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Unhappy with your breast implants?

Consult with one of San Francisco’s Top Doctors, board-certified plastic surgeon Miguel Delgado Jr. M.D. Correcting aesthetic and medical complications due to problematic breast augmentation surgeries is one of his specialties. Read about the main surgical techniques he employs in breast implant replacements, watch videos of the doctor and patients to know what to expect, and view actual patients before and after photos to evaluate the results.

Tag Archives: California

En Bloc Breast Implant Removal

En Bloc Breast Implant Removal

What Type of Capsulectomy is an En Bloc?

First developed in France, En bloc, means “as one,” and it is a procedure that leaves the breast capsule intact when breast implants are to be removed. All of the capsule is removed along with the breast implant by cutting around it.  By removing the entire unit, the silicone is contained within the capsule avoiding contamination of bacteria. If silicone implants are ruptured but contained within the capsule, removing the implant along with the capsule allows removal without any residue left. En bloc is a very meticulous and delicate procedure, and not all women are candidates for it.

For women who may be experiencing Breast Implant Illness (BII), the preferred method of removal would be the “en bloc.”  BII is where women are having symptoms such as; fatigue, memory loss, and joint pain. However, according to the FDA, the causes of these symptoms are not well understood.

How is an En Bloc Capsulectomy Performed?

The procedure for En Bloc has the incision along the infra-mammary fold.  If the original incision were along the fold, it would be the same incision line, so there will not be further scarring. Drains are usually placed to remove any accumulation of fluids and help the breast to return to its natural shape.

Before En Bloc Breast Implant Removal
After En Bloc Breast Implant Removal

This is a 56-year-old female who was seen in my San Francisco office for breast revision surgery. She has had silicone breast implants since 1974 on top of the muscle. She developed capsular contractures over the ensuing years. She complained of symptoms of breast implant illness. She underwent an En Bloc implant removal with replacement of 450 cc silicone implants at the Marin Cosmetic Surgery Center in Marin County, California.

Other Types of Capsule Removal

Capsulectomy is where part or all of the capsule is removed. The implant will be reinserted into the pocket or may be replaced with new breast implants.

Capsulotomy is where part of the scar tissue or “capsule” that surrounds the implant is removed, allowing the implant to move more freely. There is open and closed capsulotomy. Open is released surgically, closed is by compression and done manually. However, due to a high risk of rupture, the closed capsulotomy is not a recommended procedure and strongly advised against by manufacturers.

What a Breast Capsule Looks Like

Breast Capsule After Implant is removed

After En Bloc Breast Implant Removal

Many women consider having a breast lift done at the same time to remove excess skin and position the breast to a more youthful shape. Other options would include new breast implants, or some patients elect to have fat grafting to replace lost volume.

Patient Testimony by Dr. Miguel Delgado’s Patient

Dr. Miguel Delgado is nothing short of phenomenal. Dr. Delgado performed an enblock/capsulectomy surgery for me, which literally saved my life! He literally removed every detail of the issues that were affecting and causing life threatening symptoms within my body. When I tell you that this phenomenal doctor saved my life, I truly believe, that he has the gifted hands of God himself! There are no words great enough to express the depth of how I feel about what this doctor did for me, however, all I know is that I will be forever grateful for what he and his amazing staff did for me on September 19, 2019. There is no doubt in my mind that this doctor is truly the best!!!!! That Chelsea, Mo, Carol, Dr. Riddle, and the rest of doctor Delgado’s staff are so awesome!!! Upon meeting them, you are immediately impressed that your well-being and healthiness is their priority. They are an awesome team and a beautiful reflection of how Dr. Delgado operates and it shows. I so love this staff to life!!!!

This is a 39 year old female developed capsular contraction. She underwent bilateral en bloc capsulectomy with replacement of the silicone implants with Strattice, a human tissue replacement, over the left inferior aspect of her breast due to severe capsular contraction and thin skin. The implants were changed from 450 cc. silicone implants down to 325 cc

Breast Implant Exchange With Patient’s Own Fat

San Francisco, California-There are several reasons that a woman may elect to have her breast implants removed and/or replaced. The reasons vary greatly, from capsular contracture, to a rupture or deflation, double bubble, breast implant malposition  caused by pregnancy, aging, or capsular contracture, dissatisfaction with size or shape, and many other reasons.

Breast revision Malposition

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

Most women understand that breast implant devices are not “lifetime devices” and most will need to have breast revision surgery possibly every ten years. When a woman decides to have her implants replaced, she then needs to make a decision as to what she will do to replace the volume, if anything. There are many options; she can replace with the same type of implants she previously had, or switch to a different type. Many women with saline implants want to change to silicone as they have a more natural feel. If a woman has been unhappy with the size, she may choose to go larger or smaller. Many want the new “gummy bear” implants that recently got FDA approval. Some will choose not to replace their implants with anything.

Today there is another option, and that is fat transfer to the breasts from another location on the patient’s body by liposuction, usually the tummy, flanks, or thighs. Fat transfers and fat injection procedures are increasing every year. Augmenting the face, due to loss of fullness from aging, is done many times in conjunction with a facelift. The Brazilian Butt lift, which is enhancing the butt with fat transfer, has become all the rage for the obtaining the now popular “hourglass figure.”  The back of the hands, which are a giveaway for aging, no matter how young the face looks, are rejuvenated with fat injections.

Fat Removal by Liposuction

Fat Removal by Liposuction

Breast augmentation with the patient’s own fat has been around for a while, however, the technique has been improved. For most women, 80% of the transferred fat will become permanent. For women who are “done” with breast implants, the idea of re-augmenting with their own fat is very appealing.


When breast augmentation by fat transfer was a new procedure, there was a higher possibility that a lot of the fat would not survive and would go through a process called fat necrosis, which leaves lumps of calcified scar tissue that could interfere with readings of mammograms. Newer techniques of harvesting the fat give the fat a much higher chance of surviving and the incidence of fat necrosis is much less. Radiologists have gotten much better at determining calcifications associated with cancer than those of benign conditions.

When the implant is removed, the capsule that formed around the breast is not removed. The capsule is normal scar tissue, unless it becomes too thick and squeezes the implant making it distorted and feel hard, then it is referred to as capsular contracture. The fat that is removed by liposuction from the tummy or the hips is not placed into the pocket but placed in tiny micro tunnels in the layers of tissue outside the capsule. The capsule prevents the fat from migrating into the space left by the pocket. Drains are usually placed to help close the pocket.

The amount of fat that can be transferred depends on a few different factors, such as; how thick the tissue is that the fat is going into, if the implants were sub muscular there is an extra layer of muscle into which the fat can be placed. Some patients can receive enough fat to be almost the same size as they were with implants.

Disadvantages are: large enhancements cannot be done, and for a  slender woman, she might not have enough donor fat available.

Dr. Delgado is a Board Certified Plastic Surgeon, who has specialized in breast surgery since 1988, serving the greater San Francisco Bay Area, San Jose and Sacramento.


If breast enhancement with fat or breast implant exchange with fat transfers sounds like a procedure you might be interested in, call or email today  (415) 898-4161) for a consultation with Dr. Delgado to find out if you might be a candidate, he will explain the procedure to you in detail and answer all your questions.

Dow Corning Awards $5,000 for Breast Explant Claims

San Francisco, California-Dow Corning is once again in the news as the final deadline to submit an explant claim is fast approaching.

The Dow Corning Plan of Reorganization set June 2, 2014 as the deadline for eligible claimants to file for Explant Benefits. To be eligible, you must already be registered in the database, and the deadline for that was August 2004.

The $5,000 explant benefit (for class 5 only) is for women who have their Dow Corning silicone implants removed by June 2, 2014. Women who replace their Dow Corning implants with new silicone implants will not be eligible for the award; however, saline implants are allowed. To file a claim, you must submit the Explant Form and the operative report from the explant surgery.

If you choose to participate in the Explant Assistance Program, please be aware that these claims may take up to 60 days to process.

Dow Corning has had a vast number of individual and class action lawsuits regarding their silicone breast implants, starting in 1977 and growing to over 20,000 claims by 1995.

Shell of 1976 Dow Implant

Shell of 1976 Dow Implant

Silicone being removed from 1976 Dow Corning implant

Silicone being removed from 1976 Dow Corning implant










Connie Chung’s show “Face to Face with Connie Chung” is credited with bringing widespread public attention to the dubious safety of silicone breast implants of that time. The show aired in 1990 where Ms. Chung interviewed women who claimed their autoimmune disease was caused by their silicone breast implants, used in their breast augmentation surgery. Her report was a consumer opinion rather than based on scientific study.  Due to the reaction of thousands of women who saw the show,  in 1992 the FDA responded to their complaints by severely restricting the use of silicone implants by imposing a moratorium on the use of silicone gel-filled implants, (except in the case of clinical trials for breast reconstruction patients). The moratorium was not because the implants were proved to be dangerous but because the manufacturers had been unable to prove them safe.

After many years of research and clinical trials, in 2006 the FDA deemed the newer silicone implants to be safe and lifted the moratorium. It didn’t take long for silicone to become the number one choice for 80% for women having breast augmentation surgery due to their more natural feel.

Claims for damages continue to be filed with the “Settlement Facility for Dow Corning Trust” (SFDCT). If you previously filed to be part of the class action suit, you most likely are aware of the deadlines and are getting letters from SFDCT. Meanwhile, many deadlines have already passed. Go to this link to see the schedule for deadlines:  For instructions for filing forms and additional information go to the SFDCT site: Their phone number is (866) 874-6099.

As a breast revision specialist since 1988, Dr. Delgado has treated hundreds of women in the San Francisco Bay Area for breast implant removal and/or replacement. If you have any issues with your breast implants, call or email today for a consultation with Dr. Delgado at (415) 898-4161 to find out what your options are.

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.

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.


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.