Breast Procedures
Anne Peled, M.D. is widely recognized for her unique dual training in breast cancer and reconstructive plastic surgery. Acclaimed as one of the best breast surgeons in San Francisco, California, her work is noted for its cutting-edge approach and beautiful results.
Breast Augmentation
There are several choices to make in breast augmentation surgery. The implants can be filled with saline (salt water) or gel (silicone), the implants can be placed under the pectoralis muscle or directly underneath the breast gland, and the implants can be placed either through an incision underneath the breast or around the nipple. Thoughtful discussion and consultation to review each patient’s goals are essential for getting the best results after surgery.
Breast Augmentation
Before & After
Choosing your implant type
Breast implants can be filled with either saline or silicone. Saline implants are used less often than silicone because silicone are softer, feel more natural, look less round, typically weigh less, and more commonly last longer. Silicone implants are used most commonly because they tend to feel more natural than saline, are less likely to ripple, and weigh less. Both silicone and saline implants come in round and teardrop shapes. They also come in different levels of projection across different volumes. Silicone implants have a range of ‘gumminess’, which affects the feel of the implant as well as the shape and how long the implant lasts.
Over-or under-the-muscle
Pros: Depending on the amount of breast tissue a woman has, over the muscle may be an option and natural-looking results can be achieved. The recovery is generally easier in comparison to sub-muscular, with less initial discomfort.
Cons: Capsular contracture rates are higher with this approach, and rippling may be visible especially in women who have thinner skin. It can also be easier to see the edges of the implant under the breast tissue with this approach.
Pros: Placing implants under the pectoralis muscles decreases the capsular contracture rate to less than 10%. In thinner women, the added layer of the muscle over the upper and inner aspects of the implants helps to make the edges less visible and the curve of the breast appear to be more natural. It can also be easier to see the breast tissue more clearly on mammograms when implants are under the muscle.
Cons: The recovery for under the muscle tends to be more uncomfortable and last longer. It also commonly takes longer for the swelling to subside and for the breasts to settle. It can take several months to see the desired results.
Pros: Many patients who receive breast implants half under the muscle say their results feel soft, move naturally, and look indistinguishable from natural breast tissue. In our practice, this technique often plays a key role in both cosmetic enhancement and restoring confidence after breast cancer.
Cons:
Because the chest muscle is partially lifted, you may feel tightness or soreness in the upper chest during the first two weeks. Most patients return to light activity within 1–2 weeks and resume more movement by 4–6 weeks, depending on the procedure and implant type.
Choosing your implant size
The first step is to schedule an in-person or virtual consultation, depending on where you are located. During your consultation for breast implants Dr. Peled's priority is to listen carefully to you to get a thorough understanding of exactly what you're looking for. Dr. Peled also uses 3D breast augmentation stimulation software so you can see a simulation of your results. You will also be given implants to try under an unpadded bra so you can see how a range of sizes will look on you. By using these different methods, you'll better understand your various options on implant size, profile, type, shape, safety and expected results.
Breast Augmentation
incision Types
Fat Transfer / Fat Grafting
Over recent years, taking fat from one part of the body and using it to add volume to another part of the body has become increasingly popular. Fat can now be used to add volume to the face to make it appear more youthful, to the breasts for augmentation and contour improvement, and also for breast reconstruction. With fat grafting, fat is taken from one part of the body (often the abdomen or thighs) with typical liposuction techniques and then transferred to a different body part. In order for the fat to survive in its new location, the fat has to be carefully processed and put into the new area in small amounts in different layers. With careful techniques, the majority of the fat that is transferred will "take" and be incorporated into the body.
Breast reduction
(reduction mammaplasty)
Very large breasts (macromastia) can result in back pain, neck pain, shoulder pain, grooves where the bra straps meet the neck and occasionally skin irritation beneath the breast skin. Breast reduction surgery can often alleviate many of these symptoms as well as improve one’s self-image. Depending on the breast shape and size, either a lollipop or anchor-type incision is made on the skin, the excess breast tissue removed, and the skin re-draped to produce the final breast shape. The final breast appearance and size are usually seen 3-6 months after surgery.
Breast Reduction
Before & After
Breast REDUCTION & LIFT
incision Types
Breast LIFT (MASTOPEXY)
Breast sagging (also known as ptosis) can occur for a variety of reasons. Breast lift surgery is designed to re-shape the breast, remove excess skin and to re-position the nipple to recreate a youthful breast position on the chest wall. As with breast augmentation, there are several techniques which can be used to achieve these results. In fact, breast lift surgery is often combined with breast augmentation.
Breast Revision
Breast revision surgery can be done for a number of reasons, either to correct unsatisfactory results from a previous breast surgery or because results or patient preferences have changed over time. Commonly performed revision surgeries include breast implant exchange, implant removal (“explant surgery”), implant pocket corrections, re-do breast reduction or lift, or a combination of these procedures. Fat grafting may also be done during revision surgery, especially when implants are removed and not replaced. Revision surgery is also common after breast reconstruction surgeries, either as a small “touch up” or as a larger procedure potentially involving implant exchange, fat grafting, or switch from one type of reconstruction to another. As each person’s goals and desires following potential revision surgery will be different, careful consideration is given to make sure the surgical approach is carefully tailored to each patient.
Common Questions
Depending on the procedure, recovery time can be any time from 4 to 6 weeks.
You can usually start walking within the first week, and can then slowly increase your exercise over next several weeks. You are generally back to full activity in 4 to 6 weeks.
The items needed for recovery can vary depending on the procedure. You can find our favorite products here.
We understand this is an important question when determining if the procedure you’re looking to have is within your budget. Unfortunately, there’s no one size fits all price range that we are able to share with you. It’s best to schedule a consultation with Anne Peled, M.D or her Physician Assistant to find what options are best for you.
We understand this is an important question when determining if the procedure you’re looking to have is within your budget. Unfortunately, there’s no one size fits all price range that we are able to share with you. It’s best to schedule a consultation with Anne Peled, M.D or her Physician Assistant to find what options are best for you.
Yes, this is a procedure that Anne Peled, M.D offers at her practice.
Older generation implants are thought to only last 10 years, but they are anticipating that newer ones will last from 20 to 25 years.
Many patients are candidates for breast augmentations. However, it’s best to consult with a plastic surgeon to determine if a breast augmentation is right for you.
Saline and silicone implants have different benefits depending on the patient. Newer silicone gel implants (a.k.a. “gummy implants”) are commonly used when silicone is selected.
Most patients receive smooth implants, but this is always a personalized discussion with each patient.
Saline: If a saline implant breaks, it will usually deflate over a period of days or weeks. Although it will cause the appearance to change, it is not dangerous.
Silicone: If a silicone gel implant ruptures the breast may feel different but there is no evidence that a ruptured silicone implant will make you sick. If your implant ruptures, we recommend having the implant removed and replaced.
Gummy Bear: It’s uncommon gummy bear implants to break, but they can. A break is generally detected on MRI, but the patient and surgeon don’t notice a difference. A ruptured gummy bear implant can change the breast shape or feel. We recommend removing and replacing the implant, but there is no evidence that a ruptured gummy bear implant poses a threat to your health.
Breast feeding can be impacted by any type of breast surgery, but many women are successfully able to breast feed after breast lifts or augmentations.
Our office has a scar management system that is customized for each patient.
Most people take 1 to 2 weeks off after surgery before they return to work, although that period can be longer if patients have additional/combined procedures involving different parts of their body.
This is dependent on the patient. As we continue to have technological advances and patients maintain a healthy lifestyle, results are expected to last longer than previous studies.
Having permanent loss of sensation is very uncommon after breast lifts or augmentations. Some decrease in sensation in the early recovery period is common, however, and resolves over weeks to months. Anne Peled, M.D. has unique training and takes every precaution possible to ensure sensation is preserved.
Insurance companies have specific criteria for covering breast reductions. If you meet these criteria, the insurance should cover this procedure, but every patient should check beforehand with their insurance providers.