Breast Augmentation

Also Treating Campbell and Los Gatos Breast Augmentation Patients

The History of Breast Implants

For centuries, women have sought ways to enhance their breasts. For more than 100 years, surgeons have been trying to help women accomplish this objective by finding ways to implant foreign materials into their breasts. During the 20th century, early attempts at surgical breast enhancement included the use of ivory, sponges and Teflon as breast implant devices.

It was not until the 1960s that surgeons began using silicone-filled devices for surgical breast augmentation. In 1961, Houston surgeon Dr. Thomas Cronin and Dr. Frank Gerow developed a thick silicone gel material encapsulated in a rubber bag. And voilà: The first contemporary silicone breast implant was invented. In 1962, Dr. Cronin, with the help of Silas Braley, an engineer at Dow Corning, performed the first breast augmentation surgery for patient Timmie Jean Lindsay, implanting the new device under her breast gland. Saline breast implants were invented soon after, and, in 1965, French plastic surgeon Dr. Henri Arion introduced them for use in surgical breast augmentation.

Over the next 30 years, the use of both saline and silicone breast implants flourished. However, in 1992, the FDA restricted the use of silicone implants in breast augmentation surgery, due to reports of patients having adverse reactions to the silicone gel filling material.

From 1992 to 2006, saline implants were the only type of breast implants available to women in the United States. The saline implants used during this time were considered much more advanced than the early-generation saline implants, which were comprised of saline solution encapsulated in a polyethylene bag. The newer-generation saline implants were comprised of saline solution encapsulated in a thin silicone outer shell, with a small valve that could be used to fill the empty implant with saline solution after it was implanted, in turn making it possible to reduce the size of the incision. This type of saline implant is still used to this day.

Meanwhile, many clinical studies regarding the safety of silicone implants were rigorously conducted and ultimately confirmed that the inert silicone gel filling material was safe. Thus, the FDA re-approved the use of silicone implants for breast augmentation surgery in 2006.

Endoscopic Breast Augmentation With Saline Implants

Also during the 1990s, San Jose breast augmentation surgeon Dr. R. Laurence Berkowitz pioneered the development of the endoscopic breast augmentation technique, using saline breast implants. Endoscopic breast augmentation involves the use of an endoscope, a special medical device comprised of a thin, long tube with a light and camera on the end. Dr. Berkowitz uses the endoscope to help tunnel through the tissue and create the breast implant pocket into which the implant is eventually inserted. With the endoscopic approach, the plastic surgeon is able to use a very small incision in the armpit area (i.e., a transaxillary incision pattern), so no scars are visible after surgery.

Several thousand patients have experienced success with the endoscopic breast augmentation and transaxillary incision approach, with the use of saline implants. Thanks to the small incisions that saline implants require as well as other factors, some women choose to use saline implants to augment their breasts to this day. However, saline implants do not necessarily feel like natural breast tissue. In addition, they are round in shape and therefore do not mimic the shape of natural breasts. For these reasons, silicone breast implants are a popular choice among patients.

Introducing: Highly Cohesive Silicone Gel Implants

In 2003, Dr. Berkowitz was invited to take part in an extensive national study of a new generation of silicone gel breast implant devices. In contrast to traditional silicone implants, which are comprised of a more liquid-like silicone gel filling material, the newest generation of silicone implants are comprised of highly cohesive silicone gel filling material. Due to the gummy-like consistency of the highly cohesive silicone gel, these implants are often referred to as “gummy bear” implants.

In 2012, the FDA approved gummy bear implants for use in breast augmentation surgery. There are two types of anatomically shaped gummy bear implants currently available on the market: the Allergan style 410 implant and the Sientra model.

The highly cohesive silicone gel implants differ from their traditional silicone gel predecessors in several aspects. First, they are shaped like a teardrop, so their shape is more anatomically correct. In addition, gummy bear implants have a textured outer shell, which may help reduce the risk of capsular contracture, a condition in which inflexible scar tissue forms and tightens around the implant.

Advantages of Highly Cohesive Silicone Gel Implants

Although certain patients and surgeons prefer the traditional silicone gel implants for their round shape, smooth outer shell and softer filling material, gummy bear implants are growing in popularity thanks to the advantages they offer.

For instance, gummy bear implants resist leakage. They stay intact when squeezed and even when cut in half, so they are unlikely to fold or ripple within the implant pocket.
Also, due to the effect of gravity on the smooth outer shell, traditional silicone implants tend to migrate down the chest wall over time. When this happens, patients lose the desired fullness in the upper area of the breasts. On the other hand, the textured outer shell of the anatomically shaped gummy breast implants helps to maintain fullness throughout the upper breast area over the long run.

In addition, Dr. Berkowitz finds that the breasts start to adopt the shape of the underlying implant as time passes, so it makes sense to start with an implant that reflects the patient’s desired breast shape. Thus, another advantage of gummy bear implants is that they are available in 120 different shapes and sizes, allowing the patient to find a shape and size that is right for her.

More About Breast Augmentation With Highly Cohesive Silicone Implants

Although endoscopic-assisted breast augmentation with saline implants is still an appropriate option for certain patients, others will benefit from the more natural shape of the Allergan style 410 and Sientra implants.

In the latter case, Dr. Berkowitz positions the gummy bear implants under the chest muscle for improved implant coverage and lower incidence of capsular contracture. There are occasional situations in which Dr. Berkowitz can safely position the gummy bear implants over the chest muscle. The San Jose breast augmentation surgeon will review each patient’s unique anatomy and aesthetic desires during consultation before recommending an appropriate surgical treatment protocol.

Dr. Berkowitz creates the incision under the natural fold of the breasts, in what is called an inframammary incision pattern. After surgery, the inframammary incision line can be well-concealed within the bra line. He may also use a Keller funnel for implantation, a device that helps insert the implant while minimizing trauma to the implant as well as any contact with the surrounding tissues.

The board-certified plastic surgeon strongly believes that periareolar incisions (i.e., incisions that follow the outer perimeter of the areola, or the darker-pigmented skin surrounding the nipple) and transaxillary incisions should not be used when inserting gummy bear implants. Although the resulting scars may be well-hidden with a periareolar or transaxillary incision, patients often find that the appearance of the scars is unsatisfactory when stretched to accommodate the larger, prefilled implants. It has also been shown that periareolar incisions may contribute to a higher incidence of capsular contracture (15 percent, in some studies). In addition, periareolar incisions may contribute to an inability to breastfeed following surgery. Finally, to try to squeeze the highly cohesive silicone gel implants through the smaller incisions used with the periareolar and transaxillary approaches may deform the implants.

Consider Breast Augmentation Without the Use of Implants!

For certain women who desire a modest increase in breast volume — an increase of a half a cup to a full cup in breast size — autologous fat grafting is now a viable option. Thanks to several new advances in fat harvesting and transferring techniques, suctioning unwanted fat from one area of the body for use in enhancing another area of the body has recently become a reality.

In the past, the fat grafting technique was mainly used to reconstruct the breasts following cancer-treating mastectomy procedures, particularly for difficult cases. Encouraged by the ability to achieve a natural-looking and natural-feeling breast during reconstruction, Dr. Berkowitz has applied the technique to breast augmentation.

The Natural Breast Augmentation Procedure

The San Jose breast augmentation specialist uses the remarkable Cytori fat grafting system to enhance a patient’s breasts with her own fat that has been harvested from a donor site, in a procedure that is often called “natural breast augmentation.”

In the first phase of the procedure, Dr. Berkowitz employs a syringe and a Coleman cannula (a thin, hollow suctioning device) to extract fat gently from an area of the body that has a sufficient amount of excess fat. He rinses, or purifies, the harvested fat, using a layered filter system. This removes any undesirable fluids that may look like fat, but are simply oil and debris.
In the second phase of the procedure, the breast surgeon uses Cytori’s Cellbrush system to re-inject tiny droplets of fat into the breast area for enhancement. He deliberately places the fat droplets into an area under the breast, between the breast gland and the overlying skin, to avoid creating fatty cysts within the breast tissue itself.

Note: To improve the recipient tissue bed both before and immediately after fat grafting, Dr. Berkowitz uses the BRAVA external vacuum device. It is invaluable in helping him create breasts that are fuller than when using fat alone to enhance the breasts. Before inserting the harvested fat, the BRAVA device helps create space, so the surgeon can insert fat into the vacuous area more effectively. After injecting the harvested fat, the BRAVA device helps increase blood supply to the treatment area.

breastaugView More Breast Augmentation Before and After Photos

Find Out More

To schedule a personal consultation with Dr. Berkowitz, or to learn more about breast augmentation surgery, please contact his practice by calling (408) 559-7177 today. Dr. Berkowitz will listen to your concerns, provide any needed information and outline a customized surgical treatment plan to help you make your dream of a larger bust line a reality.