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Breast Augmentation

Breast Augmentation San Francisco

Breast augmentation surgery has become one of the most popular cosmetic procedures globally, boosting patients’ self-confidence and enhancing breast shape, volume, and fullness. Because of its high demand, many providers offer this plastic surgery. Few, however, possess the knowledge, skill, and experience to deliver the most outstanding results.

woman posing to show upper body

Dr. Leonard Gray, our Bay Area board-certified plastic surgeon, has extensive breast augmentation surgery experience. Frequently conducting breast augmentation procedures from his state-of-the-art facility overlooking the beautiful San Francisco Bay, he’s performed over 10,000 in his 20 plus years of practice. Dr. Gray has given countless patients gorgeous and lasting breast enhancement results.

Deciding to a have breast augmentation procedure is a big decision to make and requires proper consideration of various factors. Dr. Gray genuinely values patient education and wants his patients to have all the information they need to make an informed decision on their own.

To learn more about the best breast augmentation in San Francisco, we invite you to read on or contact Dr. Gray at 415-434-8858 or schedule your consultation online today.

Breast Implant Types

One of the most common questions surrounding breast implants is “silicone or saline?” Dr. Gray offers both of these options, although there are some key differences to be aware of:


Silicone breast implants consist of a silicone-based gel and are widely considered to feel the most like natural breast tissue. There are three silicone implant manufacturers: Sientra ®, Mentor ®, and Allergan ®.


Mentor uses the same gel and shell forever. Dr. Gray has seen about a 1% deflation rate with his patients. Many patients like how soft and natural these implants look and feel. Mentor has recently come out with a new line called “Xtra” that overfills the implant. This creates a look that gives a bit more fullness to the upper part of the breast.


“Gummy bear” implants are more highly cross-linked and maintain more of a jello-like consistency. They don’t squish down as much and are considered to be perkier than their counterparts. To date, Dr. Gray has experienced a 0% deflation rate with Sientra’s gummy bear implants.


Allergan’s silicone implants had a redesign several years ago. These implants are flat on the back and curved on the front. They have not been as popular among Dr. Gray's patients.

All breast implant companies use silicone gel, but Sientra and Allergan have a more highly cross-linked option.


Saline breast implants are filled with a sterile saline solution. These implants are said to have a firmer feel, and the volume can be slightly adjusted during surgery for precise results. Some key factors to think about when contemplating saline implants:

  • Dr. Gray can insert saline implants through smaller incisions in the nipple.
  • Since saline implants consist of a solution similar to existing liquids found within the body, it can be easily absorbed by the body if damaged.
  • Saline implants tend to ripple. They also look and feel less natural than silicone.
  • Although saline implants were popular in the past, Dr. Gray does not receive many requests for these currently.

Breast Implant Shape

Implant shape refers to the two distinct shapes that implant manufacturers offer: round or teardrop. Breast implant shells can be smooth or textured. 

Round Implants

These round, smooth breast implants generally look and feel the most natural. When they are placed beneath the muscle using the correct technique, they appear as a teardrop shape. Round breast implants are by far the most popular choice among Dr. Gray’s patients.

Teardrop Implants

These breast implants are not preferred because they have a high risk of spinning around in the breast pocket, causing revision surgery. We have found that most patients are unaware they can still achieve a natural teardrop-shaped breast using a round implant.

Textured vs. Smooth Implants

Because risks of ALCL (anaplastic large cell lymphoma), fluid collection, and other concerns have been attributed to textured breast implants, they have been essentially removed from the market. Dr. Gray does not currently offer these options.

Dr. Leonard Gray

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Instilling Beauty
Inspiring Confidence

Dr. Gray is a board-certified plastic surgeon with over 20 years of experience conducting surgical procedures of the breast, body, and face. His emphasis on patient education and attention to detail have made him the top choice for plastic surgery in the Bay Area. Dr. Gray invites you to meet with him for a friendly and informative consultation.

Implant Profile

One of the most important decisions you will make will involve the breast implant profile. This measurement refers to the distance that your implant will project from your chest. Patients looking for the best size (volume in CCs) will take into account implant projection and width, which can be determined during a consultation with Dr. Gray.

The main types of implant profiles we offer are:

Low profile implants are a suitable choice for the most conservative patient, as they provide the least amount of projection. That said, Dr. Gray has found them to be generally the least chosen option among breast implant surgery patients.

The moderate plus projection is the most popular implant profile choice globally. These implants are a relatively conservative choice compared to the larger profiles but still provide desirable fullness and shape.

This option has about a centimeter more projection and between 1-3 shot glasses (depending on the company) worth of volume than the moderate plus. This option projects further, provides a more dynamic change, and looks different than the moderate plus.

These implants provide the highest-profile boost. Women desiring the most dramatic change will likely choose Extra-high profile implants, as they create the fullest and roundest look.

Incision Types

There are three types of incisions that you can choose from, depending on your implant type, preference, and aesthetic goals:

Inframammary Fold (Breast Fold)

Currently, the most popular incision type is the inframammary incision, which Dr. Gray places beneath the breast fold. This incision is the easiest to hide and has quickly become the most sought-after incision technique. This method is inconspicuous, allows for more precise implant placement, and has low risk of damaging nipple sensitivity. It also has lower rates of capsular contracture and has a very low chance of affecting breastfeeding.

Periareolar (Nipple)

Although they are the same size, Periareolar incisions are slightly more visible than inframammary incisions. This incision can affect nipple sensitivity and breastfeeding, though these issues are rare.

Tiny Nipple Incision

Dr. Gray invented a nearly undetectable incision method dubbed the “tiny nipple incision,” and has performed this method on thousands of patients. The tiny nipple incision can only be performed when the patient selects a Saline breast implant. Silicone gel patients must choose between Inframmary or Periareolar incision placement.

Stunning natural results

Dr. Gray’s training, precision, and personalized treatment plans provide genuinely outstanding results. Want to see for yourself? Follow the link below to view before and after pictures of Dr. Gray’s actual patients.

Implant Placement

Implant placement refers to the plane in which the implant will be placed after creating the incision. Placement will affect several things, including cleavage, drooping, rippling, capsular contracture risk, and more.


Submuscular placement means that the implant will be placed beneath the pectoralis major muscle. Dr. Gray will relax the lower portion of this muscle, which allows the implant to move into position for better cleavage. Dr. Gray creates cleavage by relaxing this muscle and choosing the correct implant width. With submuscular placement, there is significantly less rippling on the upper portion of the breast, and capsular contracture rates are lower.


This option refers to when the implant is placed above the pectoralis major and beneath the breast tissue and mammary glands. Recovery tends to be less painful but takes the same amount of time as submuscular placement. Subglandular placement is known to have higher capsular contracture rates, along with rounder and more artificial-looking implants. Subglandular placement tends to be chosen by a subset of women who are athletes, bodybuilders, or desire this particular look.

How is a Breast Augmentation Performed?

Dr. Gray conducts breast enhancement surgery as an outpatient procedure under general anesthesia in Bay Area Plastic Surgery’s AAAASF accredited surgical center. Before the operation, Dr. Gray will apply a nerve block. Patients can choose from a nerve block that lasts six to eight hours, or Exparel®, a numbing solution that will last for up to four days. Exparel is ideal for patients who do not wish to be sore, want to avoid narcotic medications, have responsibilities like looking after small children, wish to work from home during recovery, or have other similar concerns.

woman in swimsuit torso

Once he makes the incision, Dr. Gray will skillfully create a pocket within the breast. Creating the pocket just right takes a considerable amount of work, but once the pocket is right, he will pick the correct implant width to make sure it fits perfectly. Dr. Gray will adjust the implant while you are lying down and then again when you are in the upright position to make sure they look good in each position.

Lastly, Dr. Gray will close your incisions with absorbable sutures and Dermaflex™ glue. You will then be taken into a recovery room when you will be monitored until you wake up.

What Should I Expect in Recovery?

After awakening from your operation, you will be able to return home the same day. Because Dr. Gray uses Dermaflex glue, you will have no dressings, drains, wrappings, or bandages. You can also shower the same day as your surgery. This glue lasts about three weeks before falling off, and any sutures will dissolve naturally. You will stay in the same underwire support bra for the first two weeks, and then  you’ll be asked to switch to a better, more supportive underwire bra for the remaining postoperative period. You will be educated and given advice on the best bras to buy to keep your natural breast augmentation results looking beautiful over time.

You will be maximally swollen three to four days after surgery. After this time, the swelling will begin to dissipate, and your breasts will begin to feel normal as they fall into their new position. It usually takes around four months for swelling to heal. You will have regular follow-ups with Dr. Gray at one week, two weeks, one month, two months, three months, and four months.

Dr. Gray advises that you limit your activity, including no heavy lifting or exercise, and stick to flat walking until the five-week mark. From here, you can begin to increase your physical exertion level gradually. Many patients work up to the five-week mark by flat walking for increasingly longer durations as they start to feel more comfortable. Dr. Gray will be there to answer any questions you may have and help you along every step of the process.

Your Breast Augmentation Consultation with Dr. Gray

Your next step is to schedule a one-on-one consultation with Dr. Gray. Here, he will take plenty of time to educate you on each of these issues, answer any questions that you may have, and let you make an informed choice on your own. You will also be able to try on actual implants to see how each option would look with your unique body type and shape. Dr. Gray genuinely wants to make sure his patients are confident, prepared, and can realistically benefit from breast enlargement surgery.

Bay Area Plastic Surgery is excited to offer this incredible operation to give you the outcome you’ve always wanted. If you are interested in learning more about why patients continue to choose Dr. Gray as their breast augmentation specialist in San Francisco, we invite you to contact us today!

San Francisco Breast Augmentation FAQ

If your breasts have been affected by age, pregnancy, or weight loss, this surgery can revive them with increased breast volume. It is also a welcomed answer if you work out with weights or have limited original breast mass. Dr. Gray would be happy to discuss your particular breast augmentation goals in consultation.

In general, a breast lift addresses a droopy breast, and breast augmentation adds breast volume. There are different breast lift options that address varying levels of droopiness. Dr. Gray can help determine which option best suits your goals during your consultation.

Yes, most women breastfeed after a breast enlargement procedure with no trouble. Some methods, such as an areolar incision and some types of breast lifts, can potentially interfere. However, this is highly unlikely. Virtually all of Dr. Gray’s breast surgery patients have had no problems breastfeeding as a result of implants. If you have any specific concerns about breastfeeding, Dr. Gray can address these in consultation.

Yes, we do provide a breast augmentation flash recovery. Dr. Gray is highly precise and will meticulously follow each procedural step to avoid bruising and ensure your recovery is as rapid and comfortable as possible. Dr. Gray also uses nerve blocks to prevent pain during and after the procedure. Exparel, a powerful numbing agent, can prevent pain for up to four days. For more details on a flash recovery, be sure to ask Dr. Gray about this in your consultation. 

The type of breast implant that often looks and feels the most natural is the silicone implant. Silicone implants tend to closely mimic the texture and weight of natural breast tissue, resulting in a more natural appearance and touch. They are available in various shapes and profiles to match different body types. Additionally, the cohesive gel in modern silicone implants helps prevent leakage and maintains shape over time, contributing to a natural feel and appearance.

Yes, it’s recommended to have someone stay with you after breast implant surgery, especially the first night. The recovery period following surgery can vary, but having a friend or family member with you can provide emotional support and help with practical tasks while you’re healing. You may experience discomfort, limited mobility, and fatigue in the initial days after surgery. Having someone there to assist with daily activities, like preparing meals, getting dressed, and ensuring you are following post-operative instructions can aid in a smoother recovery process. Additionally, having someone to monitor your condition and offer assistance in case of any complications or unexpected reactions is essential for your safety and well-being.

After a breast augmentation surgery, the typical timeframe before you can resume exercise is usually around eight weeks. The healing process varies for each individual, and it’s crucial to follow your Bay Area board-certified plastic surgeon’s guidance on returning to exercise and increased activity. During the initial weeks, your body needs time to recover and for the incisions to heal properly. Intense physical activity, especially involving the chest muscles, can strain the surgical area and potentially interfere with the healing process and/or cosmetic results.

After breast augmentation surgery, you want to avoid sleeping on your abdomen. This is because putting pressure on the surgical area could potentially disrupt the healing process and affect the position of the implants.

Instead, sleeping on your back or on your side is recommended. Using pillows for support can help you find a comfortable sleeping position that minimizes pressure on the chest area. Some people find it helpful to place a pillow under their upper back to slightly elevate their upper body while sleeping on their back. This can help reduce swelling and discomfort. As your healing progresses, you’ll be able to gradually return to your preferred sleeping positions.

Wearing a supportive bra after a breast augmentation is required to aid in the healing process and provide proper support to the newly augmented breasts. The Simone Perele Andorra t-shirt convertible bra, is recommended due to its comfort and support features. Wearing it 24 hours a day for the first two months helps maintain the position of the implants, reduces swelling, and promotes optimal healing.

After the initial two-month period, you can transition to your normal bra-wearing routine, keeping in mind that wearing bras with good support remains important. Bras with underwire are the only ones that provide good support and are advised during the early recovery phase to avoid oversetting or implant malposition.

Creating cleavage with breast augmentation involves various factors, including implant size, placement, and surgical technique.

I take specific measures to achieve approximately one centimeter of cleavage. This involves relaxing the pectoralis major muscle sufficiently, which can influence how closely the breasts sit together. Also, the choice of implant width also plays a role in cleavage result. An implant that matches the breast implant pocket allows the implants to be positioned closer to the center of the chest, contributing to the appearance of cleavage.

It’s important to remember that individual anatomy and natural breast shape can influence the final outcome. While surgical techniques can help enhance cleavage, it’s essential for patients to have realistic expectations and communicate their desired outcomes clearly with me during the consultation process.

The goal is to position the implant in the center of the chest with the nipple in a desired location, often referred to as the “bullseye area.” This aesthetic consideration aims to create a balanced and natural appearance. In general patients like for the implant to be 50% above the nipple and 50% below. Most people like cleavage of 1 cm and a touch of lateral fullness.

During your consultation, discussing your goals with me is crucial. They can provide a detailed assessment of what can be achieved based on your anatomy and help you understand the potential outcome. Keep in mind that while there are general principles, each case is unique, and I will tailor the approach to best suit your specific needs and desired results.

Choosing the best breast implant profile style and size involves a collaborative process. During an in-office consultation, Your existing breast tissue, body proportions, and personal preferences will be evaluated. Sizing will be performed with real implants for you to get an accurate look and feel of the end size and result. You will have the opportunity to go through all the profiles and gel types until you find the one that you like the most. Your input and preferences play a critical role in the decision-making process.

While I can offer recommendations based on my expertise, ultimately, the goal is to achieve the look that aligns with your vision and goals. Choosing the profile that you prefer the most ensures that the result matches your expectations and feels comfortable for you.

Remember that open communication is key. Be sure to discuss your desired outcome, concerns, and any questions you have during the consultation to make an informed decision that suits your individual body and aesthetic goals.

Yes, you can always have your implants removed. Sometimes, patients choose to have a removal and replacement of their implants. This is known as breast revision surgery. These concerns can be reviewed in consultation with Dr. Gray. 

The FDA (Food and Drug Administration) has found no increase in breast cancer from breast implants. However, textured implants have been linked ALCL (anaplastic large cell lymphoma), a cancer of the immune system. For this reason, Dr. Gray does not offer textured implants.

Capsular contracture is a risk, although it’s not particularly common. Everyone has a capsule, but capsular contracture is when the capsule begins to harden and sometimes squeeze the implant. Most contractures can be treated conservatively, and treatments for bad contracture are now better than they were in the past.

There is a risk for any implant to deflate, but this is very low. Silicone implants generally have a lower rate than saline. All manufacturers have warranties for deflation and contracture. 

For silicone implants, there are two detection options: physical exam and MRI. When saline implants deflate, they physically shrink, making them much easy to detect visually. Saline implants will deflate much quicker and are absorbed by your body naturally and safely. Silicone implants can be detected with an MRI. Both types of implants are covered under warranty.

The no-touch technique in breast augmentation refers to a surgical method where the breast implant is handled with minimal contact to the skin and surrounding tissues. The goal is to reduce the risk of bacterial contamination during the surgery, which could potentially lead to complications like capsular contracture.

I use this technique with every breast augmentation case. By minimizing direct contact between the implant and skin or surrounding tissues, the risk of introducing bacteria into the surgical area is reduced. Capsular contracture occurs when the scar tissue that forms around the implant tightens and squeezes the implant, causing discomfort and distortion.

Using the no-touch technique with every case indicates a commitment to patient safety and the prevention of potential complications. This technique, along with proper post-operative care, can contribute to better outcomes and lower risks of complications for breast augmentation patients.

An “internal bra” or a material like Galaflex may be used in breast augmentation surgeries to provide additional support and reinforcement for the breast implants. Galaflex is typically used in breast augmentation revision cases where the breast implant pockets have become stretched out.

Breast implant pockets can stretch over time due to factors like natural aging, pregnancy, weight fluctuations, or trauma. Galaflex, a type of surgical mesh or scaffold, can be used to reinforce the weakened tissue and help maintain the desired position of the implants. 

If you’re considering breast augmentation and have questions about whether an internal bra or similar technique might be beneficial for your situation, discussing your concerns and goals with me is key to making an informed decision.


Galaflex Lite is a newer variation of the Galaflex material that offers improved characteristics, such as being thinner, lighter, and more flexible. This version aims to provide similar benefits as Galaflex, such as reinforcing weakened tissue and providing support in breast augmentation surgeries, while also offering a smoother and more comfortable feel. The comparison to silk suggests that Galaflex Lite aims to offer a more natural and pleasant texture when used in surgical procedures.

No, I do not use drains for breast augmentation surgeries.

I use absorbable sutures for closing breast augmentation incisions. These sutures are designed to be gradually broken down by the body, eliminating the need for suture removal. In addition, a no knot technique is used to avoid wound healing problems in the post-operative period.

This technique, using sutures without knots and leaving a short tail that protrudes from the skin, allows for easy identification of the sutures and makes it simpler to trim them after a certain period. This “cat whisker” technique ensures that the sutures are easily accessible when it’s time to remove the small protruding portion, which is typically done around two weeks post-surgery.

Using absorbable sutures with this technique offers a few advantages, including avoiding the discomfort associated with suture removal and minimizing wound healing problems.

Following breast augmentation surgery, there will be a scar where the incision was made to insert the implants. The goal is to place the scar in a location that is least noticeable and blends with the natural contours of the body. The preferred location for the scar is often where the inframammary fold is, although its placement might differ from the fold’s original position before surgery. This is more popular than the areolar incision today because the capsular contracture rates are lower, although both can be well hidden.

After the surgery, there are measures that can be taken to help minimize the appearance of the scar. The use of biocorneum, a topical silicone preparation, can aid in promoting scar healing and reducing scar visibility.

Additionally, treatments such as micro-needling with devices like the Potenza can be utilized at a later date to further improve the appearance of scars. Micro-needling involves creating controlled micro-injuries to the skin, stimulating collagen production and potentially leading to smoother and less noticeable scars over time.

Ensuring that you achieve the desired breast implant size involves a collaborative process.

  • Sizing Consultation: During your in-person consultation, a sizing consultation will be done. This will give you the opportunity to see, touch, and try on actual silicone implants of all profiles in order to make the best decision for you.
  • Patient’s Choice: Your input is highly valued. You’re given the opportunity to select the implant profile and type of gel implant that aligns with your preferences and desired outcome.
  • Width Matching: The width of the implant is determined at the time of surgery to ensure that it matches the width of the breast implant pocket. This consideration helps achieve a more natural and balanced appearance. 


This approach ensures that I consider both your preferences and the technical aspects of achieving the best fit for your body. Communication during the sizing consultation is crucial to ensure that your expectations align with what can be realistically achieved. By actively participating in the decision-making process and sharing your goals, you increase the likelihood of getting the size and results you desire from your breast augmentation surgery.


Matching the width of the breast implant with the width of the breast implant pocket is a surgical technique that aims to achieve a specific outcome, which in this case is generating approximately one centimeter of cleavage. This technique involves placing the implant in a position that optimizes the appearance of cleavage between the breasts.

By ensuring that the width of the implant is in harmony with the width of the breast implant pocket, I can create a balanced and natural-looking result that includes the desired amount of cleavage. This precision in positioning the implant contributes to achieving your aesthetic goals.


I always provide patients with a range of implant options during the consultation process. Showing patients different implant sizes, styles, and projections helps them make informed decisions about their desired outcome. This approach of allowing patients to choose the style and type of implant they prefer, while determining the specific implant size based on the width of the pocket during surgery, reflects a customized and patient-centered approach.

This technique ensures that the final implant selection is tailored to the individual’s anatomy and surgical plan. By adjusting the implant size based on the pocket’s width, you can achieve a result that is both aesthetically pleasing and proportionate to the patient’s body.

My dedication to involving patients in the decision-making process while still maintaining the flexibility to adapt based on surgical measurements contributes to achieving personalized and successful breast augmentation outcomes.

After breast augmentation surgery, it’s common to experience a sensation of tightness in the chest area. This tightness is due to the presence of the implant and the natural swelling that occurs after surgery. Over time, as the swelling subsides and the tissues gradually adjust to the new implant, this tight feeling will lessen.

The low activity guidelines after breast augmentation surgery are designed to support a smooth and successful recovery.

  • Lifting Restrictions: Limiting lifting to no more than one pound is crucial during the initial recovery period. Lifting heavy objects or engaging in activities that strain the chest muscles could put stress on the surgical area and potentially compromise the healing process.
  • Exercise: Restricting exercise to flat walking is a cautious approach that minimizes the risk of complications. Engaging in low-impact activities like walking helps maintain circulation and promotes healing without putting undue strain on the chest muscles.
  • Duration of Low Activity: Following the low activity guidelines for six to eight weeks is a common timeframe for many breast augmentation patients. This allows sufficient time for the surgical area to heal, reduces the risk of complications, and ensures that the implants settle properly.
  • Bra Support: Wearing the recommended Simone Perele bra, 24 hours a day for two months, helps maintain proper implant positioning and provides support during the initial healing phase. This can contribute to optimal results and prevent complications.

Adhering to these guidelines is crucial for achieving the best outcome and minimizing the risk of complications. Keep in mind that individual recovery experiences can vary, and it’s important to follow your surgeon’s specific instructions and recommendations for a safe and successful recovery from breast augmentation surgery.

The most common complications of breast augmentation are:

  • Capsular Contracture: Capsular contracture occurs when the scar tissue that naturally forms around the implant tightens and compresses the implant. This can lead to discomfort, distortion of the breast shape, and a firmer feel. While your experience indicates a low rate of occurrence, factors such as implant type, surgical technique, and patient characteristics can influence the risk.
  • Deflation: Deflation typically refers to saline implants rupturing or leaking. While modern silicone implants are more commonly used, saline implants can still experience deflation due to implant failure. It’s important to note that your rate of less than one percent aligns with relatively low instances of this complication.
  • Infection: Infection is a concern with any surgical procedure. In breast augmentation, infection can occur around the implant, leading to potential complications. Careful adherence to sterilization protocols and post-operative care can help mitigate this risk.

These complications occur in less than one percent of my cases, reflecting a well-executed surgical approach and emphasizing the importance of proper patient selection, surgical technique, and post-operative care. While the risk is low, it’s still essential to understand the potential complications associated with any surgery and to follow instructions to ensure a smooth and successful recovery.

Breast implants, being man-made implantable devices, do have a finite lifespan, and there is a possibility that you may need to have them replaced in the future. The timeline for when replacement might be necessary isn’t precisely defined by specific intervals like 10, 15, or 20 years. Instead, it varies from person to person and can depend on several factors, including the type of implants used, your individual body response, and potential complications.

The general principle is “if they’re not broken, don’t fix them.” In other words, if you’re not experiencing any issues with your implants and they’re still functioning well, replacement might not be necessary. However, in the event of complications such as implant rupture or deflation, addressing the problem through replacement is recommended.

Regular follow-ups and periodic imaging, such as MRI for silicone implants, can help monitor the condition of your implants over time. Staying informed and maintaining open communication with me will ensure that you receive personalized guidance about when or if implant replacement becomes necessary. It’s important to be aware that while the potential for replacement exists, many women enjoy long-term satisfaction with their breast implants without experiencing complications.