Breast Augmentation (Under Muscle)

The incision can be placed in a number of different locations including around the areola, in the armpit, but often times it is made underneath the breast and just above the crease. The doctor takes every effort to assure that the incision is placed so the resulting scars will be as inconspicuous as possible. After the incision is made, a pocket is created either under the breast tissue or under the pectoralis muscle. This pocket is made just large enough to accommodate the implant. The implant is then positioned to give the best cosmetic result. The method of inserting and positioning an implant is dependent upon various factors, such as the patient’s anatomy. These things are discussed with your doctor at the time of the consultation.

Following surgery, detailed instructions are given to the patient as to postoperative care and activity. It is important for a patient to follow these instructions in order to minimize any complications and to help achieve the best results. The surgeon will also advise the patient as to when they can return to their normal activities. Most patients are able to return to work within a few days, and more strenuous activities in about two to three weeks following surgery.

Before After Before  After
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Breast Augmentation

Description: 38 year old mother of 9 yr. old son is 5’4″ 128 lb. 34 A to 36 B before surgery now 120 lb. 34D after periareolar, sub muscular breast augmentation with smooth round implants filled to 360 cc on the right and 375 cc on the left. Her very soft, mobile implants give a natural feel. Patient had general anesthesia with abdominoplasty (tummy tuck) at the same operation. ‘After’ photographs taken 11 months after surgery.

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Breast Augmentation (Above Muscle)

Breast augmentation is surgical procedure designed to increase the size and enhance the shape of one’s breasts. Not only can this procedure enhance your appearance, it can possibly help build your self-confidence and self esteem. Also as a result of the procedure, many women have found it easier to dress in certain styles of clothing. Women have different reasons for undergoing breast augmentation.

The best candidates for breast augmentation are:

  • Women who feel their breasts are too small and looking to improve their figure.
  • Women who have lost breast volume and shape as a result of pregnancy and nursing.
  • Woman whose breasts have lost volume and shape as a result of aging.
  • There is a significant difference in the sizes of both breasts
  • Weight loss has changed the shape and or size of your breast

For many reasons a woman might have for wanting breast augmentation, ultimately the individual should be in good physical condition and have realistic goals and expectations in order to be considered a good candidate for the procedure.

The breast augmentation procedure involves the surgical placement of an implant within a woman’s breast. A breast implant is a silicone shell filled with either a saltwater solution known as saline, or filled with a silicone gel. If the saline-filled implant leaks, the fluid is absorbed into the body. This is the same as if the saline were given as an IV fluid. Currently the FDA approved saline-filled implants to be used on an unrestricted basis, while silicone gel-filled implants are only to be used in certain cases. Information regarding implants is discussed with the patient during consultation and at the time of surgery.

Before After Before After
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Breast Augmentation

Description: 30 yo who became smaller and lost shape after 6 year old son and 9 year old daughter were born and wanted to restore her proportions. Because of significant pseudoptosis and skin laxity textured saline implants were placed above the muscle via and axillary(arm-pit) approach.

5′ 2″ 105 lb. size 34A

Implants: Mentor Siltex 325 cc implants filled to 325 cc both sides

Scar location: axilla (arm pit) Implant location: sub-glandular (“overs”)

Post op bra size 34C

Commentary: Overall very happy with size and very soft and mobile breasts. All sensation intact. Accepts readily palpable implant rippling

Post op photos: date taken 1 year 2 months after surgery.

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Breast Reduction

Women with very large, sagging breasts tend to have neck, back, and shoulder pain. Therefore, patients find breast reduction surgery to greatly improve their life. These individuals not only have relief from their symptoms but also the ability to exercise better and wear more fitting clothes. Many have even gain psychological benefits. Of all surgeries that plastic surgeons perform, breast reduction ranks among the highest in patient satisfaction.

Patients of almost any age may have breast reduction surgery; however, they are highly urged to wait until after the breasts have fully developed. Breast reduction surgery is not recommended for those women who intend to breastfeed.

The first step when considering breast reduction surgery is to meet with Dr. Pertsch at one of his facilities in Mountain View or San Mateo. During this time, a thorough examination is performed, the procedure is discussed in detail and your questions/concerns are addressed. As each patient has a unique anatomy and desired outcome, every procedure is personalized to meet her needs.

You may be a good candidate for breast reduction if you have any of the following problems:

  • Neck, back or shoulder pain
  • Shoulder notching / furrowing from you bra strap
  • Heavy, sagging breasts
  • Breasts that are too large for your body size
  • Irritation and rash beneath your breasts
  • Difficulty with exercise and physical activities due to large heavy breasts One breast that is larger than the other creating a significant asymmetry

During breast reduction surgery, fatty tissue in the breast, along with glandular tissue and excess skin are removed. By removing these elements, the breast can be pulled tighter making them lighter, smaller, and firmer. Breast reduction surgery is generally performed under a general anesthesia, and usually takes between two to four hours to complete. Incisions can be made around the areola and vertically down the breast in order to remove the necessary tissue and reshape the breast.

After your surgery, you will be wrapped in an elastic bandage or have to wear a surgical bra over gauze for two to three days. You may have a drain placed in to allow excess fluid and or blood to drain from the incision. You can expect a recovery period of about two weeks. During the recovery period, patients are urged to refrain from lifting heavy objects and participating in any strenuous activity to ensure proper healing.

San Mateo and Mountain View patients may schedule an appointment with Dr. Pertsch to further discuss their breast reduction options.

Before After Before After
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Breast Reduction

Description: 45 year old was cup size B in high school-> size C early 20’s-> remained size D after first child-> remained size DDD after 2nd childbirth -> measured 32G 3 years ago. She has neck and back pain, and pain between her shoulder blades. There was pain at the base of her neck as well as pain in her shoulders R worse than L. her back always felt as though it needed to ‘crack”.

Before surgery exam consistent with 5’1″ height and 143 lbs weight and brassiere size 32G. Grade II ptosis on both sides. R side was larger than L. Preoperative estimation of tissue to be removed 500-550 Gms on larger R and 450-500 Gms on smaller L. Insurance paid for surgery to reduce symptoms.

Surgery consisted of the “short scar” vertical technique. On the right 573 Gms was resected and 100 cc of liposuction contouring of the outer breast and to reduce chest wall fullness next to the breast totaled 673 Gms removed. On the Left 476 Gms of breast tissue was surgically removed and 100 cc of liposuction from the outer breast and lateral chest wall for a total of 576 Gms removed totally 2 ¾ pounds removed.

After surgery she had complete relief of her back, neck shoulder blade and shoulder discomfort. Her old brassiere under wires hurt even though the cup is real loose. Her current 36C brassiere is too loose. She thinks a 32 or 34C will fit best but is going to be sized for the best fit. She has some numbness remaining on the left side but realizes it takes up to 2 years for it sensation to maximally improve.

After photos taken only 3 ½ months after surgery. Scars will continue to improve for another 2 years and in most cases become pale thin barely perceptible lines. She now weighs 130 Lbs.

She very happy she had it done and very happy with the result.

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Breast Lift (Without Implants)

As time passes, pregnancy, nursing, excessive weight loss, and gravity have adverse effects on woman’s breasts causing them to lose their elasticity, firmness, and shape. This creates a sagging appearance. A breast lift is a procedure that corrects this condition by removing excess breast tissue as well as tightening the skin.

When meeting with Dr. Pertsch at his San Mateo or Mountain View practice, patients are thoroughly examined, given details regarding the procedure, and have their questions/concerns addressed. No two patients are alike, which is why every procedure is personalized to meet the patient’s anatomy and desired outcome.

The best candidates for a breast lift (mastopexy) are healthy, emotionally stable women who are realistic about the result they would like to achieve. A breast lift may enhance your appearance and your self-confidence. The best results are achieved on women with small, sagging breasts due to loss of skin elasticity secondary to pregnancy and/or nursing, or weight loss. Those who plan to have more children may want to postpone surgery, as the process of pregnancy and breastfeeding may change the final result of the surgery.

Dr. Pertsch can make incisions around the areola, vertically down the breast, and horizontally across the breast crease. The breast tissues are then raised to a higher position on the chest wall and any excess skin is trimmed away. Some patients may not require the additional incision along the crease. Patients should be aware that they will be left with scars post-surgery, but they will become faint over time.

If desired, implants may be used to restore breasts to their natural shape and size. In this circumstance, the incisions would be limited to those needed for implant placement, which would reduce the appearance of scars. You may anticipate a more youthful and voluminous appearance after your breast lift procedure.

There are benefits to undergoing breast lift surgery; however with any surgical procedure there is always the possibility of complications occurring. Possible complications associated with breast lift include bleeding and infection following surgery, which may cause scars to widen, (poor healing and wider scars are common in smokers). The procedure can also leave you with different-positioned nipples, or a change in feeling in the nipple or breast. In order to ensure a healthy recovery, it is important to follow all pre- and pos-operative instruction provided during the consultation.

If you are in the Mountain View or San Mateo area, please feel free to contact Dr. Pertsch’s practice to schedule an appointment. You may gain further information regarding breast lift surgery at this time, as well as view before and after photos of previous patient results.

Before After Before After
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Breast Lift Without Implants

Description: Patient weighed over 230 lb. for years and had no pregnancies. With Weight Watchers and exercise she lost about 130 lb. over 3 years. Now 138 lb. at age 46 5’ 8 ½ “ she felt her “skin was too big”. She wanted to be less saggy and improve her self esteem. Her breasts had shrunk from 44DDD to current 36 D. She wanted breast improvement without implants.

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Breast Lift (With Implants)

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Breast Lift and Augmentation at the same operation (Augmentation Mastopexy)

Description: 28 year old mother of 6 yr. old son lost much breast volume and shape after nursing for 2 years. R.B. is 5’8″ tall, weighed 130 lb. and was a 32 loose C brassiere size before surgery. Sub muscular 420 cc McGhan saline implants filled to 420 cc on the right and 430 cc on the left. A breast lift (mastopexy) was performed at the same surgery to reduce drooping and establish proper nipple areolar position. Patient very happy with soft, mobile breasts and 32 D brassiere size.

‘After’ photographs taken only 1 month after surgery.

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Breast Revision

Each year, many women undergo breast augmentation. It has become one of the procedures most frequently performed on women today. There are various reasons why women choose to undergo this procedure, and likewise, there are various reasons women have for choosing to undergo breast implant revision. One of the main reasons is deflation of the breast implant. Then some women who feel the need to change the implants they have now and make their breasts smaller or larger than the previous surgery. Then there are those who were not happy with the original results of their first operation and would like to have breast implant revision to gain an appearance they can be happy with. Breast implant revision offers a solution to all of these women looking to re-do their breast augmentation. Be sure to discuss your reasons for wanting breast implant revision during your consultation.

Before After Before After
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Breast Implant Revision

Breast augmentation with larger silicone gel implants

Description:  41year old mother of 3 children was very happy after her first breast augmentation performed elsewhere 12 years ago. She had gone from a B- cup to a loose D or full C size. However, after losing 30 lbs (170 -> 142) she lost much breast volume.

R.B. is 5’4″ tall and weighed 145 lb. size 36 C with 280 cc gel implants before this surgery. After, patient very happy with appearance using submuscular 600cc high profile Mcghan textured gel implants. While she can fit in a 36 D a 36DD is more comfortable. ‘After’ photographs taken 6.5 months after surgery.

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Breast Asymmetry

Breast asymmetry is a condition where one breast is larger than the other. There are options on how to correct this condition. Breast implants can be used to augment one breast, making it similar to the other one. Breast reduction can be performed to reduce the larger of the two breasts. This involves removal of excess fat and skin. Either procedure results in breasts that are more similar in size. Correcting breast asymmetry has not only helped women improve upon their appearance, but it also provides a boost to their self-esteem and self-confidence. The choice of which procedure to undergo to correct breast asymmetry is something you and your surgeon will discuss. You and your doctor can discuss these options in more detail, as well as gain a better understanding of breast augmentation and breast reduction, during a private consultation.

Before After  Before After
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Breast Implant Deflation

Before After




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