Bay Area California Breast Augmentation and Implants | Oakland and Walnut Creek

Nearly 355, 671 women ( more common than liposuction ) underwent breast augmentation in the United States in 2008! Breast implants can serve one or more of a number of purposes; breast cancer victims can use breast implants for reconstructive purposes after mastectomy, or women with disproportionately small breasts as well as those with asymmetry may use implants to provide balance, proportion and harmony.

One advantage of a saline-filled implant is related to placement in an unfilled state, often requiring a small/ one inch skin incision. The incision can be made underneath the breast crease, around the lower or upper edge of the areola, the armpit and the umbilicus. I usually prefer the upper border of the areola which has a lower tendency to scar, injure breast tissue and nerves or change nipple projection.

Breast Implant Options

Breast implant options include smooth-round, textured round, contoured/tear drop-textured and for each of these implants: low/moderate and high profile widths are available and finally either saline or ‘gummy bear-elastic’ silicone fill.

Some of the potential complications include changes in nipple or breast sensation or a scar capsule which may sometimes tighten and compress the implant, causing a sense of firmness, narrow /elevated distortion and even discomfort. In such cases, surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant. This complication is called ‘capsular contracture’ and occurs typically in one breast of 12.5% of women after breast augmentation in the United States.

Placement of the implant with the upper pole sitting under the pectoral muscle provides a more gentle superior take off point, generally appearing more natural. The greater separation of this pocket from breast tissue as compared to the ‘over the muscle’ appears to have a protective influence in reducing capsular contracture.

Breast Implants and Augmentation in the Bay Area, Oakland, Alameda, and Brentwood

The availability of FDA-approved silicone gel implants in November of 2006 has created new options for women considering breast surgery for the first time and for those who have had previous surgeries but are seeking new replacements or revision. Now, all women over 22 years of age who are seeking cosmetic breast augmentation and women seeking breast reconstruction, will be able to select silicone implants. Because silicone implants are pre-filled, a longer incision may be required. However, many women find there is a softer and less folded ‘rippling’ tendency of silicone implants. Rippling is particularly common in thinner chest walled patients and is most noticeable in the lateral or lower breast poles.

Types of Breast Implants

Some women with silicone breast implants have previously reported problems including certain connective tissue and immune-related diseases. Women without implants also have these disorders, so the key question is whether breast implants increase the risk of developing these conditions. Several large studies have been completed that provide reassurance that women with breast implants do not have a significantly increased risk for these diseases.

Breast implants are not surported by the manufacturers to be lifetime devices and most likely cannot be expected to last forever. If a saline-filled implant breaks, a portion of it’s contents is harmlessly absorbed within the body and a definite change in the size of the breast is clearly noticable. Rupture can occur as a result of trauma to the chest wall, but more commonly ( about 12.5% of women after bilateral augmentation ) occurs spontaneously. Surgery is required to replace the implant, the cost of which is usually provided by the manufacturer. Mammographic examinations should be conducted every 1-2 years after the age of 40. It will be important for you to select a Center which is experienced in techniques specific to augmented breasts. Additional views may be required or other types of examinations such as ultrasound or magnetic resonance imaging. It is possible that the presence of breast implants may impact early detection of breast cancer.

Licensed Breast Implant Sellers

There are 2 companies in the US who have licenses to sell breast implants: Mentor and Allergan ( aka Inamed and McGhan, previously ). Each company offers a standard warranty and an extended warranty for an additional cost. The saline implant standard warranty for Mentor and Allergan appear identical. That is, a free life time replacement for deflation, up to $1200 payment for surgery related to deflations, up to 10 years from implantation, free opposite implant replacement upon surgeon’s request. The extended or “Enhanced warranty for Mentor or ” Confidence Plus Premier ” for Allergan must be purchased for $100, and for each, doubles the payment to up to $2400 but otherwise has the same terms as the standard warranty. For more information on the these implants in general, see the Mentor and Allergan websites.

Saline Versus Silicone Implants

In choosing between saline versus silicone implants, the following factors must be carefully considered. Silicone may be less likely to create the feel of rippling at the base or side of the breast and may feel more natural. On the other hand, the cost of purchase of a silicone implant is twice that of saline, the FDA currently recommends MRI imaging of the chest wall every 4 years for silicone implants ( which may not be a covered benefit under the terms of your health care insurance ), the FDA currently recommends changing silicone implants every 10 years.

Patient Breast Augmentation Before and After Photos

Visit our Breast Augmentation Gallery for more before and after breast augmentation images »

The author is aware of the recent concern regarding the possible formation of a rare form of lymphoma within the capsule of breast implants. To date, there are a total of 60 reported cases of anaplastic large cell lymphoma in the 5-10 million women world wide who have breast implants. All cases were contained by the implant capsule and did not invade surrounding tissue. The median time from implantation to clinical diagnosis is 8 years. The implants involved are both silicone and saline. Four of the 34 case reports world wide, since 1997, specifically described the implant surface and all 4 implants were noted to be textured, suggesting that texturing may have a role in the causation of this rare tumor. Further studies are underway to confirm whether or not texturing has a role in causing the disease process. The current recommendation by the FDA is not to remove textured, or for that matter, smooth breast implants at this time.

Important update about Poly Implant Prothese (PIP)

The recent concern over Poly Implant Prothese (PIP) implants from France has created a concern over whether or not the saline and silicone implants will leak (reported 11%) and also possibility of causing a non Hodgkin’s Lymphoma, called Anaplastic Large cell Lymphoma (ALCL), with one reported death in France.

MRI imaging provides 87% sensitivity, 91% specificity as to whether or not there is a silent rupture in the case of gel implants in general. The breast implant shell consists of a silicone elastomer with a high level of cross linking between the polymers, whereas the filling of the implants consists of silicone gel with a lower level of cross linking.

PIP silicone breast implants were made with three different types of shells (smooth, textured, and micro textured) and at least three different types of gels (NUSIL, PIP1, and 22 PIP2). PIP1 gel was used before 2008, and PIP2 gel was used after 2008. In addition the barrier layer was removed from the shell in 2007. The silicones used in PIP silicone breast implants were not the CE marketed Nusil (MED3-6300) that was indicated as a component in the files on PIP silicone breast implants.

The Nusil silicones were substituted by other types of (industrial) silicones. The PIP silicone gels contained significant levels of silicones with low molecular mass. In addition, thermographic analysis showed that the PIP gels were much less stable than the Nusil gel.

The European Commission Scientific Committee for Safety Hazards published a report on February 1st 2012 which indicates there may be an increased risk of ALCL for the PIP implants. The authors recommendation is that any patient who is plagued by uncertainty and anxiety should have the PIP implants removed.

For patients who want definitive information regarding the patency of the implant an MRI should be performed, and if this is normal and there are no problems associated with the implant it can be observed or replaced with a non PIP implant. The Mentor Corporation is currently offering a $250 gift certificate (until Dec 31st 2012) to patients requesting exchange from the PIp implants.