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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: San Francisco Bay Area

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

Why Some Breast Implants Look Fake

Fake looking breasts in San Francisco

Women who are having any type of breast revision surgery may choose to have larger implants. Once a woman gets comfortable with her original implants, it is not uncommon that she wishes she had gone larger. When selecting the size and type of breast implants, it is essential to listen to the advice of a board certified plastic surgeon.

We have all seen women who have implants that look like a ball cut in half and stuck on their chest. The “fake” look is usually caused by 1 of 3 reasons, as follows:

Wide Implants

For a natural look the implants need to fit well on the chest wall. If they are too wide, the implant edges may be visible. Also, the patient may end up with a condition known as symmastia. Symmastia is where the breast implants are too close together, and in some cases may look like one boob, also known as a uni-boob.

Tall Implants

If breast implants are too tall for the patient, the upper pole of the breast will be too full resulting in fake looking breasts. High profile implants may be the choice for petite women with a narrow chest, however having fullness at the upper pole is not a look that is pleasing for all.

Lack of Good Elasticity of the Skin

The experienced board certified plastic surgeon will take into account the elasticity of the patient’s skin. Skin has a limit as to how far it will stretch. With aging skin comes the loss of elasticity, and with loss of elasticity, the breasts may begin to sag. To combat loss of elasticity, women need to be diligent about sun protection, wear a good support bra, and continue with healthy eating, and a good exercise program.

Unfortunately, some plastic surgeons will ignore these limitations and will use implants that are too large for the patient to fulfill the patient’s wishes.

Dr. Miguel Delgado, M.D. states that experienced board certified plastic surgeons will take the time to explain to their patients the limitations on the size and profile of the implants that will best fit their chest.

If you are thinking about breast revision surgery, call now (415) 898-4161 for an appointment with Dr. Delgado. Dr. Delgado will help you select implants that are right for you.

 

Early Versus Later Capsular Contracture

capsular contracture San Francisco

        Patient had 3 previous breast surgeries before seeing Dr. Delgado

Capsular Contracture #1 For Breast Revision Surgery

Capsular contracture is responsible for most breast revision surgeries.The rate of capsular contracture can vary significantly between surgeons.

The body’s protective response to a foreign body is the creation of a capsule around the implant. The formation of the capsule is normal, but if it should become thick or contracts, the implant can become distorted and painful. When a capsular contracture has occurred, the implant will feel hard, even though it is not the implant itself, similar to taking a fluffy pillow and stuffing it into a small pillowcase.

Causes of Capsular Contracture

Several factors may be responsible for the formation of scar tissue, such as:
• Surgical technique
• The location of the incision
• Placement of the implant
• Lack of massaging after surgery
• And more…

Inflammation is Primary Cause

Inflammation appears to be the primary cause of capsular contracture. If bacteria are present, the body’s reaction is inflammation which eventually may lead to scar formation. Sources of bacteria in the breast are:
• The milk ducts
• Blood in the pocket after surgery
• Irritants like surgical gloves that may have talc on them
• Damaged tissue from surgical trauma

Early contracture is believed to be connected to the surgery itself; blood, bacteria, and the body’s healing response. Some surgeons think that early contracture is harder to treat.

Dr. Delgado has a Very Low Capsular Contracture Rate

Dr. Miguel Delgado, M.D. takes many precautions to prevent contamination during surgery. The Keller Funnel is used to assist with the insertion of prefilled silicone implants. The benefits of the Keller Funnel are:
• “No touch” technique, gives increased protection against infection by never coming into contact with skin or the surgeon’s gloves
• Shorter incisions
• Less trauma to the tissues
Patients are given antibiotics through a drip at the beginning of surgery and a prescription to take at home for a few days. Dr. Delgado’s preferred method is the inframammary incision and placing the implants sub-muscular. He has noted that with all of these methods in place, his rate of capsular contracture has decreased dramatically.

Later Contracture Caused by the Immune System

Later contracture is believed to occur with the immune system breaking down, or if there is a microscopic bleed of silicone within the shell, it may result in inflammation. Some patients report that their breasts have become painful after a dental treatment or an infection elsewhere in their body.

There is still a lot unknown about capsular contracture. Plastic surgeons have different opinions, but all agree if you are noticing changes in your breasts, if they are swollen, tender, or painful, see your plastic surgeon right away.

Call Now!

Don’t wait; call Dr. Delgado today (415) 898-4161 if you are having any issues with your breasts.

 

The Value of Before and After Surgery Pictures

Before and After Breast Revision Surgery

                                          Before and After Breast Revision

Board Certified Plastic Surgeons receive specialized training in taking before and after pictures of their surgery patients. The attention to detail in the photos may reflect the surgeons’ attention to detail in the operating room. Images are one of the most valuable tools surgeons have in communicating with patients their aesthetic talents. When consulting with a plastic surgeon, you want both quantity and quality of the pictures presented.

Look for Consistency

An important factor to watch for is consistency in the photographs. The ratio of the height to the width should be the same for both before and after pictures. The position and distance of the patient from the camera lens should be the same. Lighting and color saturation needs to be comparable. More than one angle should be presented so that you do not see just the “best view.” The background should be the same.

There are photography tricks that can make after pictures look better. Be wary if the before picture has the arms at the sides and the after picture has the arms raised, which will make the breasts look perkier.

Are Pictures Aesthetically Pleasing?

Look for patients that may be about the same age, ethnicity, and body type as you. Notice if the after pictures look natural and are aesthetically pleasing.

All pictures presented on Dr. Miguel Delgado, M.D.’s website and office photo albums have written consent from the patients. Sharing of before and after photos are very beneficial to new patients and are much appreciated by Dr. Delgado. However, it is entirely optional, Dr. Delgado respects the privacy of all of his patients.

Call Today!

If you are considering breast revision surgery, call now (415) 898-4161 for a consultation with Dr. Delgado.

What is Symmastia and How is it Corrected?

Symmastia in San Francisco

                                      Symmastia

Symmastia is a condition where the breasts have merged making one breast. There is “web-like” tissue that crosses the sternum connecting to breasts medially.This is also referred to as; “breadloafing,” “kissing implants,” and “uniboob.”

Congenital Symmastia

There are 2 types of symmastia; one is congenital, and the other is iatrogenic. Congenital symmastia, meaning you were born with it, is very rare. There have not been many cases reported, with limited knowledge on the ideal treatment. To date, the 2 most common procedures for congenital symmastia are; reduction mammoplasty and liposuction.

Iatrogenic Symmastia

More common but still fairly rare is iatrogenic symmastia. This rare complication follows breast augmentation surgery which may present right after surgery or develop later. Symmastia can be minimal where the implants look too close together, to the extreme where the implant pockets merge.

Symmastia Causes

The cause for symmastia can be a surgical error or sometimes occurs when the surgeon is attempting to increase cleavage. Thin women are more prone to getting symmastia due to insufficient breast tissue over the breastbone. Patient with “pectus excavatum,” which is a concave chest, also have a higher risk of symmastia as their implants tend to lean toward the center of their chest.

Correcting Symmastia

Breast revision for symmastia can be complicated. Repair for some patients is for the surgeon to reattach fat and skin to the sternum, closing the pockets that have become too wide. More recently, some plastic surgeons use a technique known as “neosubpectoral pockets.” For this procedure, the surgeon creates new pockets under the muscle. Strattice (acellular dermal matrix) may be used on select patients for additional support if the patient’s tissues are thin. If the symmastia is sub-glandular or on top of the muscle the easy correction would be to place it sub-muscular.

Corrective procedures will vary depending on whether the implants were placed over or under the muscle. Fortunately, this complication is rare, but it is essential to choose the correct size and placement for the implants.

Dr. Miguel Delgado, M.D. warns that selecting implants that are too large for your chest size increases the possibility of symmastia.

Call Today!

Breast revision specialist, Dr. Delgado is available for consultation by calling (415) 898-4161.

Asymmetrical Augmented Breasts

Asymmetrical Breasts in San francisco

Asymmetrical Breasts Before and After Surgery

Breast augmentation patients may end up with asymmetrical breasts due to various conditions that include:
• False asymmetry
• Hematoma
• Seroma
• Rotation of the breast implant

Breast Implants May Take Months to Drop

For a woman to notice that her breasts are asymmetrical after breast augmentation surgery can be very upsetting. Noticeable uneven breasts can diminish the excitement of breast augmentation.

It is important for women to understand that it can take several weeks and even months for implants to settle into their permanent position. Post-surgical swelling may affect one breast more than the other and until the swelling resolves and the implants drop they may appear uneven. This condition is referred to as “false asymmetry.”

Understandably, it is tough for women to be patient for several months before determining if breast revision surgery will be necessary. In some instances, the asymmetry is so minor that many women choose to ignore it.

Many women naturally have uneven breasts, and in the hands of a qualified Board Certified Plastic Surgeon, the breasts can be made symmetrical with the use of different size implants.

Causes for Asymmetry of the Breasts

Another cause for asymmetry would be the development of a hematoma. A hematoma is where there is a collection of blood around the implant pocket. Hematomas usually occur within 24 to 48 hours after surgery. The body may absorb small hematomas, and no treatment is required. If the hematoma is significant, surgical intervention may be necessary. If you notice any unusual swelling, be sure to notify your surgeon.

It is also possible for the breast augmentation patient to develop a seroma, similar to a hematoma but instead of blood, a seroma is clear lymph fluid.

Under some circumstances, the breast implant may rotate. If the implants are round, there is no issue. If the implant is teardrop or anatomical and it should rotate, the asymmetry will be apparent. The muscle of the upper part of the breast will be stretched and makes correction difficult if not addressed in a timely manner.

Avoiding Asymmetry

To avoid asymmetry, Dr. Miguel Delgado, M.D. recommends patients choose their surgeon carefully. An experienced Board Certified Plastic Surgeon will be able to help a patient determine the right size and shape breast implants that will fit their chest wall.

Call Now!

Women who are experiencing any issues with their breasts are invited to call Dr. Delgado (415) 898-4161 for a consultation.

Breast Revision Recovery

breast revision with larger implants

Breast Revision With Larger Implants

Breast revision recovery is different for each patient. Some patients have a very high pain threshold, and others do not, so you cannot compare someone’s recovery to your own.

Sometimes the Original Pocket is Used

If the original pocket is being used, recovery may be easier unless the pocket is being made smaller or larger depending on the new implants. However, many women choose the change the size of their breast implants when breast revision is necessary for other reasons. Usually, a change in size is for larger implants, and many times the placement of the pocket maybe going from overs to unders. In this case, recovery will be somewhat longer as the surgical procedure is slightly more complex and invasive.

If the implants are smaller than the originals, the pocket size may be fine depending on the difference in size. If there is a significant change, the pocket may need to be reduced with internal stitches, or for some patients, a breast lift may be required.

Recovery for Each Patient is Different

Dr. Miguel Delgado, M.D. states that recovery for each patient is different. The amount of revision surgery will determine how much discomfort will be present. With that being said, some women sail right through their recovery with little to no discomfort, requiring only Tylenol for pain control.

No matter what degree of discomfort is experienced, women need to take care to sleep with their head and back elevated to reduce swelling. Showers are allowed 24 hours after the removal of the drains, prior to that just sponge baths are permitted. Return to normal activities is usually in 7 to 10 days, and formal exercise is allowed in 4 to 6 weeks, depending on how the recovery is going.

Make an Appointment With Dr. Delgado Today!

If you have concerns about your breast implants, Dr. Delgado has been performing breast revision surgery since 1988, and he would be happy to see you in consultation, call today (415) 898-4161.

Updating Breast Implants after Weight Loss

Breast Revision in San Francisco

                                    Before and After Breast Revision Surgery

Many women choose to lose weight after having a breast augmentation because they are pleased with their new look and are motivated to do more. It is difficult to lose weight, but a new slimmer body can be quite rewarding.

Significant Weight Loss May Affect Your Breasts

A common question that is asked of Dr. Miguel Delgado, M.D. is “how will I look if I lose weight after my breast augmentation?” Depending on the amount of weight loss there can be some downsides. For example, if you have breast implants, the size and shape that were selected for you before weight loss, may no longer look right.

It is difficult to say how a woman’s breasts will look after significant weight loss as women have different ratios of fat and breast tissue. Usually, women who seek breast augmentation do not have a lot of breast fat. For most, 10 to 20 pounds of weight loss won’t make a visible difference. In some cases, losing weight may make the breast implants more visible with less tissue for coverage. When there are physical changes, the implants may settle into a new position. It is possible that the nipples will be lower and the breasts will sag. However, women gain and lose weight in different areas of their body. If in the past (before breast augmentation surgery), if you noted how your breasts responded to weight fluctuations, it will be the same.

There Are Many Implant Choices

If it has been several years since you have had your breast augmentation, there are several new breast implants available offering more choices. Additionally, if you are unhappy with sagging breasts, you might want to consider a breast lift along with new breast implants.

Call Now!

Call today (415) 898-4161 for a consultation with Dr. Delgado and learn what options are available to you.

How Will I Look if I Have My Breast Implants Removed?

Breast Implant Removal, Breast Enhancement By Fat

                           Before and After Breast Enhancement By Fat Transfer

Breast implants are not for all women. There are several reasons women may decide to have their implants removed, such as; capsular contracture, discomfort, droopiness, avoiding future revisions, not happy with the appearance. Some just don’t want them anymore as they feel they no longer fit their lifestyle.

Why Some Women Want Their Breast Implants Removed

Every woman is different, but many women are happy with their breasts after implant removal. Initially, their breasts may look like a deflated balloon after removal. There will not be upper pole fullness that the breast implants provided. Other factors to consider are:

• Skin elasticity determines how much the skin will “bounce” back
• Large implants may cause more sagging skin
• The amount of natural breast tissue may have changed since before implants
• Changes in weight
• Pregnancies
• Sagging due to aging

A Breast Lift May Be Needed

Once the breasts have healed, most women are pleased with the appearance of their breasts. However, some women may benefit from a breast lift, and some opt to have to have a lift done at the same time as the explantation.

About 2 or 3 weeks after the implants have been removed, they will “fluff” back out. It is important to note that the breasts appearance right after surgery is not the final look.

Dr. Miguel Delgado, M.D. tells women who no longer want breast implants but still desire fuller breasts might consider fat transfer to the breasts as an alternative. By removing fat by liposuction from another part of the body, after a purification technique, it can be transferred to the breasts. This is a two part procedure with the benefit of reducing the abdomen and/or the love handles to harvest fat for the breasts. The procedure takes about 3 hours, and recovery is about 7 to 10 days.

Call Now!

If you have been considering breast implant explantation, call today (415) 898-4161 for a consultation with Dr. Delgado to find what options are available to you.

When to Have Breast Revision Surgery

Breast revision surgery in San Francisco

This 30 year old patient wanted larger implants and correction of some slight asymmetries. She changed from 350cc saline implants to 600cc silicone on the left and 650cc silicone on the right.

When to have breast revision surgery will depend on your unique situation. There are several factors to consider before scheduling surgery.

Breast Implants Take Time to Settle

Most women are immediately happy with their breast augmentation surgery. However, some women are disappointed with their results and want a breast revision right away. Patients need to understand that their results may take 6 months to a year before the implants relax into their final position. Once the implants have settled in, most patients find that they are happy with their outcome. The body needs time to recover from major surgery. If after a year the patient is still unhappy, then revision surgery should be considered.

The most common reasons for dissatisfaction with breast augmentation are; the size of the implants, the choice of saline or silicone, the shape, or the style.

Choosing the Right Breast Implant

Dr. Miguel Delgado, M.D. spends a great deal of time with his breast augmentation patients to help them choose the right implant the first time. He has them do the “rice test” which allows them to visualize the size. He has them hold a saline implant and a silicone implant so they can feel the difference. Dr. Delgado explains in detail how different projections and size will fit their chest based on their chest size.

 

Each patient needs to decide how comfortable they are waiting to have surgery for aesthetic purposes. At some point, they may need a revision for a complication that needs to be addressed such as; a capsular contracture, a ruptured or deflated implant(s), a double bubble, asymmetry, symmastia or other complication. If the patient wants to change the size, style, or type of implant, ideally the time would be best when another revision is needed. However, this is a personal decision and the right time for surgery is when she is ready, and her body is ready.

Call Today!

Call (415) 898-4161 for an appointment today to meet with Dr. Delgado to discuss any breast revision concerns you may have.