En español Haga Clic Aqui Call Us: 415.898.4161
"Finding the right plastic surgeon can be a very challenging experience. You want to find one that not only has expert skills but also understands exactly what your own personal goals are."
Patient J.G.
HIDE / SHOW TESTIMONIAL

Category Archives: Breast lift

Consider “Gummy Bear” Implants for Breast Revision Surgery

Miguel Delgado, M.D. Cosmetic Plastic Surgeon

Miguel Delgado, M.D.
Cosmetic Plastic Surgeon

 

 

 

 

 

 

 

 

 

★★★★★  Ratings: 4.74 -118 Reviews

 

New Implants for Breast Revision

 

When considering breast revision surgery, one of the decisions to be made will be what type of breast implants to choose. Depending on what issues have determined the need for breast revision, implants can make a difference.

Sientra is the importer and distributor of Silimed implants from Brazil, being the only company outside the United States that has FDA approved breast implants. Brazil is now considered a first world economy, and uses the same FDA inspectors as Mentor and Allergan, the major implant manufacturers in the United States.

Gummy Bear Implants Get FDA Approval

Sientra was the first company to get FDA approval for their highly cohesive, form stable implants. Sientra’s form stable implants are referred to as the “gummy bear” implants, due to their consistency of the popular candy. All manufacturers now offer highly cohesive implants, but each with their own proprietary variation.

One of the biggest advantages of Sientra’s “gummy bear” implants is that they cannot leak; they do not have any “inner gel.” Due to the texture of the implant, it is believed there is less possibility of a capsular contracture forming. Additionally the teardrop shape gives upper pole fullness that may help correct minor sagging or drooping and possibly avoiding a breast lift.

Natural Teardrop shape

 

When a woman is standing, the teardrop shape is very natural, with a youthful perky appearance. However when a woman is lying down the Sientra gummy bear implants do not flatten out as much as the round implant will, like a real breast. The Sientra implant appears to be softer than the 410 (Allergan), and CPG (Mentor) form stable implants and maintains its shape better than all standard round silicone gel implants, including their own.

The gummy bear implants can only be inserted through an inframammary incision (under the breast). Therefore, there will be a scar hidden only by the fold of the breast. Normally, Miguel Delgado, M.D. will use the peri-areolar approach for breast  surgery so that the incision heals to almost invisible around the areola.

There has been a lot of press about the “new” implants, and due to requests from his patients; Miguel Delgado, M.D. has made them available, even though they are more expensive.

Contact Miguel Delgado, M.D.

 

If you think the gummy bear implants may be a good option for you, you are encouraged to contact the office for a consultation with Miguel Delgado, M.D. He will review your specific situation with you and help you determine the best implant for your breast revision surgery.

Breast Revision Costs and Payment Options

Hopefully, when you first got your breast implants for breast augmentation surgery, your surgeon explained that this is most likely, not a “one time” procedure. Dr. Delgado is very careful to explain to his San Francisco Bay Area patients that usually within ten years’ time some type of revision most likely will need to be done so that it will not come as a surprise. Some women may need more than one revision in their lifetime.

Breast Revision Before and After

Sonoma, California – A 45-year-old female of Monterey, California who presents to the San Francisco office at Union Square for breast revision surgery. She has had five previous breast revision surgeries. In 1996, she underwent breast augmentation using 270cc anatomic normal saline implants. Because of implant wrinkling, in year 2000 she had 35cc of saline placed within the same implant. In 2001, she had ex-plantation of the normal saline implants because of the persistent wrinkling and had placed 360cc silicone breast implants. In 2005 she wanted increase in size and underwent replacement of her 360 cc implants to 500 cc high profile silicone implants. In 2006 she developed a capsular contracture on her right side and underwent capsular contracture removal and replacement with 500cc Mentor silicone breast implants.

As stated under the “breast revision procedures” section of this website, there are several different reasons for breast revision surgery. The cost of breast revision surgery can vary quite a bit depending on what the issue is, such as;

  • Do the implants need to be replaced?
  • Are the implants ruptured or deflated?
  • Will there need to be a new pocket for the implants?

There are many other variations and combinations so it is hard to give an idea of the cost since it is a case by case situation. It will most likely be as much as the original surgery and perhaps more.

The good news is you may not be responsible for all of the fees. For example, depending on the reason for breast revision surgery, the manufacturer may supply replacement implants at no cost to you. If your revision surgery takes place less than 10 years of the original surgery, the manufacturer sometimes offers limited financial assistance.

Mentor (which is the manufacturer of the implants Dr. Delgado uses) includes a limited warranty with the purchase of their implants to assist with surgical fees during the first 10 years should a revision be necessary. Mentor also offers an extended warranty to patients for a nominal fee which may double the amount of assistance.

However, if your original surgery was more than 10 years ago, there may still be help for you. Your implants come with a lifetime guarantee, so depending on the reason of failure of the implant(s) the manufacturer will most likely replace them at no cost to you. Additionally, depending on the reason for revision, your medical insurance may cover some costs. Dr. Delgado’s patient coordinator will be able to help you apply for coverage to your insurance.

email and phone icon

 

Dr. Delgado has been doing breast revision surgery since 1989, call today (415) 898-4161 or email (info@dr-delgado.com) for an evaluation for all breast revision complications.

How Long will Breast Implants Last?

Implant deflation

San Francisco, CA – A 22 year old resident of Sacramento, CA presented to the Union Square San Francisco office for breast revision surgery. Her normal saline implant on the left side was a complete deflation. She had replacement of her normal saline implants with 420cc silicone implants under the muscle.  The lower pole of the breasts are stretched showing signs of bottoming out. She did not want correction of this deformity.

When contemplating breast augmentation surgery, many Marin County women ask Dr. Miguel Delgado how long breast implants will last. There is no way to know how long as it is different for everyone. There isn’t an expiration date on them. Implants are not biodegradable, they are designed to last forever, and technically they could. However, other factors such as the age of the woman and the condition of her skin and muscles and the ensuing sagging of the breast will determine when the implants may need to be exchanged. Some women may need a breast lift when they have breast revision surgery.

If you are not having a problem with your implants, they do not need to be replaced; however, you should be prepared to have breast revision surgery at least once in your life, and maybe more.

Basically, all breast implants have the same design. They are made up of a silicone envelope and filled with either saline or silicone gel. Breast implants can develop a tear or hole. Ruptures or deflations can happen if there is a severe blow to the chest. If implants are old, it is possible that they can rupture during a mammogram. Saline implants have a valve. If the valve is defective, or breaks, it will deflate, as pictured above.

Recent advancements for breast implants have made them safer and longer lasting than ever. Breast implant manufacturers stand behind their products and give them a lifetime replacement guarantee. They also extend a ten year warranty for reimbursement of some of the surgical costs, if breast revision surgery becomes necessary.

If you are having issues with your breast implants, you are encouraged to call (415 898-4161) or email (info@dr-delgado.com)for a consultation with Dr. Delgado.

Considerations for Changing Breast Implant Size

 

dr-miguel-delgado-300x200

Miguel A. Delgado, Jr., M.D.
Cosmetic Plastic Surgeon

 

 

 

 

 

 

 

 

 

There are several different reasons for breast implant exchange; one of the most common is to change the size of the implants. Many women will wait until they might need a breast revision for something else which will usually occur within ten years of the original breast augmentation, but some who are unhappy with their size may not want to wait.

Dr. Miguel Delgado spends a great deal of time with his patients prior to surgery in determining the correct size, so fortunately dissatisfaction with breast implant size is rarely an issue. For the few women who wished they had a different size, 90% to 95% wished they had gone larger. Usually when trying to decide between two sizes, it is advised to go with the larger of the two.

Women need to have good communication with their cosmetic plastic surgeon and trust his/her opinion when it comes to picking the right size. There are considerations for the surgeon that the patient may not understand. The surgeon wants to maintain the proportion of the breast size to the anatomical dimension of a woman’s body, taking into consideration the relation of the shoulders and hips.

There are three main body types:

1.           Ectomorph –slim, more like a fashion model

2.           Endomorph – pear or hourglass shape where body fat has a tendency to settle in the lower region of the body

3.           Mesomorph –hips are generally the same width as the shoulder, the body is more muscular in shape and body fat is stored fairly evenly over the body

Most women are a combination of body types, so it is essential that she is evaluated by an expertly trained cosmetic plastic surgeon to determine the correct size for her breast implants. However, the wishes of the patient are definitely taken into consideration. The patient needs to understand that if she wants very large implants, she may be limited by the width of her chest.  Other factors help determine the profile of the implants, such as the patient’s age and the condition of her the skin.

Breast revision 3

Santa Rosa, California – A 36-year-old mother of two who presents to the San Francisco office at Union Square for breast revision surgery. She has previously had a breast augmentation using 250cc normal saline implants. Her desire is to have an increase in size and change to silicone breast implants. She underwent removal and replacement using 360cc silicone high-profile implants as well as a tummy tuck and liposuction for a “mommy makeover”. Her surgery was performed at Dr. Delgado’s private surgical facility, Marin Cosmetic Surgery Center in Novato, Marin County, California

Different body types will accommodate different size implants; it is not a one size fits all. Bringing in pictures to the initial consultation will help the surgeon understand the patient’s goals. It is strongly advised that the patient ask to see before and after pictures of the surgeon’s actual patients.

Dr. Delgado’s main goal is patient satisfaction; fortunately he rarely has a patient dissatisfied with the choice of implants as much time is spent in helping the patient come to a decision, including doing the “rice test” which helps her visualize what the outcome will be before surgery.

 

Some breast augmentation patients are anxious to have a breast revision right away if they are not happy with the results. They need to understand that implants normally ride high for the first four months or more, the skin and muscle need to stretch allowing the implants to drop into the correct position. While some patients may think they are not happy with their immediate results, once the implants drop into position, they may change their mind; time must also be given for the patient to adjust to her new body image.

If the decision is to change implants for a larger size, it may be necessary to modify the implant pocket to accommodate larger implants. On the other hand, if a woman wants smaller implants, it is possible a breast lift may be required if there is some degree of skin laxity. Each situation is individual, and depending on what changes are to be made, will affect the cost of breast revision surgery. Breast revision usually is complicated and selection of a Board Certified Plastic Surgeon who specializes in breast surgery is essential.

 

If you have concerns about your breast implants, email and phone iconcall today (415 898-4161)or email (info@dr-delgado.com) for a consultation with Dr. Delgado, who will be able to evaluate your situation and make available to you all your options.

Does Breast Revision Surgery Cost More or Less than the Original Surgery?

Saline to Silicone

A. 43-year-old mother of two resident of Santa Rosa, California who presents to the Marin County office for breast revision surgery. She underwent breast augmentation in 2001 using 300cc normal saline breast implants inflated up to 360cc. She developed a slow leak on her right side. She underwent removal of the saline implants and replacement with 500cc moderate-plus Mentor gel implants. Note the overall fullness and nice symmetry of her breasts. Her surgery was performed at Dr. Delgado’s private surgical facility, Marin Cosmetic Surgery Center in Novato, Marin County, California

This question comes up frequently on RealSelf.com, but there isn’t one definitive answer. There are many different reasons for breast revision surgery as you will notice under the procedure section of this website.

One of the main reasons a patient has a breast revision is because she is dissatisfied with the size of her breasts, Dr. Delgado does not have this happen very often as he reviews size with the patient very carefully and has her do the rice test.  If breast implant exchange is done in the first year, Miguel Delgado, M.D. does not charge a professional fee, but there will be fees for new implants, anesthesia and the surgery center.

Breast revision surgery can be quite complicated, if the breast implants are silicone and have ruptured, it is a very tedious and time consuming procedure to remove the silicone. This is less of a problem with the newer cohesive gel implants as the gel mostly will retract back into the implant envelope. If a deflation or rupture has occurred, it is possible that the manufacturer will replace the implants at no cost and may contribute to surgical costs if it has happened within 10 years of the original surgery.

Some women will want to have the location of the implants changed from over the muscle to under the muscle; they may want to change to silicone from saline or vice versa. For “bottoming out” problems, the internal pocket may need adjustment.  It is possible that a woman will need a breast lift at some point in the future.

It is important for women to be aware that breast augmentation surgery is rarely a one-time procedure. The breast revision cost will vary greatly depending on what corrective procedure is done. The bigger concern than the cost should be in the selection of the right surgeon. In addition to being a Board Certified Plastic Surgeon, the patient should be seeking out a surgeon that has much experience with breast surgeries. It is possible to get a lot of information on the internet about different surgeons, look at their website for before and after pictures, read reviews posted by other patients. Prepare ahead of time for your consultation with a list of questions. Do not hesitate to ask the doctor what procedure he/she recommends for you and how it would be performed.

email and phone iconDr. Miguel A. Delgado is an expert breast revision specialist having done hundreds of complicated cases. Call (415 898-4161) or email (info@dr-delgado.com) today to schedule a consultation for your breast revision concerns.

Scar Treatment After Breast Revision Surgery

Breast revision3

This is a 38-year-old, female resident of Sonoma who presented to the Novato office in Marin County for evaluation for revisional breast surgery. She underwent a short-scar breast lift in 1995 and then a breast augmentation in 1996 using 120 cc, silicone breast implants. This was done at another facility. Her complaints on presentation to me were high-riding breast implants with breast contractures. She underwent complete capsulectomies on both sides with replacement with 300cc normal-saline breast implants inflated up to 325 cc bilaterally. Her procedure was performed at Marin Cosmetic Surgery Center in Marin County, California. Note the improved contour and projection of her breasts and how well the incisions have healed, especially the vertical breast lift incisional scars.

 

San Francisco, California-Breast revision surgery can be any surgery done after the initial breast surgery.

Breast revision surgery is not uncommon for the woman who has breast implants; she will most likely need at least one revision in her lifetime and maybe more. Breast augmentation complications necessitating revision surgery would include: capsular contracture, deflation or rupture of implant(s), double bubble, etc. Women who have had other types of breast surgery other than breast augmentation; such as a breast lift with or without breast implants, and/or a breast reduction, will find different factors requiring a revision such as, weight fluctuations, aging or trauma.

Women who need to have breast revision surgery have several concerns that include; how will recovery compare to the initial surgery, will the outcome be satisfactory, what will the cost be?  Many are concerned about scarring.

There are several factors that can determine the degree of scarring, for example:

•    Age-As we age our skin loses elasticity and becomes thinner and, therefore, doesn’t      heal as well.

•    Genetics-If your parents or siblings tend to scar easily, you may, as well.

•    Size and depth of the incision-Larger and deeper incisions take longer to heal giving more opportunity to scarring.

•    Race-Dark skin people are more prone to hypertrophic and keloid scars

•    Smoking-People who smoke are at a greater risk of infection, scarring and slower healing. Most Board Certified Plastic Surgeons will not operate on patients that smoke.

•    Dehydration-The patient needs to stay well hydrated, or many complications can occur and interfere with healing.

 

It is extremely important for a woman to choose her Board Certified Plastic Surgeon carefully, look for one that specializes in breast revision surgery. Examine before and after pictures of the surgeon’s patients with special attention to the final result.

The expert breast revision surgeon will know how to minimize scarring and may even be able to revise and improve on initial scars.

There are various methods of treatment for the healing of incisions, and it is important for the patient to follow her surgeon’s instructions carefully.

Patients are warned to avoid direct sunlight on their healing incisions to prevent hyper-pigmentation. Collagen is what heals a wound, and fibroblasts are a certain type of cell in the skin that is responsible for the production of collagen. Our bodies need vitamin C to produce collagen. Vitamin C supplements are important both before and after surgery. 500 mg twice a day is recommended until the incision is healed. In addition, protein is very important in the healing process as the amino acids in protein is used by your cells for building blocks in creating new cells.

Silicone Sheeting

Silicone Sheeting

Once the incision is healed, Dr. Delgado recommends his patients use silicone sheeting to promote healing. They will be given specific instructions on how to apply the silicone. All patients are given a detailed surgery information packet at their pre-operative visit that explains all pre-operative and post-operative instructions specific to their surgery.

Dr. Delgado has been doing breast revision surgery since 1988, serving all of the San Francisco Bay Area, including Sacramento, San Jose and Los Angeles. Call today (415) 898-4161 for an evaluation of your breast revision surgery needs.

How is Strattice Used in Breast Revision Surgery?

San Francisco, CaliforniaStrattice Tissue Matrix is a surgical mesh from LifeCell. Plastic surgeons use Strattice for breast lift and breast augmentation revision surgeries. Strattice works as a scaffold to support and position weakened or thinned breast tissue.

strattice-02
For the skilled cosmetic plastic surgeon, Strattice Tissue Matrix aids the surgeon with breast revision surgeries such as:

1.    Bottoming out-when the skin has lost elasticity the breast implant may drop lower than desired. Strattice helps the surgeon maintain the implant to the correct position.

2.    Capsular contracture-When scar tissue forms around one or both breast implants, the implant can’t move freely, and the implant feels hard. In some cases,  capsular contracture can become quite painful. During revision surgery, the surgeon can use Strattice to reinforce the breast tissue.

3.    Rippling and Wrinkling-some women do not have enough breast tissue to completely cover the implant which can cause rippling and wrinkling of the skin. With the use of Strattice, the tissue is reinforced, and the breast pocket will have support.

4.    Fold Malposition-If the tissue is weakened; the breast border may move down or to the side but can be redefined surgically with support from Strattice.

5.    Symmastia-If the tissue is weak between the breasts they may move too close together. During breast revision surgery, the plastic surgeon can use Strattice to have control over positioning and the size of the pocket.

strattice-03

In addition to breast revision surgeries, Strattice Tissue Matrix aids the surgeon for the patient with lax tissue that is undergoing a mastopexy (breast lift) augmentation.

To successfully correct breast deformities of these types, will require a surgeon with extensive knowledge and surgical skill.

 

LifeCell designed Strattice Tissue Matrix to reinforce inadequate tissue. It is a flexible product derived from porcine dermis. It is used in many various surgical procedures, including heart valves. However, it cannot be used for patients that have sensitivity to porcine products or Polysorbate 20.

Dr. Delgado is a top cosmetic plastic surgeon who has specialized in breast revision surgery since 1988. He treats patients in the greater San Francisco Bay Area, Sacramento, San Jose and Los Angeles.

 

For a consultation for your breast revision surgery needs, call (415) 898-4161 or email today.

 

How to Choose a Surgeon for Breast Revision Surgery

breast revision 2

A 28-year-old resident of Tiburon, California who presents to the San Francisco office at Union Square for evaluation for breast revision surgery. She initially underwent bilateral breast augmentation with 275cc normal saline implants. She developed mal-position and high riding implants bilaterally, and presented for replacement of her implants with a larger size and to improve the breast implant position. She underwent implant removal and replacement with 350cc normal saline high-profile Mentor breast implants. The breast pocket was also lowered. The photographs are seen approximately 8 months after surgery. Her procedure was performed at Dr. Delgado’s private surgical facility, Marin Cosmetic Surgery Center in Novato, Marin County, California

San Francisco, California-Most women who have breast implants from a breast augmentation, breast lift or breast reduction surgery, will most likely need to have breast revision surgery at least once in her lifetime. There are several different reasons for a revision, including; capsular contracture, bottoming out, double bubble, rupture, deflation, or the desire to change type of implant or size. In many cases, women need to find a new surgeon, due to the fact that their original surgeon may have; retired, or the patient was dissatisfied with her care, or perhaps she has moved out of the area.

It is imperative that the woman selects her surgeon carefully so that she can reduce the likelihood of additional revisional surgeries. The internet is a good starting point with a lot of information on plastic surgeons in their area. In looking at a surgeon’s website, look at the information on the surgeon to see what type of training he/she has had.

The American Society for Aesthetic Plastic Surgery (ASAPS) is one of the most prestigious plastic surgery societies in the United States. According to ASAPS, state laws allows licensed physicians to call themselves “cosmetic surgeons” or “plastic surgeons” even though they have not had any specialized training in plastic surgery. They may have had their formal training in another specialty, but many times it may have been in a non-surgical specialty.  That is why it is important to make sure that your surgeon is Board Certified in Plastic Surgery.
A surgeon that is Board Certified in Plastic Surgery means they have had at least 5 years of surgical training including a residency in plastic surgery after obtaining their medical degree. They are required to pass comprehensive written, and oral exams in plastic surgery to be certified by the American Board of Plastic Surgery (ABPS).

Next look to see if the surgeon has any complaints filed against him or her with their states medical board. This information is available online.

It is suggested that a woman has 2 or 3 consultations with surgeons that have met the above criteria to find one that understands her goals and makes her feel comfortable At the time of the consultation, ask many questions about how the breast revision procedure is to be done and how many breast revision surgeries are performed each year. Look at before and after pictures of patients with similar complications and ask if you can speak to 1 or 2 patients that have had the surgery.
If your breast revision is simple or complicated, you want an experienced top plastic cosmetic surgeon. Dr. Delgado has done hundreds of complicated breast revision surgeries with beautiful results. Call now if you have questions or wish to schedule a consultation at (415) 898-4161 or email.

What Risks are Associated With Breast Revision Surgeries?

Breast Revision Before and After

San Francisco, California – A 39-year-old mother of 5 who resides in Sonoma, California who visits the Marin County office in Novato for breast revision surgery. She has had three previous breast revision surgeries. She now presents with bilateral breast capsular contracture with breast malposition. Her surgical treatment was a complete capsulectomy (breast capsule scar removal) from the right side and replacement

 

San Francisco, California-When choosing a Board Certified Plastic Surgeon for breast revision surgery, the risks and complication rates for surgery are very low. However, a patient needs to be aware that there is always a possibility of complications. All surgeries have the same risks in common, which are:

1.    Bleeding, in rare cases if it is enough to require a transfusion, surgery may be terminated. A blood test is usually one prior to surgery to determine what a patient’s propensity is to bleeding. Patients are warned preoperatively to stop all blood thinners for a minimum of 2 weeks before and 2 weeks after surgery.

2.    Anesthesia complications are uncommon when administered by a Board Certified Anesthesiologist. The anesthesiologist will be reviewing your medical history prior to surgery and monitoring all vitals during surgery.

3.    Blood Clots can be a serious risk, due to inactivity after surgery. Most patients are encouraged to be ambulatory shortly after surgery. Some patients are given heparin after surgery to thin the blood to prevent clots.

4.    Infection can present a severe risk, and therefore, patients are given antibiotics before and after surgery. Having a sterile surgical environment for surgery is critical.

Breast revision surgery has the same risks as the original breast augmentation surgery which includes; capsular contracture, rippling, rupture or deflation, and implant displacement.  There are a few risks, in addition to those mentioned, that may be specific to the type of breast revision surgery being done. For example, the breast augmentation patient that has developed a capsular contracture may have the capsule form again even after corrective surgery. It is still unknown exactly why some women get a capsular contracture and others do not. There  is a variety of techniques that plastic surgeons now perform to reduce the likelihood of recurrence.  There is mounting evidence that low, sub-clinical, infection may play a significant roll.

Other possible complications with breast revision surgery can be with the nipple/areola complex having sensitivity and blood supply issues. If the patient does not have good skin elasticity, it is possible the skin may stretch out again which seems to happen more often for women with larger breast implants.

Scarring is to be expected if the revision breast surgery includes a breast lift or mastopexy. However with diligent scar care, the scars usually will fade with time.

Cost for breast revision surgery is of concern to many San Francisco Bay Area women. Since breast augmentation is elective surgery, most insurance companies will not cover any of the costs, however, under some circumstances some coverage may be available and is worth looking into, ask your surgeon to help you with this.. If breast revision is being done due to a rupture or deflation the manufacturers usually supply replacement implants at no cost to the patient. If the replacement is being done in less than 10 years of the original surgery, the manufacturer may compensate the patient for part of the surgical fees. For the woman who is unhappy with her choice of shape or size of her implants, she should talk to her surgeon; some surgeons waive their surgical fee, charging only for the cost of the new implants, anesthesia and the surgical facility, if it is done within a year of the original surgery.

Breast implants are not considered lifetime devices and almost all women who have had breast enhancement surgery will need a breast revision surgery at least once in her life and possibly even more. For women who have issues with their breast implants such as; pain, distortion, deflation or just dissatisfaction with size, it is highly recommended that they seek out the best top plastic cosmetic surgeon that specializes in breast revision surgery who will review all surgical risks. Call Today For a Consultation at (415) 898-4161 or email.