Breast Augmentation Testimonials

Do you have silicone gel implants? Are they more than 5 years old? Have you had an ultrasound or MRI to see if you have a silent leakage? 

Silicone implants are great, but they are not lifetime devices. It is recommended that you scan for silent ruptures every 3-5 years. (NOTE: This is not applicable to saline implants, as when saline implants leak the implant goes flat as your body absorbs the saline, so the leak is visible.) The silicone gel breast implant warranty lasts for 10 years, and like all warranties, things tend to be okay before then. But since I have been in practice for over 25 years, I am starting to see a trickle of silicone breast augmentation patients who I did implants in 15, 17, 19 years ago come in with leaking silicone gel implants. They had no symptoms. The gel was contained within their capsule. It was found when they went in for their yearly mammogram. A few things before you freak out:

• Your body forms a balloon of scar tissue around your implant when it is placed, so even if your implant has leaked, the silicone is usually caught by the capsule. (This is “intracapsular”)
• Silicone implants are cohesive gel, so they aren’t as liquid as they were in the past.
• This is treatable. But you will need a surgery.

So how do you know if you are leaking?

At the last Aesthetic Meeting in 2025 in Austin, I went to a course about ultrasounds. Technology has advanced so much, and now there are handheld ultrasound machines we can use in our little ol’ plastic surgery offices, hook it up to an iPad, and see what is going on. Turns out it is a great device to see if your implant has ruptured.

Benefits of in office ultrasound at Lauren Greenberg MD?

• Painless. We just put a little gel on your skin and scan.
• No radiation. It is an ultrasound.
• Low cost. $100-200. If you have a rupture and need surgery, we apply it to your surgical cost. MRIs and ultrasounds done in the hospital are $$.
• Peace of Mind.
• Health. You should know how your implant is doing.

It gives me great joy to be able to offer this to my patients. Both I, and Meghan Douglass my nurse, are trained in this new ultrasound. It is about a half hour visit to the office.

I think implants are safe, and well researched and understood. But they are not lifetime devices and need to be replaced. It is easier to replace an old implant before it ruptures. If ruptured, the surgery to replace or remove is also straightforward, but it takes a little more time to do the capsulectomy. It is good to know what you are going to find before you get in there. You can decide to revise during breast revision or remove with breast implant removal.

Who should do it and when should you do it?

• If you have silicone gel implants that are more than 5 years old
• If your implants are over 10 years old, I recommend scanning every 2-3 years
• If you have a change in your implant- new wrinkle, hardness, shape change
• If you are worried and just want to see it. (The ultrasounds are cool, and peace of mind is priceless).

This is a tool. It is not a guarantee of an intact implant or a ruptured implant. We have the T mode on the ultrasound which helps us see the area better (Go AI technology!), but we are not official radiologists.

First, let me start by saying I see many women come in for breast implant removal. There are a host of issues for the “why”- they are over it, they want to be smaller, they worry their implants are making them sick (BII- breast implant illness). Many of them ask, “Can’t you just put my fat in there instead?”

This is a study out of Belgium where they are attempting to do just that.

This is an article out of the July 2021 Aesthetic Surgery Journal, “Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation with Power Assisted Liposuction and Lipofilling.”  They even have a catchy name for it “PALLL.”

Study:

They proposed a new technique to remodel the breast after removing the implant by using an internal suture to loop the breast to help it narrow and have more projection. The researchers claim it also helps recruit tissue from the upper abdomen and axilla (armpit) area, which gives more tissue to fill with fat.

• They did 52 consecutive patients, average age 55, and BMI 24.
• 41% were smokers
• Reason for removal – 28% for rupture, 58% for capsular contracture and 14% for pain or migration.
• Average implant volume removed 292cc
• Average lipofilling was 223cc
• Average breast volume by the suture loop 82cc

Technical issues: They did not remove the breast capsule unless it was thickened with severe capsular contracture. To create the double loop, they tunnel using a cannula in the subcutaneous plane lower, going deeper as they go cephalad. They do this loop twice. They use a nonabsorbable Filapeau 2 suture. Then, they do fat transfer where they can, rinsing out any fat that ends up in the old breast implant cavity. Patients wear loose non compressible bras for 2 months after surgery.

They do the fat grafting using power assisted handpiece, which they think the vibration and grafting together helps the fat transfer by preventing coalescence of fat lobules.

They discuss issues with fat grafting to the breast. 1. Fat resorption. 2. Unpredictable movement of injected fat, and you are limited to grafting into the native breast tissue only. 3. It can’t reverse breast droop. 4. It does not give good projection to the breast.

Discussion

Others have tried to improve fat grafting survival in the breast by increasing the space to graft into by BRAVA domes and other expanders. (BRAVA domes are no longer available on the market) They also discuss those who do serial surgeries, grafting more each time .

My thoughts?

Wow. I think I need to address this as a separate blog as I have many thoughts. I think doing a suture loop to lift the breast or shape the breast is fraught with tons of issues. Dr. Khouri did it when I studied with him in Miami. I am a HUGE Dr. Khouri fan, but just like I don’t like threadlifts in the face to do facelifts (and even our literature doesn’t support them), and I feel “threadlifts” for the breast are the same. For true change, you can’t treat tissue like a marionette string.

As for fat grafting to the breast, there are uses for it, but it is tricky. Where the implant used to be is a space with no blood supply. To put fat into that space doesn’t work- it would be like planting a tree into a concrete swimming pool.

This is out of the Aesthetic Surgery Journal March 2019.  “Physical Properties of Silicone Gel Breast Implants.” Yawn.  Not a catchy title, but important things to know.  With the options for silicone gel implants exploding, how do you choose?

There are some things which are not addressed here:

• the width and projection of the implant, which give you the profile of implant (low, medium, high profile)
• the volume of the implant (measured in ccs, which ranges from 120-600)

The study:

• They looked at 4 manufacturers: Sientra, Mentor, Allergan, and Establishment labs
• They did bench testing to look at
  • form stability– does the device retain its dimensions when you move from horizontal (lying down) to vertical (standing up)?  The less it changes, the more they have shape retention.
  • dynamic response to the gel– when you compress it, what is the gel cohesivity, resistance to gel deformation (stiffness), and energy absorption (softness)?
  • Shell thickness, tested in five regions of the implant.
• They tested 3 textured shaped implants, 6 textured round implants, and 8 smooth round implants.  They tested 6 of each type.

Findings:

• Form stability:
  • SHAPED SILICONE GEL BREAST IMPLANTS: Natrelle 410 implants containing Truform 3 gel retained significantly more of their original dimensions than Mentor MemoryShape and Sientra Textured Shaped implants.
  • TEXTURED ROUND SILICONE GEL IMPLANTS: Inspira (Allergan) implants with Truform 3 gel, followed by TruForm 2 gel.
    • Sientra had the lowest form stability in height,
    • Mentor had the lowest form stability in projection
    • Inspira Truform 1 gel had lower form stability in the upper pole.
  • SMOOTH ROUND SILICONE GEL IMPLANTS: Inspira Truform 3 gel was equal to Motiva ProgressiveGel Plus
    • Inspira Truform 2 gel was equal to Motiva ProgressiveGEl Ultima
    • Sientra implants with High Strength Cohesive Plus gel did in the middle
    • Mentor implants Cohesive 1 implants had lowest form stability in each dimension
• Gel Material Properties
  • Allergan Natrelle 410 implants with TruForm 3 had significantly higher gel cohesion, resistance to gel deformation, and lower energy absorption complared to Mentor MemoryShape or Sientra Textured shaped implants
    • Truform 3 had higher retention of all 3 properties than Truform2 or Truform 1
  • In general the gel properties of the implants varied “significantly across devices.” The order of gel cohesion:
    • Natrelle 410 or round with TruForm 3 gel
    • Mentor textured shaped with Cohesive III gel
    • Sientral with High Strength Cohesive gel
    • Motiva with ProgressiveGel Ultima
    • Mentor with Cohesive 1 gel
    • Inspira with TruForm 1 gel
• Shell thickness
  • Allergan shell thickness was consistent in all textured implants regardless of shape
  • Natrelle 410 and Mentor MemoryShape had the same mean shell thickness.
  • Sientra textured were thinner
  • The round textured implants, Inspira implants were thicker than Mentor implants or Sientra implants

So what does this all mean??

In their discussion, the authors talk about these differences may affect performance of the breast implants in clinical settings.  If you have more form stability, you will retain the breast implant shape better.  The more cohesive the gel in the breast implant means more form stability, which determines shape retention.  The shell thickness may also have an effect.

What does this mean to you?

After reading this, or skimming this, or just skipping all of the above and reading my summary here, you may think- aha! I need to do a form stable implant with the highest cohesive gel so my implant retains its shape as much and as long as possible.

Not so fast.

The more cohesive the implant, the firmer the breast feels. I have patients who think their implant has a capsular contracture because the implant feels firm.  They don’t have capsular contracture. They are just feeing the firmness of the high cohesive silicone gel itself.

The higher cohesive gels also keep the upper pole of the breast fuller, which for those who want a more cleavage, augmented look is great.  But for those who want a more subtle, natural look having a really full upper pole looks like they had a breast augmentation- and they don’t want that.

All of the brands have variations in cohesiveness- hence the confusing lingo above with different levels of cohesive gel. It seems that Allergan TruForm 3 gel is the most stable.  (Of note, this study was done by Allergan consultant doctors, and in the critique of the study, it was noted an independent study supporting these findings would be nice.)

When you meet with your doctor, ask to feel the different cohesive gels.  They should have samples of each.  I think it is useful for you to feel it- you will know which you like the best. I use primarily Allergan implants.  I can have you feel and squeeze an implant with TruForm 1, 2, or 3 type gel.

After consulting with three other surgeons, I decided to have Dr. Greenberg perform my breast augmentation to have my 30 year implants removed. Dr. Greenberg is professional, patient and knowledgeable in the field of breast augmentation. She explained what to expect during and after the surgery, and was always available to answer any concerns I had. It has been 5 weeks since I had the surgery and I am very pleased with the results! I highly recommend Dr. Greenberg if you are considering having your breast implants removed.

– Elle H. January 22, 2017

I went to Dr. Greenberg originally for breast implants.  She is the only doctor I saw who asked me to bring two tops as we sized my new breasts.  She explained that turtlenecks would emphasize the breasts, and V-necks deemphasize them.  She was endlessly patient with me, as I tried on first one and then the other in the various sizes we were looking at.  She steered me towards the optimum range medically, but let me make the final choice.  The breasts Dr. Greenberg gave me look natural.  They fit my build, and you’d never know, if I didn’t tell you, that they’re not the ones I was born with.  This is particularly impressive given the fact that I’m small-ribbed and small-boned, and had virtually nothing to begin with.  Where other doctors feared to tread, she created a sweet miracle. Lauren Greenberg is knowledgeable, has skill, and integrity. She is honest and direct: she tells me what’s likely to work and what’s not, rather than trying to sell me services. And she does beautiful work.”

O.S.,  Breast Augmentation, Botox, Sculptra patient,  Redwood City, CA

“My experience with Dr. Greenberg was absolutely wonderful.  I had been thinking of breast augmentation for years and never had the courage to go through with the process until I met Lauren Greenberg.  After having two children, my already small breasts had flattened out completely. I explained to her that I had never minded being small breasted but just wanted back what I had before children.  I did not want large unnatural-looking implants.  In the process of researching doctors, every person I met who had the nicest and most natural results had all been to Dr. Greenberg.  After my first consult with her I knew she was my doctor.  Her confidence and honesty got me through the process and I could not be happier with my results.  It has been one year and four months since surgery and I am so happy I did it.  The entire process was so much easier than I ever thought.  I knew if I did exactly what she told me to do I would get the results I wanted and I did.  In the past year, I have referred two very good friends to her, and of course, the results are beautiful.  Thank you Dr. Greenberg!”

C.T., Breast Augmentation patient, San Carlos, CA

“I decided to look in to undergoing a breast augmentation late last year, and was referred to Dr. Greenberg. I met with her two/three times prior to deciding to go through with the procedure. Each time she made me feel more comfortable, but most importantly, made me feel that it was completely and totally my decision, and my decision only. Her professionalism and obvious knowledge was extremely comforting. She was on call to answer any of my questions before, and after the surgery. I think she’s fantastic and will be singing her praises to anyone who will listen! I’m thrilled with the outcome of the surgery and have Dr. Greenberg to thank!”

J., Breast Augmentation patient, San Carlos, CA

“I chose Dr. Greenberg because of her honesty and her amazing results focused on keeping her patients looking natural.  I can’t say enough about how positive my experience has been.  She has made this a smooth process and I am so happy with my results!  She has always promptly addressed my concerns before and after surgery which has made this so personal for me.  I recommend Dr. Greenberg to all my family and friends! Thank you for making my personal choice to have surgery so personal.

Thanks Dr. G.!”

K.O., Breast Augmentation, Eye Lift, and Liposuction patient, San Mateo, CA

Here’s the deal, Dr. Greenberg is not going to lie to you and do surgery on you just to get some money and I love that! If she thinks that what you want is unrealistic she will tell you (in a very kind way). She is very honest with her patients and she really wants all of her patients to have great results. I consulted with a few doctors before her and I was extremely turned off. She made me feel very comfortable and not at all pressured into doing anything. I asked her several questions at and after my consultation and she answered all of them. I would email her with questions and she would call me within hours to follow up and answer my questions over the phone. I got a breast augmentation and I could not be happier. She really knows her stuff and she knows what is going to look good and what isn’t. She really paid attention to what I wanted which is important because I feel like that is very hard to find in a surgeon. I received a breast augmentation and I struggled with all of the different options there are to choose from. She was very honest with me about what results I would get from each option and the good and bad. I love my results and I feel that achieved exactly what I was looking for. They fit my body very nicely and they look natural.The fact that she is a woman is also a plus because I feel like she gets it more than a male doctor would. She also made me feel very comfortable as I was going in for surgery.

I would recommend her to anyone!!!! She is awesome!

T.H., Breast Augmentation, San Jose, CA

I searched for a plastic surgeon for about 2 years. Dr Greenberg was the last surgeon I met with and am so glad it took as long as it did. I found Dr Greenberg to be very knowledgeable and to be a great listener. Yes she is Stanford educated which is great but it’s her quest to discover the newest, safest techniques to improve outcomes that I found especially attractive in her practice. She did not have “an agenda”, she did not try to push for any unnecessary procedures. She listened to what I needed and offered me the best approaches to meeting my goals. She is an amazing surgeon! I had a breast augmentation and lipo about 2 months ago and I couldn’t be happier! My body looks 100% natural. I don’t have any visible scarring which is amazing. Dr Greenberg took such great care in ensuring all my incisions would blend right in. She certainly has a client for life!!!

K.K., Breast Augmentation and Liposuction patient, Stanford, CA