The art and science of breast augmentation and enhancement has improved considerably over the past several years. Now with the Natrelle® Collection women have beautiful and safe options for breast augmentation never before possible. The Natrelle® Collection is the result of 25 years of experience with the science and aesthetics of breast augmentation and enhancement and represents the very best in breast augmentation and enhancement technology.
 

Ever wonder how you might look after breast enhancement? Use this dynamic visualization tool to see how breast surgery can help you achieve the look you want. Work with the example photo in the visualizer or upload your own photo for a real-life simulation of the new you!

Breast Augmentation
(Breast Enhancement, Augmentation Mammaplasty, Breast Enlargement)

Breast augmentation enhances breast shape and size, corrects a loss of volume after pregnancy, improves symmetry, and will give the breasts a small lift.
 

Deciding What's Best For You
Your own decisions will increase your satisfaction with breast augmentation and other enhancement procedures. I first meet with you in my Palo Alto office to discuss options. You will need to decide to use silicone "gel" implants or saline implants, to place the implant in front of or behind the muscle, the incision site, and the size. I do a wide range of combinations, and contour the surgery to each individual patient. Until recently, the majority of my patients chose saline implants located behind the pectoral muscle. There are pros and cons to every choice. Saline implants behind the muscle gives a natural look, helps reduce the risk of implant hardening, has little risk with deflation, and minimizes interference with breast examinations and mammography. Silicone implants were just reintroduced into the market for use with first time breast augmentation. Silicone implants never fully left the market: our use was restricted to patients who qualified for the study, for which I am a member of the Inamed and Mentor studies. The gel implants I use are the newest generation of "cohesive gel" implants. The media has liked the term "gummy bear" implant. The true gummy bear is an even more cohesive gel implant, the style 410, which is not available in the US. These are a shaped implant, and may feel firmer. The current generation available here is the third generation of cohesive gel, which is softer. As for how to choose, the look of saline and gel is similar. The difference is really in the feel. I find silicone implants are particularly useful for breast enhancement in very thin patients, as they are at risk for palpable rippling with a saline implant. This is a difficult decision for most patients. For additional information please see: breastimplantstoday.com and mentorcorp.com. There are three different incisional approaches I use: in the axilla (armpit,) periareolar (a small incision at the junction of the areola and breast skin), or inframammary (underneath the breast where an underwire goes.) Again there are pros and cons to each, which I review during your consultation. My aesthetic is a natural one, which tends to go well with my Bay Area patient base. As for size, I like you to have a ballpark idea of cup size, but I find trying on sizing implants to be the most accurate way to find the appropriate volume for you.

Personal Consultation
During your consultation in my office, I meet with you personally. The choices in breast enhancement can be confusing. I am a strong believer in education, and will try to help you understand the pros and cons of gel versus saline implants, subglandular versus subpectoral placement, sizing, incision choices, and implant styles (low, medium, and high profile implants, shaped and anatomic implants versus round implants.) During my exam, I will note differences between your breasts. Most women are asymmetric. Frequently the breasts have different sizes or positions. Nipples are at different heights. The rib cage may be asymmetric. It is important during breast enhancement that we see these asymmetries and try to soften them and make you more symmetric. There are breast shapes which require special techniques, particularly the tubular breast and constricted breast. During this initial exam, I have you try on implant sizers to help visualize the results and size, so bring a form-fitting top. Photos of breasts you consider attractive are useful as well.

Choosing A Surgen
Again, breast augmentation is a surgery where choosing your surgeon is important. Make sure the surgeon is board certified by the American Board of Plastic Surgery, and that you feel comfortable with them. Find out how often they do the procedure. Some of us did additional training specializing in breast surgery after our plastic surgical training. Most importantly, look at the photos. Every surgeon has an aesthetic, what they think is a “pretty breast.” Make sure you agree.

The cosmetic breast augmentation surgery is 1 ½ hours. Recovery time is one to two weeks.
Breast Augmentation Before and After Photos


Breast Reduction (Reduction Mammaplasty)

Breast reduction LIFTS and REDUCES the size of the breasts. It is ideal for women whose breasts are too large. Common reasons include feeling self-conscious, back pain, neck pain, shoulder notching (where the bra straps have caused an indentation on your shoulder), breast sagging, difficulty with exercise, and difficulty finding bras and clothing. It is one of the highest patient satisfaction surgeries I perform.

Having completed a fellowship in breast surgery, and because many of my patients are interested in a female surgeon, this is an area of particular expertise in my practice. The goal is to give you smaller, lighter, firmer breasts with a nice shape. Frequently, the areola size is reduced. Many women notice following the procedure their postures are better, their neck and back pains subside, and they feel more confident about their bodies. There is no typical patient, except that the breasts should be fully developed. Occasionally, when a young woman has serious physical discomfort, a breast reduction can be done in the mid-teens, with the caveat that a second reduction may be needed subsequently.

Your breast enhancement consultation begins at my Palo Alto office, where I discuss the procedure in detail, review photos of typical results, and do an examination to find differences between the size and shape of your breasts. At that visit we discuss the types of reduction: vertical breast reduction, periareolar reduction, liposuction, and inferior pedicle/wise pattern reduction.


Types of Breast Reduction

Vertical reduction, “short scar” technique:
The vertical breast reduction is a new technique and is my technique of choice. I like it because it allows me to fully reshape the breast tissue to get good form and projection. Many patients comment they have never been so round and perky. Those internal breast sutures help take tension off the skin, which helps my breast reductions maintain their shape and have better scars than other techniques. It also minimizes the scar, with a "lollipop" scar instead of the traditional anchor scar, so there is no scar under the breast.

Inferior pedicle/wise pattern, “anchor scar”:
This is still a popular breast reduction technique and has been the workhorse of breast reduction surgery for thirty years. For extremely large reductions, I will still perform this procedure. I do not think it is as long lasting as the vertical lift, it relies on skin tone to do the lift, and the scar is substantially larger, with an “anchor” pattern.

Periareolar reduction:
This scar is just around the areola. It is good for a very small reduction/lift.

Liposuction:
Is good to reduce the volume of the breast in fatty breasts. Most young women have dense breast tissue, so liposuction is more difficult. For those with sagging skin, this procedure does not tighten and lift the breast well.

Breast reduction surgery is three hours under general anesthesia. Recovery time is two weeks. I perform these procedures at Stanford, the Menlo Park surgical hospital, and the private outpatient plastic surgery center in Palo Alto

Insurance will sometimes cover the surgery depending on your height, weight, and approximate volume to be removed. Women who have not had children should note breast reduction may interfere with breast feeding ability.



Breast Lift (Mastopexy)

As we age, gravity, pregnancy, and nursing all take their toll on the elasticity and shape of the breast. You may notice your breasts becoming pendulous, the breast substance lacks firmness, your nipples point downward, or your breast hangs below the crease. A breast lift will raise and reshape the breast.

Mastopexies vary widely. An analysis is done of your breast shape, skin elasticity, and breast volume. For some, just a lift is needed. For others who have lost volume or have small breasts, breast enlargement can be performed in conjunction with the mastopexy to give the desired volume and shape. There are different kinds of lifts, with different locations and amount of scar. During your breast lift consultation at my Palo Alto office, we will review your goals and the possible ways of achieving them.

The surgery lasts about three hours. Recovery time is two weeks.



Breast Reconstruction ( Breast Cancer)

Breast cancer affects one of every eight women. Ages range from 30s to the 80s. When you find a lump or have an abnormal mammogram, you need to see your doctor immediately. Plastic surgeons become involved when you have been diagnosed with cancer and are going to have a mastectomy, a total removal of the breast tissue.

Breast reconstruction is done to restore the breast lost to cancer. It is one of the most rewarding breast enhancement surgical procedures available today. With modern refinements, we can create breasts that come close in form and appearance to matching a natural breast. Sometimes the shock and the number of necessary decisions are overwhelming when a woman is diagnosed with breast cancer. Reconstruction can be done immediately, at the time of mastectomy, or it can be delayed. Reconstruction can be done with an implant/expander or with your body's own tissue.

Some women choose to have breast reconstruction, others do not. The choice is a personal one. When you meet with a plastic surgeon, we can help you identify what decision is best for you. I have assisted many patients in determining whether undergoing breast augmentation is the right choice for them. We can meet in the comfort of my Palo Alto office and discuss all the options available to you.

There are two fundamental types of reconstruction. First is tissue expander/implant reconstruction. When you have a mastectomy, the nipple, areola, and some breast skin is removed. This tightens the breast envelope. As the skin flaps are thin, an expander is placed underneath the pectoral muscle to slowly stretch the skin. The expander is inflated through multiple office visits, using a simple, painless 15-minute procedure. This breast enhancement technique will gradually stretch out the skin to accommodate an implant. The implant is placed at a second surgery.

The second type of reconstruction is called the 'autologous' reconstruction. The most common procedure done in this group is the TRAM flap. A TRAM flap uses your body's own fat and skin from the abdomen to reconstruct the breast. It has the additional benefit of giving an abdominoplasty. The surgery and recovery time are longer than the expander/implant reconstruction. In an appropriate patient, it is a great breast enlargement surgery.

A 'symmetry' procedure can also be done to help the breasts look alike. This may involve a breast lift, breast enlargement, or a combination of these breast augmentation procedures during surgery. This is covered by insurance. Nipple and areola reconstruction can also be done. This occurs months after your initial reconstruction. The nipple is reconstructed by using a local skin flap. The areola is reconstructed using a skin graft or tattoo. Examples of both can be reviewed.

Depending on your surgery, you can have surgery at Stanford, the Menlo Park surgery center (has overnight stay capabilities), or an outpatient center in Palo Alto.
Breast Cancer Information



Breast Cancer Information

There are a multitude of Internet sites, community groups, and supports. I have information in my office on everything from support groups to where to buy a good wig. Much of my information comes from my patients. When a new patient comes in, I try to match them with a similar age/diagnosis patient. I find this is a difficult time, as many women try to be strong for their family, husbands, colleagues, and children. I strongly urge you to find a doctor whom you like, as breast cancer is about far more than the surgery.