Dr. Leonard W. Gray

450 Sutter Street Suite 2303, San Francisco, CA 94108
Contact Us Now 415-434-8858

Breast Augmentation with Silicone in San Francisco, CA

34 Procedures ( View All )

What Are Silicone Implants?

Breast augmentation is one of the most popular surgical cosmetic procedure in the United States. It is an operation for women who are looking for more volume and better shape, as well as those who have had children and have lost breast volume after breastfeeding. San Francisco, CA board-certified cosmetic surgeon Dr. Leonard Gray creates gorgeous, lasting results for his patients and performs this surgery numerous times per week. While silicone implants are oftentimes the preferred choice by patients who visit our practice, both saline and silicone implants still remain popular choices.

During the consultation, Dr. Gray reviews the risks, as well as the recovery from this operation. The goal is to make sure that his patients are well informed, have had their questions answered, and have an exceptional consultation experience. He always takes the necessary time to adequately size his patients with the real sample implants so they can accurately see what they will look like. During the consult, Dr. Gray and the patient will also choose the shape, projection, and size that is right for them. In the end, they have a clear image of what they will look like. Dr. Gray strives to ensure the patient feels comfortable, confident, and prepared prior to undergoing cosmetic breast surgery.

Silicone implants are softer and tend to look and feel more natural. They are more conservative and tend to look less round. They have less rippling and palpability and look more natural over time. Silicone implants have a lower deflation rate than saline implants. The incision is a bit larger for silicone, but it can be hidden well at the inframammary fold or areola. Silicone implants are more popular at Bay Area Plastic Surgery currently. Silicone implants come in a variety of profiles. In general, the flatter profiles are more conservative and the more projecting implants are perkier and less conservative. At the current time, there are four different types of projection: low, moderate, high-profile, and extra high-profile.


There are three FDA-approved breast implant manufacturers: Sientra®, Mentor®, and Allergan®.  Both Mentor and Allergan use the exact same silicone gel in their implants.  The shell design of their smooth implants is the same and is based on a 1988 patent.  The Allergan implants are made in Puerto Rico and the Mentors are made in Texas. The Sientra company uses a thicker silicone gel made in a separate factory in Santa Barbara, CA.  This thicker, silicone cohesive gel implant is commonly called a  "gummy bear" implant.  In addition, the Sientra company has a textured shell that is different from the Mentor and Allergan types.  Only the Sientra texturing shows a decrease in capsular contracture rates when the implant is placed under the muscle. Sientra implants are only available to Board Certified Plastic Surgeons.  Each implant line has some advantages.  Dr. Gray uses all of the manufacturers and all of the different profiles and always lets the patient choose their favorite.

What is an Implant PROFILE?

There are many different profiles of silicone gel breast implants that are available. In general, there are low profile implants, moderate profile implants, high profile implants, and extra-high profile implants.  Mentor and Allergan both have all 4 lines. Sientra offers has low, moderate and high.

What are the implant SHAPEs?

There are round-shaped implants and contoured shaped implants.  Predominately, we use round-shaped implants. When they are placed under the muscle they have a contour shape. They look slopey on the top and full on the bottom.  If someone were to have subglandular placement, then a contour shaped implant would look less round.  In our practice, however, almost every woman picks round implants placed under the muscle which gives a very natural result with a sloping superior pole and a full lower breast pole.

What is implant TEXTURE?

Both Mentor and Allergan created texture surfaced implants in the 1980s.  The hope was that these textured surfaces would decrease the Capsular Contracture rates under the muscle.  As it turned out, neither of them was of any benefit in decreasing Capsular Contracture rates under the muscle.  We don’t tend to use Mentor and Allergan textured implants.  The Allergan texturing, called Biocell, is also associated with late seromas and low-grade lymphoma. It’s even less likely that we would use these textured implants.  The Sientra textured implants, on the other hand, have a lower rate of Capsular Contracture and the patient does not have to massage them.  Patients who are interested in those features will tend to choose this implant.


In general, we place our implants submuscularly they tend to have a slopey upper pole and a more full lower pole and thus look the most natural.  In addition, this submuscular placement leads to less rippling and palpability and a lower rate of capsular contracture. Subglandular placement is rare and tends to be chosen by women who are professional bodybuilders or women who like a very round, "fake" appearance.

Types of INCISIONs

There is an incision at the areola, the inframammary fold and also the armpit. The armpit incision is Dr. Gray’s least favorite because there is very little control of the surgery field with this approach.  There is more bleeding, more asymmetry, and poorer cleavage. The areolar approach has some effect on breastfeeding and has a higher capsular contracture rate compared to the inframammary approach.  In terms of visibility, the inframammary incision is generally less visible. Both incisions have a low risk of affecting nipple sensation. Generally, the inframammary incision is chosen 2:1 compared to the areolar incision. Dr. Gray allows the patient to choose her incision site.

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Average Cost  
$8,000 - $9,500
Recovery Time  
6 Weeks
Average Procedure Time  
3 Hours
Post-op Follow-up  
4 Months
Procedure Recovery Location  
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Silicone FAQ's

How often do silicone gel implants rupture (or deflate)?

Silicone gel implants do not rupture very often. Although manufacturers quote approximately 5%, Dr. Gray has a 1% deflation rate over the last 20 years as compiled by the Mentor Corporation. Most of the time, deflation is unrelated to any specific cause. It just happens out of the blue.

What is the best test for a silicone gel rupture (or deflation)?

Most often times the breast will feel softer and look a bit flatter. When the breast is squeezed the flow of the gel looks a bit different than a breast with an intact implant. It generally doesn’t hurt and it generally doesn’t swell. However, sometimes it is quite difficult to determine if there is a rupture with a physical examination. The best test has always been an MRI. The problem with the MRI is that they are very expensive and they have a 20% false-positive rate. This means that they read a deflation when there really isn’t deflation.

Do breast implants have a warranty for rupture (or deflation)?

Yes, silicone gel implants do a deflation warranty. All three implants companies, Mentor, Allergan, and Sientra offer a near-identical policy. They offer lifetime replacement of your ruptured implants and for the first 10 years after surgery, up to $3,500 to help cover your surgery costs.

Have you ever seen anyone become sick following a rupture of their silicone gel implant?

No. Over the last 26 years, having performed thousands of breast augmentation surgeries, Dr. Gray has never seen illness related to a breast implant rupture. The FDA study on silicone gel implants, which started in 1993 and went on for nearly 20 years. This study also found no increase in any disease associated with silicone gel breast implants, whether they were intact or ruptured. It was for this reason that silicone gel implants came back on the market here in the United States, roughly a decade ago.

How often do breast implants get infected?

The national rate for breast implant infection is 1%. Dr. Gray has a lower rate than the national rate.

What are the signs of a breast implant infection?

The breast usually swells. Sometimes this is followed by redness, breast warmth, and a fever. Antibiotics by themselves will not cure a breast implant infection.

What is the treatment for a breast implant infection?

Breast implant infection, which means there are bacteria surrounding the breast implant, requires implant removal. Following this, oftentimes, the breast implant can be replaced after waiting for a period anywhere from three months to a year.

Which incisions can be used for breast augmentation?

For silicone gel implants, there are several incision options. There are areolar incisions, inframammary fold incision, or an armpit incision choice. The armpit incision is somewhat problematic, in Dr. Gray’s opinion. It is generally a blunt technique where a spatula type instrument is used to blindly make the breast implant pocket. This technique can lead to more bleeding, asymmetry, and poor breast shape. The incision can sometimes hide well but sometimes it’s quite visible in sleeveless shirts, tank tops, etc. This approach is not as popular as the other two incision options. The areola incision can affect breastfeeding and has a higher rate of capsular contracture. The inframammary incision affects breastfeeding less and the capsular contracture rate is lower with this approach.

Which breast implant incision is least visible when undressed?

The inframammary fold incision hides better most often times because the breast itself covers it up. The areolar incision tends to catch the light a bit more.

Which breast augmentation incision is the most popular?

The inframammary fold incision outnumbers the areolar incision 2:1. The armpit incision is a distant third in popularity.

Do any of the incision options have a higher rate of losing nipple sensation?

It used to be thought that the areolar incision had a higher rate of losing nipple sensation, but more recent studies have shown the risk is low and equivalent for both areolar and inframammary incision. Dr. Gray has a lower rate of nipple sensory loss than the national average rate of 1%.

What are the advantages of putting the breast implant under the muscle?

The submuscular placement of the implant has several key advantages. First off, the capsular contracture, or hardness rates, are significantly lower. Second, the risk of nerve injury, which leads to loss of nipple sensation, is considerably lower with submuscular placement. In addition, there is less visible and palpable rippling when the implant is placed submuscular. Lastly, the breast look is more natural in appearance. It is more slope-like on the top, full at the bottom, and does not have round, "fake" appearing breasts.

How do you make sure the breast has good cleavage?

In order to achieve good cleavage, there are two things that are the most important. First off, the muscle has to be adequately released and relaxed in the lower breast pole. Secondly, the implant has to be wide enough to cover the breast implant pocket from inside to outside (or medially to laterally). Dr. Gray prides himself on making sure that the implant matches the implant pocket so cleavage is ideal.

What are the indications for putting a breast implant over-the-muscle?

Professional bodybuilders are a subset of women who may do better with subglandular placement. They use their pectoralis major muscle so much that it is preferable to place the implant over-the-muscle. Other groups that may prefer over-the-muscle placement are women who want a very round appearance. Unfortunately, the rate of rippling, capsular contracture, and nipple sensory loss are higher with this approach. Dr. Gray generally prefers submuscular (or under-the-muscle) placement when performing breast augmentation surgery.

What are the main advantages of silicone over saline implants?

Silicone gel breast implants are generally softer, squishy, ripple less, wrinkle less, look more natural, feel more natural and most importantly look and feel more natural over time as compared to the saline implants. The rupture (or deflation) rates for silicone gel implants are lower than saline implants. The incision for silicone implants is a bit larger than the saline incision, however. Dr. Gray finds that almost all requests by his patients these days are for silicone gel.

What is breast implant texturing and why is it available?

The story starts back in the 1970s. At that time, there was a company that made an implant that was different than the smooth implants that were available on the market. The Meme company made an implant that was coated with polyurethane foam. It sounds like a funny idea, but these implants became popular in the 1970s because the capsular contracture/hardness rates were much lower. They were used in the U.S. for a decade or so until it was found that the polyurethane was being digested or breaking down in the body. Worse, studies showed that the breakdown products of polyurethane were carcinogenic. So, the FDA banned these implants (interestingly they are still available in Europe and South America). The implant manufacturers thought maybe there is something to having a rough or texted surface so they developed a texturing to their implants. The Mentor company called theirs "Siltex" and the Allergan company called theirs "Biocell." Unfortunately, the texture did not improve capsular contracture rates when implants were placed under-the-muscle.

What are the differences between round implants and teardrop implants?

Teardrop (or shaped) implants are used more frequently in breast reconstruction surgery. With augmentation surgery, the round implants are more popular. When the implants are placed under the muscle, the muscle compresses the upper part of the round implant yielding a teardrop shape. Round implants have a lower revision rate, lower asymmetry rate and this may be why the round implants are more popular in the augmentation group.

What are the three breast implant companies and how are their products different?

Mentor, Allergan, and Sientra are the three implant companies. Both Mentor and Allergan source their silicone from the same factory in Santa Barbara, CA. The breast implant shell design of their products is based upon the same patent from 1988. Sientra uses a thicker gel, sometimes called a “gummy bear” sourced from a different factory in Santa Barbara, CA. They also have a unique shell and textured design. Sientra implants feel a little firmer and look a little rounder but they are non-massaging and they have a lower rate of capsular contracture and deflation. As of late, the Allergan company is coming out with more cohesive gel options for their round implants. These implants are also referred to as gummy bear implants.

What is breast implant projection and why is it important?

All of the implant manufacturers have various lines of breast implants. There are very flat ones called “low profile”. There are modest projection ones called “moderate profile” and there are implants that project, even more, called "high profile." The implants that project or stick out the most are called "ultra-high profile" or "extra-high profile."

The low profile implants are the most conservative line and are not chosen that frequently because many patients think they look too flat. The moderate or moderate-plus lines, are the most popular choice and are more conservative than the high-profile implants. The high profile implants are also popular. They project out from the chest more. They still provide a natural breast shape under the muscle but they change a woman’s profile compared to the moderate profile. In general, they tend to make women look a bit taller, thinner, and less conservative. The ultra-high profile implants provide the least conservative look. They have the most projection and are generally the largest size that patients pick.

Is breast augmentation a painful procedure?

Dr. Gray always numbs his patients up prior to surgery with chest nerve blocks. This gives excellent comfort during surgery, in the recovery area, and on the ride home after surgery. It generally wears off by the time you get home. There is another option today where the pain relief lasts longer. A different local anesthetic called "Exparel" can be used. In this case, comfort and decreased pain last for four days. These patients generally do not need to take narcotic pain relievers at home and they avoid nausea and dopey-feeling associated with narcotic pain relievers.

When do the stitches come out?

Dr. Gray uses absorbable stitches when closing the incision. In addition, he uses derma-flex or dermabond skin glue. With this skin glue in place, our patients may take a shower the same day as surgery. Baths are not allowed. At two weeks post-op, the ends of the absorbable sutures are cut with a fine scissor. The skin glue lasts about three weeks post-op.

When can I exercise after breast augmentation surgery?

Dr. Gray likes his breast augmentation patients to have low activity. He asks them to walk in flat areas (no stairs or climbing hills) and to not lift more than one pound. At three weeks post-op, he allows them to exercise legs and abdominal muscles only in the gym. Any heavy-duty exercise starts at weeks 5 – 6, post-operatively. For secondary breast augmentation patients, he postpones full exercise until week 7 – 8. Sometimes exceptions are made to these rules, for mothers with small children, for example. But Dr. Gray does not want his patients to do too much and develop extra swelling or discomfort in the recovery period.

Should I wear a bra after breast augmentation surgery?

Dr. Gray likes his breast augmentation patients to wear an underwire bra after surgery in all cases. He generally starts them out in a specific inexpensive bra and at two weeks post-op he asks them to switch to a specific French or European bra that fits better. He has his patients wear this bra day and night for two months with breaks, as needed. This is to ensure that the breasts settle absolutely evenly. After two months, Dr. Gray recommends these same French and European bras for most outfits. On occasion, if a bra doesn’t work with a particular outfit he thinks it's just fine to skip it. For exercise, sports bras such as Lululemon are just fine. At night time, he prefers a bit of lateral support to prevent lateral drift over the years.

Will there be drains after surgery?

Dr. Gray has never used drains for breast augmentation surgery whether as a primary or a revision.

Will I have bandages or wraps after breast augmentation surgery?

No. Dr. Gray uses skin glue so there is no need for any dressing or bandage. This skin glue allows a patient to take a shower (no baths) the same day as surgery. Dr. Gray likes an underwire post-operative bra and generally does not use any type of wrap. In the last 20 years, Dr. Gray’s patients have liked this simple post-op routine.

How long should I take off from work after breast augmentation surgery?

As a general rule, it depends on the type of work a patient does and how comfortable they are. Women who have a desk or computer type job, generally go back to work in 4 – 7 days. Women whose job involves some degree of arm movement (hair stylists, etc.) generally take 2 – 3 weeks off. Women who have a very vigorous job (police, nurses, etc.) take two months off. Sometimes, women working in the police force, fire or highway patrol can get a modified desk job for a period of time until they are ready to return to full duty.

When I can expect my final result after breast augmentation surgery?

In general, just after breast augmentation surgery women have swelling, the muscle feels tight and the breast implants ride a bit high. Swelling goes away gradually. A good rule of thumb is 50% of the swelling is gone at a one-month post-op. Approximately, 80% of the swelling is gone at two months post-op. All swelling is generally gone at 4 – 6 months post-op. Muscle tightness, which pushes the implants up, also relaxes over time. Generally, women are at their final result with the implants settled in at 4 – 6 months post-op. Sometimes, Dr. Gray uses massaging to help the implants settle. He almost never uses wraps or bands.

Do I need to have my breast implants replaced every 10 years?

There is nothing in the manufacturer's literature that suggests changing implants every 10 years. There is nothing in the Plastic Surgery literature, that recommends changing your implants every 10 years. A good rule of thumb that Dr. Gray follows is if the implants aren’t broken, don’t fix them.

How long will I have to massage my breasts after surgery?

For the smooth implants, by Mentor, Allergan, and Sientra, Dr. Gray recommends lots of massaging for the first two months. This is because most of the scar tissue is formed during the first two months. After two months, he recommends that women massage for a few minutes twice a day (the same amount of time spent brushing your teeth). The textured implants, from Sientra, generally don’t require any massaging.

Is breastfeeding possible with breast implants?

Yes, many women are able to breastfeed after breast augmentation surgery.

How does getting pregnant affect my breast implants?

With pregnancy, breasts become engorged and become larger. Following the delivery and sometimes breastfeeding, the breasts get smaller once again. Sometimes, the breasts are smaller than they were before the pregnancy. Sometimes, they are larger than they were before pregnancy. Sometimes women get more droopy after pregnancy and others do not.

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*Individual results are not guaranteed and may vary from person to person. Images may contain models.