Breast Augmentation: by Matthew Romans, MD

I have been doing breast augmentation in private practice since 1996. During that time, I have developed a list of important issues that patients need to know about breast augmentation and implant choices in Salinas and Monterey, CA.


What Is Breast Augmentation?

Breast augmentation, also known as augmentation mammoplasty, is a surgical procedure used to increase the size and projection of the breasts. This breast procedure involves the creation of incisions and the placement of breast implants beneath the tissues.


Ideal Breast Augmentation Candidates

The best breast augmentation candidates are in good overall health, as this reduces the likelihood of complications. Good candidates are non-smokers, since smoking negatively affects the health of the skin and can result in a prolonged healing process.

Additionally, ideal breast enlargement candidates have realistic expectations for their results. The best way to have clear and realistic expectations is by looking over breast augmentation before and after photos.


Implant Choices: Silicone gel versus Saline

The first decision that most women who are considering breast augmentation need to make is what type of implant to use. Some prefer large breast implants, whereas others are more suited for small breast implants. Deciding on the best breast implants for you requires learning more about your implant options.

I tell each of my potential breast augmentation patients the following:

  • No implant is a lifetime device. Both saline and silicone breast implants can leak and rupture. The average life span of most implants is 10-20 year. If you choose to have breast augmentation, at some point in your life you will almost certainly need to have surgery to remove and/or replace your implants.
  • If you have a saline implant and it starts leaking, your body will safely absorb the saline and you will call us to tell us your implant is leaking.
  • If you have a silicone gel implant, when it starts to leak it is very gradual and the leaking gel does not go anywhere. You likely will not know right away that your implant is leaking. The first clue is usually a gradual hardening of the pocket around the implant, causing your breast to become more firm.
  • The most accurate test to detect a leak in a silicone breast implant is an MRI, but this test is only accurate about 80% of the time.
  • Saline implants tend to look less and feel less natural than silicone gel implants.
  • Silicone breast implants are softer and look more natural.
  • Silicone breast implants were unavailable for widespread use from 1992-2007 because of concerns that they could cause autoimmune diseases, connective tissue disease, or cancer. Over the 15-year period, numerous studies were done in thousands of patients. No study has ever shown a link between these diseases and silicone gel implants. Because of this, in 2007 the FDA lifted the restriction on their use.
  • When they first re-release silicone breast implants for unrestricted use, they were recommending an MRI every 3 years, but they have since lifted that recommendation.
  • The only restriction on silicone gel breast implant use for cosmetic purposes is that the FDA has stipulated that you have to be 22 years of age or older to qualify for silicone gel implants.
Before & After
Before & After

* Individual results may vary.

Photo Gallery

View before-and-after pictures of real patients of Dr. Matthew Romans

View Before & Afters


Implant Type Summary


  • Filled in operating room.
  • Tend to feel and look slightly less natural.
  • Inexpensive; cost is less than $300 each.
  • When they leak, it is easy to detect the leak because the body absorbs the fluid as fast as it leaks out and the breast becomes noticeably smaller.
  • Available to anyone over the age of 18 for cosmetic purposes.


  • Allergan NATRELLE implants come in several different types of silicone implants available. They are all related to the amount of cross-linking between the silicone molecules. The more cross-links between the molecules, the more viscous the gel material is.
  • They come pre-filled from the factory.
  • Definitely more expensive than saline implants.
  • When silicone implants leak, it is a very gradual thing over time and early leaks can be hard to detect because the body does not absorb the gel material and it stays in the pocket the body forms around the implant.
  • The FDA has made silicone implants available to anyone 22 years and older (no one seems to know why age 22 and not age 21 or age 18).


Additional Information About Silicone Gel Implant Choices

There are now silicone gel implants available that have a very viscous gel material in the center (the “gummy bear” implant). They originally came only as shaped and textured implants but Allergan introduced round smooth cohesive gel implants in 2017. The gel material is very cohesive so the center is “less liquid”.

The cohesive gel round implants hold their shape better so there is some consideration that they may have less rippling. When gummy bear implants experience a rupture, they do not leak; instead, their material stays safely inside the implant. They are more expensive than traditional gel implants and are not for everyone.

There are three types of Allergan gel smooth implants; the “traditional gel”, the “soft touch”, and the full “cohesive gel”.

Type 1. Natrelle INSPIRA® Responsive. Least amount of cross-linking. Has softer, more-natural appearing upper pole result. This is the least expensive of the Natrelle INSPIRA® product line at about $800 each.

Natrelle Inspiria Responsive

Type 2. Natrelle INSPIRA® SoftTouch. Has more cross-linking between molecules. We feel this offers the best combination of upper-pole fullness, price and gel stability at about $875 each. This is the most common implant we use at Salinas Valley Plastic Surgery. We have it in stock at the Surgery Center on the shelf for most sizes we use so the implants are not special order for your surgery.

Natrelle Insiria SoftTouch

Type 3. Natrelle INSPIRA® Cohesive. This is the full “gummy bear” smooth gel implant. It gives the most upper pole fullness and is slightly firmer than other silicone implants. This implant is the most expensive of the Natrelle INSPIRA® implant line at about $1175 each.

Natrelle Inspiria Cohesive

Type 4. INSPIRA®Textured Shaped cohesive gel. This is the original gummy bear implant approved in the United States. At Salinas Valley Plastic Surgery we have used this implant commonly for breast reconstruction, but only occasionally for cosmetic augmentation. As of mid-2018, we have stopped using these because of concerns outlined below about BIA-ALCL.

Natrelle Inspiria Textured Gel


BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma)

  • The FDA (Federal Drug Administration) started issuing alerts or warnings in 2011 about a rare form of cancer that can form around breast implants that have been in for a long time. It is not breast cancer but a form of non-Hodgkin’s Lymphoma.
  • If accurately diagnosed, it is very treatable and almost always curable.
  • It seems to be associated exclusively with textured implants.
  • Worldwide confirmed cases number somewhere around 400.
  • As more is learned about BIA-ALCL, the apparent incidence appears to be climbing.
  • Current (June 2018) incidence seems to be somewhere in the 1 case in 3500 patients. Estimates just a few years ago were estimated closer to 1 case in 30,000 patients.
  • With the uncertainty surrounding these implants, we at Salinas Valley Plastic Surgery have decided to stop using textured implants.

Information from the website of the FDA.

Information from the ASPS (American Society of Plastic Surgeons).


Breast Augmentation with Lift

It is possible to combine breast enlargement with a breast lift in order to create more comprehensive enhancement and rejuvenation. This combination breast procedure is known as a breast augmentation with lift, or augmentation mastopexy.

Pairing a breast lift and implants reduces sagging while increasing volume and projection. A breast lift without implants is also available if you are purely interested in resolving sagging.

The Procedure: What to Expect

Delivery of anesthesia is the first step of any breast surgery. Usually, general anesthesia is chosen, but in some cases, local anesthesia with sedation may be used. This choice will be made during the initial consultation. Anesthesia keeps the patient comfortable and free of any pain during the surgery.

Following this step, incisions are made. One of the following incision options may be used:

  • Periareolar – This incision is made around the bottom border of the areola.
  • Transaxillary – This incision is created in the armpit.
  • Inframammary – This incision is made in the crease below the breast.

Pockets are then made in the breast tissues through the incisions. The breast implants are placed into the pockets snugly to prevent implant migration. After the implants are positioned correctly, the incisions are closed with medical sutures and then dressed appropriately.

Breast Augmentation Recovery and Healing

It is important to avoid rushing the breast augmentation healing process; the body has gone through a change and needs time to recover properly. During breast augmentation recovery, you will need to follow your surgeon’s post-surgical care instructions very closely.

You will need to address bruising and swelling in the surgical area using a cold compress. Wearing a post-surgical bra without underwire will help to support the tissues as they heal.

Taking a week off from work will be necessary, as will avoiding any sort of strenuous activity for several weeks. This includes sports and physically taxing exercise regimens.

Breast Augmentation Cost

When considering breast enlargement, patients typically put price high up on their list of potential concerns. Breast augmentation cost is determined by a multitude of factors, include the length of time required to complete the surgery, the breast implants chosen, and the specific techniques used.

Arrange a Consultation

Patients who are interested in breast augmentation in Salinas and Monterey, CA, should contact Salinas Valley Plastic Surgery for a consultation. During a consultation, patients can view breast augmentation before and after photos, ask questions, and more. Take the first step towards achieving your aesthetic goals – make your appointment today.

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