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Breast Augmentation Surgery


Dr. Delgado performs breast augmentations at Marin Cosmetic Surgery Center, a private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.

Before general anesthesia is given, demarcations of the breasts and chest are outlined using a surgical marking pen. This acts as a roadmap during surgery, allowing the surgeon to make the appropriate adjustments for the gravitational changes that occur as a person moves from lying on the back (supine) to a sitting position, for example.

Breast implants can be placed through one of four incisions. The most common is the peri-areolar incision between the dark and light interface of the areola and paler breast skin. This incision gives an excellent cosmetic result. It can also be placed at the skin crease underneath the breast itself or through the underarm region, referred to as a transaxillary approach or lastly, through the navel (umbilicus or belly button), referred to as the TUBA (trans-umbilical breast augmentation) approach. The TUBA approach is a very difficult approach and turns a moderately difficult procedure into a much more complicated one. Considering the fact that most breast augmentation patients will require more breast surgery in the future, a more direct approach is preferred.

Breast implants can be placed either on top of the pectoralis muscle or beneath it. Dr. Delgado prefers the peri-areolar approach and placement of the breast implants below the pectoralis muscle. The sub-pectoralis placement provides a more natural look, especially in the superior margins of the breasts and also better protection and support for the breast implant. During surgery, once the breast implants are in place, the operating table is adjusted so that patient is placed in an upright (sitting) position. This way, any necessary adjustments can be made to the breast implant placement or, in the case of saline breast implants, to size, prior to closure. A multiple-layer closure is performed. A soft support bra with front hook closure is placed. Often, a compression band with Velcro™ closure is also secured around the patient’s back and chest, compressing the upper part of the breasts. This ensures that the breast implants settle properly into the newly formed breast pockets.

Some women have loose breast skin from pregnancy, weight loss, or just genetics. In some cases, breast implants will fill out the breasts and solve this problem, but in other cases, a breast lift may need to be included. Breast lifts modify the skin superior to the areola, restoring a more youthful placement to the nipple in relation to the breast.


Breast implant surgery is performed under general anesthesia. At Marin Cosmetic Surgery Center, general anesthesia is administered only by a physician who is board-certified in anesthesia. (See credentials for Randy Gaynor, MD on this website.) Dr. Delgado and the anesthesiologist will assist you in making the best choice for your anesthesia. Additionally, the anesthesiologist calls the patient the evening before surgery to review his/her medical history, confirm last minute instructions and answer any questions he/she may have regarding the anesthesia.

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