can be concealed by placing the incision around the areola, near the armpit, or near the bellybutton. Silicone implants typically require larger incisions as they are pre-filled.

Silicone implants are often a good option for patients that have thinner chest walls or patients that are otherwise at higher risk for rippling post surgery. Rippling is most noticeable in the lateral and lower breast poles. The right surgeon can help you make an informed decision about what type of implant and surgery would be best for your individual needs. Consult with your surgeon to learn more about the individualized benefits of saline implants, silicone implants, and Sientra “gummy bear” implant in addition to advanced methods of breast augmentation that decrease risk of scarring.

Claims that breast implants have a direct correlation with higher rates of tissue and autoimmune-related disorders are yet to be proven statistically significant. Consult with an informed plastic surgeon about risks and individual concerns specific to medical history, lifestyle, and body type.

Lesser-Known Benefits of Breast Implants Years After Surgery

It is widely speculated that women that get breast implant surgery are able to detect breast cancer at earlier stages per FDA guidelines. Increased awareness coupled with increased imaging can detect tumors sooner and treat cancer more effectively. It is recommended that women receive a mammogram every one or two years after age forty. Increased accessibility to advanced imaging techniques can also help patients address saline leaks early.

Risks Associated with Breast Augmentation Surgery

There are a few potential complications that are commonly associated with breast implant surgery. A scar capsule can occur. Effects may include changes in localized sensation such as numbness in the breast or nipple. Patients may have to undergo an additional operation to address unwanted sense of firmness, elevation, distortion, or discomfort. About 12.5% of women that undergo breast implant surgery in the United States experience capsular contracture in one breast.

The Right Surgeon, Right Implants, and Right Individualized Options

Every patient has a unique personal history and goal for a successful breast augmentation. Some patients want to recover from a traumatic experience. Some patients want to improve their appearance and confidence. Other patients want to invest in breast implants to increase their self-esteem. The right surgeon will work with you to meet your individualized needs. There is no right or wrong reason to get the breast implant surgery you deserve. Work with an experienced plastic surgeon that will get the results you want.

Your decision making process should include the following question check-list:

  1. the incision location: base of breast, lower edge of areola, upper edge of areola, armpit and through the belly button?
  2. and length of incision: can vary from  2 – 6.5 cms?
  3. placement of the implant with regard to the chest muscle, called the ‘Pectoralis Major’: in front or behind the muscle?
  4. the texture of the implant: smooth or textured? A recent 2017 study demonstrated that contoured, textured and tear drop shaped implants provide to no benefit in terms of visible appearance over round implants. Further, in view of the above and a recent concern over the formation of capsular lymphoma from implantation with texturing ( see below ), it my preference to use smooth round implants.
  5. the diameter of the implant: wide & flat, narrow & round or in between?
  6. the volume of the implant: how many cc’s or milliliters inside?
  7. saline or silicone and if silicone: gummy bear or non – gummy bear?
  8. Name of the implant manufacturer: Allergan, Mentor or Sientra?
  9. drainage tube or no drainage tube and location where drainage tube comes through the skin?
  10. surgical pain control using injection of local anesthetic: short acting (1-2 hours) long acting (4-5 hours ) or time released (3-4 days )?
  11. implant warranty:  duration of warranty and financial amount of reimbursement for additional surgery to replace the implant, and specifically: a. whether or not replacement of the implant on the other side is covered if there is a deflation, ie is there a charge for changing the size to both sides if there is a deflation, c. will a new implant ( one or both sides ) be given at no cost if there is a scar ‘capsular ‘ contracture around the implant which will require another surgery?
  12. does the surgeon charge the patient for implant replacement surgery following deflation, of an implant which was placed by that same surgeon?
  13. what is the out of pocket cost to the patient for the anesthesia fee and facility fee for implant replacement surgery?

Bay Area Patient Breast Augmentation Before and After Photos 

Before & After of Breast Augmentation

Breast Implant Large Cell Anaplastic Lymphoma ( BI-LCL)

The author is aware of the recent concern regarding the possible formation of a rare form of lymphoma within the capsule of breast implants. As of  February 2017 , there have been a total of 259 reported cases of anaplastic large cell lymphoma arising within the capsule of breast implants in the 5-10 million women world wide. The incidence of this condition is thought to be one person in 50,00-300,000 persons following breast implantation. There have been 9 reported deaths as a result of this tumor. The median time from implantation to clinical diagnosis is 8 years. Of the reported cases involved implants, 60% have been following silicone gel implantation and 40% after saline, with 11% occurring with smooth walled and 89% with textured walled implants. Symptoms and signs most commonly would appear some years after implantation, with the finding of an asymptomatic mass within the wall or adjacent to the breast implant capsule at the time of either changing the implant or removing the capsule or the formation of a new onset capsular contracture with or without the finding of a seroma ( fluid collection ) around the implant. The latter may be associated with the implant pocket enlargement and or the sense of fullness/tension of the affected side of the chest wall  containing the implant. The current recommendation by the FDA is not to remove textured, or for that matter, smooth breast implants at this time. For additional information click here.

Recall of Textured Allergan Biocell Breast Implants

Allergan announced a recall option on July 24, 2019, to replace BIOCELL ® textured breast implant with smooth implant in consultation with their plastic surgeon. Allergan will provide Allergan smooth device replacements for free. The program will run for 24 months, until July 24, 2021, and will apply to revision surgeries on or after the date of the recall announcement, July 24, 2019.

The decision to get a breast implant revision is a personal decision between patients and their plastic surgeons, and must be decided based on the appropriate discussion of benefits and risks.

As part of this program, Allergan will not provide surgical fee assistance to revision patients. This decision is in-line with the FDA’s recommendation not to remove textured implants or other types of breast implants in patients who have no symptoms of Breast Implant Associated Anaplastic Large Cell Lymphoma (“BIA-ALCL”) due to the low risk of developing BIA-ALCL.

Patients who decide to keep their BIOCELL ® textured devices will continue to be covered under the NATRELLE® ConfidencePlus® warranty, which includes reimbursement for up to $1,000 in diagnostic fees and up to $7,500 in surgical fees related to diagnosing and treating BIA-ALCL.
Some frequently asked questions about this policy are attached. You may initiate a replacement request under the BIOCELL ® Replacement Warranty by talking with your Allergan Plastic Surgery Sales representative or by contacting the Allergan Product Surveillance team prior to surgery at 1-800-624-4261.

To find out more about available treatments and procedures, request a consultation with Dr. Moulton-Barrett at one of his Bay Area offices. Board certified plastic surgeon Rex Moulton-Barrett, M.D., offers advanced care and procedures for Bay Area residents. He has offices in Alameda and Brentwood, CA.

Our Clinics

Alameda Clinic

2070 Clinton Ave
Fourth Floor
Alameda, CA 94501

Phone  (510) 864-1800

Brentwood Clinic

1280 Central Blvd
Suite J-5
Brentwood, CA 94513

Phone  (925) 240-8775



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2070 Clinton Ave, Alameda, CA 94501

(510) 379-7919

1280 Central Blvd, Suite J-5, Brentwood, CA 94513

(925) 350-8752