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Breast Implants

Saline, Silicone Breast Implants

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Breast Augmentation is one of the most popular Plastic & Cosmetic Surgery Procedures being performed in Los Angeles, Beverly Hills and around the world. Dr. Francis Palmer performs Breast Augmentation on the west side of Los Angeles near the California Coast. If you are considering either saline or silicone breast implants it is important to be well informed of your choices and surgical options.

Before having Breast Augmentation (Breast Enhancement & Breast Enlargement) procedures there are several things for you to consider. What size would you like your Breasts to be after the Enhancement Surgery? Are you interested in Saline or Silicone Breast Implants? Where would you like the incisions to be placed? Should you have the implants placed above or below the Muscle (Pectoralis Muscle)? At first glace, these decisions may seem overwhelming but Dr. Palmer believes that after you have a thorough explanation, of your options for Breast Augmentation, you’ll be well suited to make an informed decision about your Breast Enhancement and Enlargement Procedure.

Deciding Cup Size before Breast Augmentation:

Breast Augmentation can enhance the size and shape of your breasts. One of the first things to decide is what cup size you would like your breasts to be after the Breast Augmentation or Enhancement Surgery. Take a tape measure and measure the diameter, of your breast in centimeters, across the middle of your breasts through the (areola) nipple complex. This will give you some idea of the capacity for your Breasts to be Enlarged or Augmented using Breast Implants. The diameter of your breasts give some indication of the breast cleavage as well as the outer shape (roundness) of the breasts.

Generally speaking, a Breast Diameter of 11 cm’s is an A cup, 12 a B, 13 a C, 14 a D and so on. When considering Breast Augmentation, it’s important to understand the variables in Breast Sizes. It’s typically possible to Enlarge the Breasts one full cup size and sometimes two sizes with Breast Implants, but you would not expect a D cup after the Breast Enhancement Procedure if you started out with an A cup. Breast Enhancement through Augmentation, certainly can fill out the Breasts making them appear Enlarged and more shapely. If a more dramatic Enlargement is desired, Breast Augmentation may be repeated after the tissues have had the opportunity to stretch and relax around the Breast Implant.

Measure Breast Diameter

This illustration* shows how the difference Breast Augmentation can make when it comes to the Enhancement of the breasts. As a general rule, you can draw an imaginary vertical line from the outer hips and the Breasts should touch that line. This gives a balanced overall shape to the body and serves as a measure of how large the Breast Augmentation should be. Of course, this illustration is only a rough guide and the ultimate decision on how much to Enhance your Breasts should be yours. Dr. Francis Palmer believes that Breast Augmentation, like all Plastic and Cosmetic Surgery Procedures, should be tailor-made to the specific needs of each individual.

Deciding Breast Asymmetry before Breast Augmentation:

The next decision to make is whether, or not, the Breasts are asymmetric enough in size and shape to require different sizes of Breast Implants when the Augmentation Procedure is being performed. It is not uncommon for one Breast to be slightly larger, smaller, higher or lower in position than the other Breast and some of these issues can be addressed during the Breast Augmentation. Before your Augmentation Surgery however, you should understand that Breast Enhancement won’t give you perfectly symmetrical Breasts, just one’s that are full, more shapely and attractive. Remember, the purpose of Breast Enlargement is to increase the size of the breasts by placing a Breast Implant within the breast tissues to achieve a more attractive appearance. You should not expect to have perfectly shaped or symmetrical breasts as this is an unrealistic expectation.

Deciding Placement, of the Breast Implant, before Breast Augmentation:

Before your Breast Augmentation Procedure, a decision must be made as to the level of placement of the Breast Implant itself. During the Breast Augmentation Procedure, the Breast Implant may be placed above the Pectoralis Muscle or below it. Each method of Breast Implant placement has its benefits. Let’s look at these issues, one at a time, and see how they can impact your decision before your Breast Enhancement Procedure.

Breast Implants may be placed either above, or below, the muscle layer. If the Breast Implant is placed above the muscle, there is less tissue between the implant and the skin and rippling may be visible around the upper edges of the breast. Placement of the Breast Implant below the muscle layer reduces the amount of rippling that is observed. Because the muscle layer must be dissected in order to make a space for Breast Implant placement, there may be some minor discomfort postoperatively. This is usually well tolerated and is minimized further with the use of a general muscle relaxant like Flexeril. Dr. Palmer typically prescribes Flexeril for 3 days after your Breast Augmentation if the Sub-muscular placement is to be used.

Breast Augmentation Incisions:

Breast Augmentation may be performed through various incisions as a way of gaining access to the breast tissues during placement of the Breast Implant. Where the incision is placed is a consideration as it does have an effect on the visibility of the scar, possible damage to the milk ducts of the breasts and the lymphatic drainage of the Breasts. Breast Augmentation can be performed through an incision in the breast or at a remote location. Incisions in the breast include those that are around a portion of the areola (nipple complex) or within the crease below the breast. Remote incision locations include the armpit (axilla) and the belly button (umbilicus).

Here the picture* shows a lower periareolar incision, but during Breast Enhancement and Augmentation, this incision can be made along the upper half of the areola and be combined with a Crescent lift. The Crescent Lift removes a small amount of skin above the incision and the nipple is lifted upwards appearing to have less droop (ptosis). This makes this an ideal incision when Breast Augmentation with a bit of a lift is desired. When incisions are placed around a portion of the nipple (areola), these incisions are visible, although they tend to heal well. Incisions placed here also mean that as the Breast Enhancement is performed and the tissue of the breast is dissected in preparation of the Breast Implant placement, some of the milk ducts of the breast may be damaged. This typically does not prevent breast feeding after the Augmentation. As mentioned earlier, if a lift is desired or required, the superior areolar incision is a nice way of accomplishing both goals during the Breast Augmentation Procedure.

Incisions placed within the breast crease will create less disruption of the milk ducts and offer more direct access to the Pectoralis Muscle. A crescent lift could not be performed through this type of incision however some believe that this incision is the least disruptive to the lymphatic drainage of the breast. This becomes an important consideration should a breast tumor occur.

The incision can be placed inside the armpit (axilla). Here, the Breast Augmentation is done through an incision that is not readily visible however, there are some issues raised with this approach. Dissection is a bit more difficult as there are many nerves within the tissues of the armpit that need to be avoided during the Breast Augmentation Procedure. If some of these nerves are injured, weakness of the arm and hands could result. If bleeding is encountered, it may not be possible to reach it from the armpit. This may require the placement of another incision that’s closer to the point of bleeding. This may not sound like a big deal, but it sure can be. Minute amounts of bleeding during and immediately after the Breast Augmentation may contribute to hardening (capsular contracture) of the Breast tissue around the implant. Significant bleeding (hematoma) may cause real problems with tissue compromise or infection of the Breast Implant. So the take home message here is, bleeding should be controlled during Breast Enhancement Surgery and this may not be possible with a remote incision in the armpit or the bellybutton.

Another remote incision location for Breast Augmentation Surgery is the belly button. This has the same bleeding issues as mentioned above for the armpit incision. Incisions in the belly button, during Breast Enhancement will allow the use of Saline (salt water filled) Breast Implants only. When using this incision, during the Breast Augmentation Procedure, the Breast Implant must be rolled tightly in order to have it go inside a tunnel from the belly button to the breast tissue. Once within the breast tissue, the Breast Implant is filled with Saline through an extension tube to the Breast Implant. Once the Breast Implant is filled, this tube is removed. Silicone Breast Implants can’t be used from this far away, as they come pre-filled. A pre-filled Breast Implant would not be able to be placed through the tunnel between the belly button and the breast tissue. The tunnel required, is too large. That’s why the unfilled Saline Breast Implant is rolled up so that it fits through the tunnel in the tissues connecting the belly button and the breast tissue.

As you can see from the photo, of round and tear shaped Breast Implants, an inflated Breast Implant would require that a large pocket be placed through the tissues in order to accommodate the placement of the Breast Implant from the remote incision site to the Breast. That means the tunnel trough which the Breast Implant would need to be placed would have to be approximately equal to the diameter of the Breast Implant. This would be quite large and therefore impractical.

Deciding Implant material before Breast Augmentation:

Before your Breast Augmentation, you’ll have to decide whether you want Breast Implants that are filled with Saline (Salt water) or Silicone. Currently, in this country, you can have Breast Enlargement with Saline Implants but must meet certain clinical criteria in order to qualify for Silicone Breast Implants. In essence, some additional pre-set clinical conditions must exist beside the fact that you would like to Enhance your Breasts. Some of these include previous Breast Augmentation, Deformities of the Breast(s) or chest wall and Breast Reconstruction. This is not meant to be a complete list and Dr. Palmer will discuss this with you during your initial consultation and examination. Inamed and Mentor corporations have both applied to the FDA to lift the clinical restrictions on the use of Silicone Breast Implants for Breast Augmentation. That decision is before the FDA. Ultimately, the decision must be yours whether your Breast Augmentation will be performed using Saline or Silicone Breast Implants. Here is a brief explanation of the two types of Breast Implant material currently available in the U.S.

Saline Breast Implants:

Basically physiologic salt water, if it ruptures, the implant deflates immediately and the body absorbs the salt water.

Has a low density (specific gravity) of only 1, that means that because the water is not heavy, when you are upright the water, in the Breast Implant, will tend to fall to the bottom of the Breast Implant. This creates the rippling that can be visible through the skin. Some experts believe that the area(s) of contact, between the implant shell (within these ripples), may cause rubbing and eventual wear and leakage of the implant. The low specific gravity (density) tends to feel lighter than breast tissue after the Breast Enhancement Procedure.

The Saline Breast Implant still has a silicone outer shell that encases the salt water.

Silicone Breast Implants:

Made from Silicon a naturally occurring element: Derivates of Silicon have been used in the consumer industry (suntan lotion, hairspray) for decades. Silicone has been used to coat surgical suture and thread for years. Used inside syringes, pace makers, facial implants and much more, silicone has been used in the medical field in many applications.

Higher density (specific gravity): This means that the material within the implant tends to resist the downward pull of gravity and more material stays in the upper areas of the Breast Implant. This means less rippling. The higher density also means that these Breast Implants tend to feel more like breast tissue.

Safety Concerns: Silicone materials have undergone extensive testing and these have not shown an increase in autoimmune, connective tissue diseases or the incidence of breast cancer. The very latest data is available at the NIH and I urge all women who are considering Breast Augmentation to stop and spend some time deciding what Breast Implant material they would prefer. Although the surgeon can guide you to the information, the ultimate decision must rest with you as the patient.

Breast Implants come in varying styles and shapes:

Both types of Breast Implants come in round or tear-drop shapes. The Tear drop is sometimes referred to as the anatomical shape.

Here are some of the differences between these types of Breast Implants for Breast Augmentation or Breast Enhancement Procedures:

Round Breast Implants will enlarge, enhance and augment the entire breast. This is preferable when the upper area of the breast has lost breast tissue and volume. This typically occurs after pregnancies but may also be a result of less breast tissue forming during breast development. Round Breast Implants come in varying diameters that will determine the cup size of your breast after the Breast Augmentation Surgery. Within the same diameter, the amount of Breast Implant fill (called projection) also varies. Think of the projection as the thickness of the Breast Implant. The thicker Breast Implants give more augmentation to the breasts at the same diameter than one of lesser projection. Here’s an example. A young woman wants a Breast Augmentation to Enhance the size of her Breasts. She is petite with a breast that measures 12 centimeters in diameter but wants the maximum amount of breast enhancement possible. If you look at the measurements of Breast Implants, a Breast Augmentation Procedure using a 12 cm diameter Breast Implant would be a B cup however, if we use a high profile Breast Implant with a higher projection or Breast Implant thickness, she will able to have much more cleavage and breast enhancement after the augmentation. Dr. Francis Palmer will discuss these options as a means to tailor the Breast Augmentation Procedure to meet your specific Breast Enhancement needs.

Tear-drop or anatomical shaped Breast Implants should be considered when you want to accentuate the gentle slope that occurs from the top to the bottom of the breasts. Breast Augmentation with this type of implant fills the bottom, of the breasts, more than the top portions. Because this type of Breast Implant has a specific shape that is dependent on the exact placement of the Breast Implant, some believe that if the implant rotates, in either clockwise or counter-clockwise position within the breast, the overall breast shape might change. It has been our experience that women seeking Breast Enhancement are fairly clear on the desired shape that they wish the Breast Augmentation Procedure to achieve. We will discuss these options, with you, during your consultation with Dr. Francis Palmer.

Deciding required ancillary procedures during Breast Augmentation:

Additional procedures that may be performed during your Breast Augmentation Surgery include Breast Lifts, removal and replacement of Breast Implants, Capsulotomies or Capsulectomies. These are discussed below:

Breast Lifts can be performed with Breast Augmentation. Breasts begin to sag with age and the effects of gravity. This may accelerate after pregnacies or significant weight loss. This is called Breast Ptosis and is clinically measured by a numerical system from 1-4, with 4 being the most ptotic or sagged. We discussed above, in the section on breast incisions, how a crescent lift can be performed to give the illusion of lifting the areolar complex to a higher position on the breast. True breast lifts will require additional incisions around the areolar complex and may include an incision from the areola to the breast crease below the breast. This mid-line incision can be a straight line or an S-shaped incision. All of these formal breast lifts are designed to re-position the entire areola to a higher position on the breast. That means that some breast tissue is removed and the entire areola is move upward and re-sewn in the higher position. Obviously, there are additional scars and this must be taken into account before choosing this option. The other point that should be made here is the following: if your breasts are already sagging and a Breast Implant is placed within your breast tissue, will your breasts be more perky, or will then become more saggy? Although the crease below the breast can be lowered, thereby allowing the Breast Implant to rotate upward by dropping into the lowered breast fold, it may not be enough to compensate for the added weight of the Breast Implant. So, the bottom line is that you may need to consider some type of lift during the Breast Augmentation Procedure. Dr. Francis Palmer will discuss this during your consultation and examination fro Breast Augmentation and Enhancement.
Previous Breast implant removal and replacement. There are several reasons to replace (exchange) Breast Implants. There maybe signs of Breast Implant leakage. With saline Breast Implants this typically coincides with a dramatic change (decrease) in the size of the breasts. With silicone Breast Implants the change in size and shape usually occurs more slowly. Dr. Francis Palmer tells his patients to observe and note any minor shape changes that occur in your breasts, if you have silicone Breast Implants. Specifically look for changes in the upper regions of the breast that may indicate small areas of hardening around the implant. While capsular contracture can occur anytime with any type of Breast Implant, isolated areas of hardening may indicate minor breaks or leaks in the silicone Breast Implant. Remember, this happens slowly over months. If you suspect this, there are test like MRI and CT scans that may reveal the leak.

Here are some other reasons to replace Breast Implants:

You want to make your Breasts larger, or smaller and need to use a different sized Breast Implant. Dr. Francis Palmer tells his patients that just because you’ve had your Breast Implants for some time doesn’t mean that they automatically need to be replaced. If your breasts have remained soft and the shape has not changed indicating a leaky implant, there’s really no reason to replace the Breast Implants with a Breast Augmentation Procedure. It should be mentioned that some of the older Breast Implants had a protective outer layer on the Breast Implant. We have seen cases where this layer begins to dissolve creating shape changes and isolated areas of hardening of the breasts. If this occurs, you may consider removing these Breast Implants and replacing them with a newer type that doesn’t have this outer covering. With time (years later), your breasts may have lost some of the initial Enhancement and volume from your Breast Augmentation Procedure. Replacing (exchanging) Breast Implants with larger ones is quite common and generally a simple procedure. The converse is also true. You may exchange your Breast Implants for smaller ones should you wish to reduce the overall size of your breasts. Typically, you can go down one full cup size without risking sagging, of the breasts, or loose skin…but this obviously varies a great deal from patient to patient and should be discussed with Dr. Francis Palmer during your consultation for Breast Augmentation Surgery.

The breasts have become hard and or misshapen. If the breasts are hard all over and a leaky Breast Implant is not suspected, then a Capsulotomy or Capsulectomy may be required. Tissue may become hard around the Breast Implants after Breast Augmentation Surgery. This is called capsular contracture and is measured clinically by a 4 point numerical grade (Baker) with 4 being the most severe.

Baker Grading System – 4 Grades of Capsule Contracture

Baker Grade I: The breast appears soft and looks natural. Every Breast Implant will form some type of tissue capsule around the Breast Implant after Breast Augmentation Surgery. This does not require any type of action.
Baker Grade II: The breast looks natural but feels a bit firm. Typically, this can be observed and no action taken if contracture does not progress further. Some of the preventative measures described below may be attempted. When the contracture progresses this tissue begins to harden and shrink, as designated by the following Baker Grades, and may require a Capsulotomy or Capsulectomy.

Baker Grade III: The breast is firm and the breast shape appears distorted.

Baker Grade IV: The breast is firm, hard, painful and significantly distorted in shape.

With Baker Grades 3 and 4, a procedure to modify this capsule may be indicated with Breast Augmentation and exchange of the Breast Implants. Incisions can be made into the capsule along the base of the capsule where it meets the chest wall and tangentially upwards toward the middle of the capsule to release the contracture. This is called a Capsulotomy. If there is sufficient breast tissue to allow complete removal of the contracted capsule and still allow adequate tissue covering for the Breast Implant during the Breast Augmentation Procedure, a Capsulectomy may be considered. This basically removes all of the hardened tissue and the Breast Augmentation can be performed in soft breast tissue. Of course, capsular contracture can occur anytime after Breast Augmentation. It may or may not occur…may occur in one breast and not the other. Dr. Francis Palmer does not perform Closed Capsulotomies where the breast is forcibly squeezed in an effort to break the capsule as the Breast Implant manufacturers do not recommend this maneuver. Some of the things thought to increase capsular Contracture include: bleeding, infection and implant variations.

Unfortunately, there is no way to guarantee that you will not experience some type of capsular contracture after your Breast Augmentation Procedure however, there are some things that can be done before, during and after your Breast Augmentation to try to limit the amount that does occur.

Avoid aspirin, vitamin E and other medications that can thin the blood and promote bleeding before your Breast Augmentation.

Avoid over exertion after your Breast Augmentation Procedure as this raises your blood pressure and may cause micro bleeding within the breast tissues. Small amounts of bleeding that occur within the breast tissue, after Breast Augmentation, is one of the suspected causes of increased capsule formation.

Place the Breast Implant below the muscle instead of over it within the breast tissue. Some believe that using this approach during Breast Augmentation allows the Breast Implant to be separated from the breast ducts. Bacteria located within these breast milk ducts is another suspect in increased capsule formation. The bacteria is believed to create a low grade infection or inflammation that causes contracture and hardening of the capsule.

Massage your breasts after the Breast Augmentation Procedure. Dr. Francis Palmer believes that it’s important to massage your breasts so that the Breast Implants continue to keep the tissue pocket expanded. Massaging is performed gently, at first, until the breasts are healed from the Breast enhancement surgery. After this the level of massaging is increased.

Type of Breast Implants. Textured, smooth, saline or silicone may all effect capsule formation.

Prophylactic antibiotics after your Breast Augmentation. Dr. Francis Palmer recommends that his patients with Breast Implants take two doses of prophylactic antibiotics when having any type of dental work. Bacteria, that is stirred up with dental work, may be a factor in increased capsule formation.

Preventative medications or remedies. Some have suggested that Vitamin E post Breast Augmentation may help reduce the amount of capsule formation. Be sure that you are well healed from the Breast Augmentation before beginning vitamin E as it has been known to possibly thin the blood and promote bleeding. Papaverine is a vasodilator and muscle relaxant that some believe may help to control capsule formation. Accolate is an asthma medication that shows promise for the control and possible reversal of capsule formation. It may be considered after Breast Augmentation in women at higher risk of capsule formation, this would include Breast Augmentation with Capsulotomy or Capsulectomy.

Before and After Pictures

Pictures and Photos are a good way to see the typical types of results that may be achieved with these procedures. Dr. Francis Palmer performs Breast Augmentation in his fully-accredited outpatient surgical facility in Beverly Hills, California. The Beverly Hills International Center for Aesthetic Surgery is here to assist you in all your Plastic and Cosmetic Surgery needs as well as providing non-surgical beauty enhancements and the latest in Cosmeceutical skin care.

Breast Enhancement with a Crescent Breast Lift and Saline Breast Implant placement below the muscle in a 30 year old. Case # 72115:

Here is a preoperative Picture/Photo before Breast Augmentation with Saline Breast Implants that were placed below the muscle to Enhance the Size and shape of the Breasts. The Breast Augmentation was recommended to fill out the lost Breast Tissue at the upper areas of the Breasts. You can see the general outline of the Breast skin envelope as identified in the Picture/Photo by the preoperative Breast markings. With the patient standing, this gives a good indication of the Breast Diameter which may then be used in selection of Breast Implant size and projection. The Breasts also show signs of Ptosis (sagging) and it was decided to perform a Crescent Breast Lift at the time of the Breast Augmentation with Breast Implants. The surgical marking pen shows the outline of a Crescent Breast Lift. The Picture/Photos also show how the Breast dissection can be limited in the lateral Breast region towards the axilla (armpit) during the Breast Augmentation. This gives the Breasts (Breast Implants) a more oval and anatomical appearance after the Breasts have been Enhanced. The Breast Implants are placed through the incision used for the Crescent Breast Lift for Breast Implant Placement.

Here’s a Picture/Photo of the same patient after the Breast Augmentation Procedure with Saline Breast Implants. The Breasts are Enhanced and Augmented and the Areolae are lifted. The Breasts have a nice full Enlarged appearance. Breast Augmentation/Enhancement patients are encouraged to massage their Breasts, for several months, after their Breast Augmentation Procedure. In Dr. Francis Palmers opinion, this helps maintain soft Breasts after the Breast Augmentation Procedure.

The profile Picture/Photo before Breast Augmentation/Enhancement with Saline Breast Implants shows the loss of Breast tissue in the upper Breast regions. The Breasts are marked, before the Breast Augmentation, indicating the Breast skin envelope and possible diameter of Breast Implant that can be used to Enlarge and Enhance the Breasts. The Breast markings for the Crescent Breast Lift are also visible. If you do not wish Increased Breasts protruding outward by the axilla (armpit), the Breast dissection can be limited during the Breast Augmentation/Enhancement Procedure as shown in this Picture/Photo.

Post operative Picture/Photo shows the Breasts, on profile, after they have had Breast Augmentation/Enhancement with Saline Breast Implants that were placed below the muscle. The Picture/Photo shows the Enhancement and Augmentation in the upper Breast area where the Breasts were relatively flat before the Breast Augmentation and placement of Saline Breast Implants. A low profile Saline Breast Implant was used in this Breast Augmentation Procedure. For patients seeking even more Breast Enhancement and Enlargement a moderate or high profile Breast Implant could have been used during the Breast Augmentation Procedure. The projection, or profile, of the Breast Implant indicates the different thicknesses of Breast Implants. The higher the profile, the thicker the Breast Implant and the greater the Enlargement/Enhancement to the Breasts
Breast Augmentation below the Muscle in a 24 year old. Case # 82617:

This Picture/Photo shows a case of primary Breast Enlargement using an Augmentation/Enhancement Procedure performed with Saline Low Profile Breast Implants. The Breast Implants were placed below the muscle. The available Breast skin and tissue envelope can be seen in this Picture/Photo. The patient desired a modest amount of Augmentation/Enhancement/Enlargement of her Breasts. There is no evidence of Breast Ptosis so the patient opted for an incision that was placed in the Infra-mammary fold for placement of the Saline Breast Implants. Saline Breast Implants are rolled upon themselves for placement during the Breast Augmentation Procedure and may be inserted through a rather small incision in the crease of the Breasts as evidenced in this Picture/Photo. Once the Breast Implant is positioned properly, within the Breast, the Breast Implant is filled with sterile saline (salt water) to the desired Breast Implant specifications. The fill tube is then removed from the Breast Implant and the Breast tissue is closed in layers.

Here’s the post Breast Augmentation/Enhancement/Enlargement Picture/Photo demonstrating Breasts that are Augmented and Enlarged. The patient received the modest Breast Enlargement, that she desired, while still achieving more shapely Enhanced Breasts from the Low profile Saline Breast Implants. The Breast Augmentation incision is well hidden under the Breasts in the lower Breast crease. Dr. Francis Palmer believes that placement of the Breast Implants below the muscle allows more Breast tissue coverage of the Breast Implants making it less likely to see rippling along the upper edges of the Breast Implants…as the edges are covered by the muscle.
breast15Profile Picture/Photo of the same patient before the Breast Augmentation/Enhancement/Enlargement with Saline Breast Implants below the muscle. There is relatively little Breast tissue with which to cover the Breast Implants therefore the Breast Implants were placed below the muscle for additional Breast tissue coverage during the Breast Augmentation. The Picture/Photo shows the area of planned dissection, of Breast tissue, during the Breast Augmentation Procedure. Meticulous planning and marking, of the Breasts, before the Breast Augmentation Procedure is essential for obtaining the desired size and shape of the Breasts after the Breast Enhancement Surgery.

After the Breast Augmentation/Enhancement/Enlargement Procedure. The Picture/Photo shows Breasts that are fuller, Enhanced, Enlarged and more shapely. The increase in Breast size is obvious from the profile Picture/Photo. The low profile Saline Breast Implants were round in shape. Dr. Francis Palmer believes that the anatomical shaped Breast Implants may rotate after the Breast Augmentation and that the rotation of the Breast Implants may create an undesirable change in the shape of the Breasts. For this reason, Dr. Francis Palmer uses round Breast Implants and avoids using anatomical shaped Breasts Implants for Breast Augmentation.

Crescent Lift with below the muscle Silicone Breast Augmentation on a 40 year old. Case # 54313:

This before Breast Augmentation/Enhancement Procedure Picture/Photo demonstrates Breasts that are asymmetric with the left Breast higher and a different size than the right Breast. Both Breasts exhibit Breast Ptosis that can be seen in this Picture/Photo. There is a lack of Breast fullness in the upper Breast regions. The Picture/Photo shows the Breast markings for a Crescent Breast Lift to elevate the areolae to reverse the effects of sagging Breasts. The midline between both Breasts as well as the mid-sternal notch to the proposed elevated nipple position can be seen in the Picture/Photo. Markings for an Abdominoplasty (Tummy Tuck) hyperlink to be performed at the same setting as the Breast Augmentation Procedure can be seen in this Picture/Photo.

Profile Picture/Photo of the same patient before the Breast Augmentation/Enhancement and Abdominoplasty Procedures. The Breasts are sagging and there is a clear loss of Breast tissue fullness in the upper Breast Area. The Picture/Photo also shows laxity and excess of the skin over the abdomen. The patient chose round Silicone Breast Implants for the Breast Augmentation/Enhancement Procedure. The Silicone Breast Implants, unlike Saline Breast Implants, come pre-filled to a specific volume in cc’s (milliliters) that can not be altered during the Breast Augmentation Surgery. Because the Silicone Breast Implants are pre-filled, the placement of the Breast Implants requires a slightly larger incision in the Breast. Dr. Francis Palmer placed the Silicone Breast Implants through the same incision used for the Crescent Breast Lifts. The Silicone Breast Implants were placed below the muscle to provide added Breast tissue coverage for the Silicone Breast Implants.

Profile and angled front Picture/Photo after Breast Augmentation/Enhancement Surgery with a round moderate profile Silicone Breast Implant placed below the muscle. Crescent Breast Lifts were also performed. The Picture/Photo shows the Breast Enlargement and Enhancement after the Breast Augmentation and Crescent Breast Lift. Compare the Breast size and shape in this after Breast Augmentation Picture/Photo compared to the before Breast Augmentation Picture/Photo above. The Picture/Photo also shows a tighter, flat abdomen after the Abdominoplasty (Tummy Tuck) Procedure.

Breast Augmentation with Saline Breast Implants Below the Muscle. Case# 32634:

This before Breast Augmentation/Enhancement Procedure Picture/Photo shows a young female in her 20’s. There is marked loss of upper Breast fullness as well as sagging (Ptosis) of the Breasts. The Picture/Photo shows markings before the Breast Augmentation Surgery where the Breast skin and tissue envelopes have been marked. The Breasts are a bit asymmetric with the left Breast higher and more ptotic than the right Breast. The patient opted for round moderate profile Saline Breast Implants placed below the muscle with a Crescent Breast Lift for her Breast Augmentation/Enhancement Surgery.
After the Breast Augmentation/Enhancement with smooth, round, moderate profile Saline Breast Implants with bilateral Crescent Breast Lifts. The Picture/Photo reveals Enhanced and Enlarged full, more shapely Breasts with less ptosis (sagging). The Saline Breast Implants were placed through the Crescent Breast Lift incisions which typically heal very well. This Picture/Photo was taken 3 months after the Breast Augmentatiomn/Enhancement Procedure. The Picture clearly shows an increase in upper Breast fullness when compared to the before Breast Augmentation Picture/Photo.

The after Breast Augmentation/Enhancement Picture/Photo taken in profile shows the Breast Enlargement obtained after the Breast Augmentation Surgery. The Crescent Breast Lift incisions are well healed and the Breasts are elevated into a more youthful position. Dr. Francis Palmer places Breast Implants below the muscle to allow more Breast tissue coverage over the Breast Implant. Remember, Saline is salt water with a specific gravity of 1. This means that the Saline in Saline Breast Implants is less dense than the surrounding Breast tissue. When the Saline Breast Implant is positioned upright (patient is standing or sitting upright) gravity tends to pull the Saline into the lower portion of the Saline Breast Implant. This causes a relative decrease in the amount of Saline at the upper portion of the Saline Breast Implant and the Breast Implant shows signs of this by rippling on itself. Placing the Saline Breast Implant under the muscle covers the upper portion of the Saline Breast Implant thereby decreasing the visibility of this effect. In other words, it’s more difficult to see the rippling in the Saline Breast Implant when the Breast Implant is placed below the muscle. A similar thing happens with Silicone Breast Implants but to a lesser degree because the Silicone within the Silicone Breast Implant has a higher specific gravity (is more dense) and as such resists the pull of gravity into the lower portions of the Silicone Breast Implant. This increase in density is also why Silicone Breast Implants feel more like Breast tissue.

Saline Breast Augmentation Below the Muscle. Case # 26386:

Here’s a Picture/Photo before Breast Augmentation of a Primary (first Time) Breast Augmentation. The patient requested larger, fuller Breasts. There is no sign of sagging (ptosis) and the patient opted for a Breast incision along the lower portion of her areolae. The Breast skin tissue envelope is seen marked in this Picture/Photo. There is an asymmetry of the Breasts with the left Breast higher. In the Picture/Photo, Dr. Francis Palmer has marked the new lower position of the left Breast crease to more closely match the right Breast crease.

The Picture/Photo taken 1 month after Breast Augmentation Procedure performed using smooth, round, high profile, Saline Breast Implants placed below the muscle. The patient was looking for the maximum amount of Breast Enlargement that was possible from the Breast Augmentation/Enhancement Procedure. The incisions are easily covered with a little makeup, although these will fade within another month or so. The patient went from a small B-cup to a full D-Cup. The Picture/Photo shows the Breasts have been filled out with the high profile Saline Breast Implants.

The profile of the before Breast Augmentation/Enhancement Picture/Photo shows the small amount of Breast tissue before placement of the smooth, round, high profile, Saline Breast Implants below the muscle. The Picture shows the extent of the Breast skin and tissue envelope which was used to calculate the maximum diameter of Saline Breast Implant that could be used in the Breast Augmentation Surgery. Contrary, to popular belief, there is a limit to the size of Breast Implant that can be placed, in the Breast, during a Breast Augmentation Procedure. If this Breast Implant size is exceeded, there may not be sufficient Breast tissue to accommodate the Breast Implant.

The after Breast Augmentation/Enhancement profile Picture/Photo shows that the Breasts have been Augmented, Enlarged, Enhanced and made more full and shapely. The Picture/Photo was taken 1 month after the Breast Augmentation Surgery and the incision is still pink. Makeup will cover this incision which should fade to skin color in another month or so. The patient has D-Cup Breasts and was very happy with the Breast size. The Saline Breast Implants were placed below the Muscle and the left Breast crease was lowered to allow more symmetry between the position of the right and left Breasts.

Case # 224901: Before Breast Augmentation with Smooth, Round Saline Breast Implants placed beneath the muscle with a Crescent Breast Lift in a 40 year old female. The Picture/Photo shows a loss of Breast Tissue in the superior (upper) Breast area. Dr. Francis Palmer has marked the Breast Tissue envelope with a surgical marker. The Patient was seeking Breast Enhancement with a significant amount of Breast Augmentation.

After Picture/Photo of Breast Augmentation with Saline Breast Implants on the same patient taken at 3 months post-op. You can see the Breasts have been Augmented and Enhanced and there is more Breast Cleavage. The Breast Implant was placed through the same incision used to perform the Crescent Breast Lift. The Superior pole, of the Breasts, have been Enhanced and the entire Breast appears more full and shapely after the Breast Enhancement Procedure.

The Breast tissue envelope is marked with a surgical marking pen as well the outer extent of the Breast dissection and Saline Breast Implant placement. (lower arrow). By making the round Saline Breast Implant go into a relative smaller pocket, in the breast, the Saline Breast Implant takes on a more oval anatomical-like shape. The Markings for the Crescent Breast Lift are also visible in this Picture.

After Photo of the same patient after her Breast Augmentation and Enhancement Procedure. The Picture shows the Enhancement and Augmentation of the Breasts that was achieved with the Smooth, Round Saline Breast Implants placed below the muscle. The Breast Implants have given the breasts a more shapely, enhanced, augmented and youthful fullness. The peri-areolar incisions have healed well and are easily hidden with a little makeup.

Picture/Photo of the opposite Breast on the same patient before the Breast Augmentation with Smooth, Round Saline Breast Implants. When compared to the after Breast Augmentation Picture/Photo (below), the Breast has obvious loss of Breast tissue in the pre-op photo. The extent of the Breast tissue envelope is the outer purple mark made with a surgical marking pen. The Inner mark visible in this Picture is the extent of the Breast tissue dissection for placement of the Saline Breast Implant.

The after Breast Augmentation/Enhancement Picture/Photo clearly shows how the Breast is fuller and more shapely after the Saline Breast Implant was placed below the muscle. This out of town patient was cleared for air travel 8 days after Dr. Francis Palmer performed her Breast Augmentation/Enhancement Surgery Procedure. The Crescent Breast Lift has elevated the nipple and areola into a more youthful position.

Case # 224790: Before Breast Augmentation/Enhancement Picture/Photo of a woman in her twenties that was seeking Breast Augmentation. She wanted to fill out both Breasts and to make the left Breast more even to the size of the Right Breast. From this Picture, you can see that the left Breast is underdeveloped compared to the right Breast and is smaller and higher in position. The patient requested Saline Breast Implants. She asked for a small amount of Breast Augmentation to the right Breast with more Augmentation to the left Breast for added symmetry.

After Breast Augmentation/Enhancement Picture/Photo of the same patient. Smooth, round, Saline Breast Implants were placed below the muscle using an inferior areolar incision. Because of the significant difference in Breast Size, two different sizes of Saline Breast Implants were used in this case. A larger Saline Breast Implant was used to Augment the left Breast for added Breast Enhancement. The Picture/Photo shows the Breasts are more even in size and shape after the Breast Augmentation with Saline Breast Implants. Patients with underdeveloped Breast(s) may also fit the clinical criteria for Silicone Breast Implants, however this patient opted for Saline Breast Implants for her Breast Enhancement Procedure.

Picture/Photo from the side revealing the underdevelopment of the left Breast before the Breast Augmentation/Enhancement Surgical Procedure. In these types of Breast Augmentation cases, it is very important to be sure that there is adequate Breast tissue to cover the Breast Implant regardless of whether a Saline or Silicone Breast Implant is to be used. One way to accomplish this goal is to place the Breast Implant below the muscle. As shown in the illustrations above, the muscle adds an added tissue layer that covers the upper ~ 1/3 of the Breast Implant.

The after Breast Augmentation Picture/Photo reveals how the Breasts are more even in size and shape. Using a larger Saline Breast Implant for the left Breast Enhancement allows more Augmentation to that Breast as clearly seen in this after Picture/Photo. The patient no longer feels self conscious about her Breasts and is quite happy with the results of her Breast Augmentation/Enhancement Procedure. These Pictures/Photos were taken at ~3 months after her Breast Augmentation Surgery.

Saline Breast Implant placement below the muscle in a 33 year old. Case # 52119:

Here is a preoperative (before) Picture/Photo of a Breast Augmentation with Smooth, round Saline Breast Implants that were placed below the muscle. The patient requested a minimal amount of Enhancement to the size and shape of the Breasts. In this Photo/Picture the Breasts appear somewhat flat, especially in the upper Breast Area. The Breast Augmentation was recommended to fill out the Breast Tissue at the upper areas of the Breasts. You can see the general outline of the Breast skin envelope as identified in the Picture/Photo by the preoperative Breast markings. The lower diagonal lines outline the ribcage while the upper lines show the direction of the underlying muscle. The Breast markings for a Breast Augmentation and Enhancement Procedure are performed with the patient standing. This gives a good indication of the Breast Diameter which may then be used in selection of Breast Implant size and projection. The Breasts do not show signs of Ptosis (sagging) so no Breast Lifting Procedures were recommended during the Breast Augmentation Surgery with Breast Implants. The Picture/Photos also show how the Breast dissection can be limited in the lateral Breast region towards the axilla (armpit) during the Breast Augmentation. This gives the Breasts (Breast Implants) a more oval and anatomical appearance after the Breasts have been Enhanced. The Breast Implants are placed through an incision along the lower portion of the areolar complex.

Here’s an (after) Picture/Photo, at about 2-3 weeks, of the same patient after the Breast Augmentation Procedure with Saline Breast Implants. The Breasts are Enlarged, Enhanced and Augmented. The Breasts have a nice full Enlarged appearance. Breast Augmentation/Enhancement patients are encouraged to massage their Breasts, for several months, after their Breast Augmentation Procedure. In Dr. Francis Palmer’s opinion, this helps maintain soft Breasts after the Breast Augmentation Procedure. The incision is closed with dissolvable sutures and typically heals quite well.

Here we see the same patient in profile. The (before) Breast Augmentation and Enhancement with Saline Breast Implants Picture/Photo clearly shows the lack of Breast tissue in the upper Breast regions. The Breasts are marked, before the Breast Augmentation, indicating the Breast skin envelope and possible diameter of Breast Implant that can be used to Enlarge and Enhance the Breasts. In this particular case, the patient wanted only a modest amount of Breast Augmentation and Enlargement. In addition, to avoid the look of Breasts protruding outward towards the axilla (armpit), the Breast dissection was limited during the Breast Augmentation/Enhancement Procedure as shown in this Picture/Photo.

Post operative Picture/Photo shows the Breasts, on profile, after they have had Breast Augmentation/Enhancement with Saline Breast Implants that were placed below the muscle. The Picture/Photo shows the modest, but significant, Enhancement and Augmentation in the upper Breast area where the Breasts were relatively flat before the Breast Augmentation and placement of Saline Breast Implants. A low profile Saline Breast Implant was used in this Breast Augmentation Procedure. breast41 For patients seeking even more Breast Enhancement and Enlargement a moderate or high profile Breast Implant could have been used during the Breast Augmentation Procedure. The projection, or profile, of the Breast Implant indicates the different thicknesses of Breast Implants. The higher the profile, the thicker the Breast Implant and the greater the Enlargement/Enhancement to the Breasts. This patient was extremely happy with the New Augmented size and shape of her breasts.

Breast Enhancement using Saline Breast Implant placement below the muscle. Case # 19437:

Here is a preoperative (before) Picture/Photo of a Breast Augmentation with Smooth, round Saline Breast Implants. The Breast Implants were placed below the muscle during the Breast Augmentation Procedure to of Enhance the size and shape of the Breasts. This before Photo/Picture shows that the Breasts appear somewhat small but there is no evidence of Breast ptosis. The patient selected smooth, round, Saline Breast Implants for her Breast Augmentation Surgery. You can see the general outline of the Breast skin envelope. These photos were taken before the standard preoperative Breast markings that are performed with the patient standing. This gives a good indication of the Breast Diameter which guides the selection of Breast Implant size and projection.

The Postoperative (after) picture/photo of the same patient after her Breast Augmentation/Enhancement Procedure with smooth, round Saline Breast Implants placed below the muscle through an incision along the lower edge of her areola. The picture was taken at about 3 weeks postoperatively and shows Breasts that are full and enhanced. The incision typically heals very well and the sutures are all dissolvable. Dr. Francis Palmer has his Breast Augmentation patients massage their Breasts after the Breast Enhancement Surgery when they appear healed enough to do so.
Actual Patient Photos. Results may vary.
Here’s a preoperative (left) before and postoperative (right) after the Breast Augmentation Procedure. The Breasts appear small, before the Breast Enhancement, and the patient requested Saline Breast Implants to Augment the size and shape of her Breasts. The patient was looking for a marked increase in the size of her Breasts and the appropriate sized Saline Breast Implant to accomplish that goal was selected for the Breast Augmentation Procedure.

Here’s the opposite profile preoperative (left) before and Postoperative (right) after the Breast Augmentation & Enhancement Surgery. The Pictures/Photos show how the Breast dissection can be limited in the lateral Breast region towards the axilla (armpit) during the Breast Augmentation procedure. This limits the lateral extent of the Breast Enhancement and gives the Breasts (Breast Implants) a more oval and anatomical appearance after the Breasts have been Augmented. The Breast Implants are placed through an incision along the lower portion of the areolar complex. The Breasts are full, Enhanced and more shapely after the Breast Augmentation Procedure.

Breast Enhancement using Saline Breast Implant placement below the muscle. Case # 43129:

This is a preoperative (before) picture of a woman who had previous Saline Breast Augmentation. She has some encapsulation and hardening of the Breasts that can be seen on the lateral portion of the Breasts by the axilla (armpit). The Patient requested that the existing Breast Implants be removed and be replaced with larger smooth, round Saline Breast Implants placed below the muscle for the Breast Augmentation & Enhancement Procedure.

Here’s the postoperative (after) photo of the same patient at about 1 month from the date she had her Breast Augmentation & Enhancement Surgery. The Saline Breast Implants were placed through an existing incision in the lower Breast Crease. Postoperatively, the Breasts appear larger, fuller both in size and shape after the Breast Augmentation Procedure
Actual Patient Photos. Results may vary.

Below are the pictures/photos of the same patient on profile preoperative (left) before and postoperative (right) after Breast Augmentation & Enhancement Procedure with smooth, round Saline Breast Implants placed below the muscle through an infra-mammary incision. A capsulotomy was performed on both Breasts to allow expansion of the new larger Saline Breast Implants into an expanded Breast pocket.

Whether you are traveling from across the world, from anywhere in California, San Francisco, San Diego, Orange County, Newport Beach, or you happen to live right here in Los Angeles or Beverly Hills and you’re interested in Breast Augmentation surgery or just want to discuss your options…come see us. Dr. Palmer’s office is located in Beverly Hills and is freeway close to all of the Los Angeles Freeways. We are located 10 minutes from downtown Los Angeles, 15 minutes from the Pacific Palisades, 10 minutes from Santa Monica, 15 minutes from Brentwood and 30 minutes from Los Angeles International Airport. We are located minutes from Rodeo Drive and downtown Beverly Hills.

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