Breast Augmentation
Dr. Horton
Emily Sespaniak, MSN, FNP-C
Danielle Bautista, MSN, ANP
What is Breast Augmentation?
Benefits of Breast Augmentation Surgery
Breast Augmentation Before and After Photos
Who is a Good Candidate for Breast Augmentation?
Types of Breast Implants
Breast Augmentation Incision Options
Breast Implant Placement Options
Choosing Your Breast Implant Size
Breast Augmentation Patient Stories
Preparing for Breast Augmentation
The Breast Augmentation Procedure
Recovery After Breast Augmentation
Implant Massage
Risks and Safety (FDA, capsular contracture, implant rupture, BIA-ALCL)
FAQs About Breast Augmentation
About Dr. Karen Horton
Contact Our San Francisco Office
Breast augmentation is one of the most common cosmetic surgery procedures worldwide, chosen by many women to enhance breast size, improve breast volume, and refine breast appearance while supporting natural-looking results.
Board-Certified Plastic Surgeon Dr. Karen Horton provides personalized breast augmentation surgery in San Francisco, serving patients across the San Francisco Bay Area, including Marin, the East Bay, the Peninsula, and the greater Bay Area in California. Every surgical plan is customized to your anatomy, your breast tissue, and your aesthetic goals, with careful attention to proportion, symmetry, and a natural feel.
Dr. Horton’s background includes extensive experience in complex breast reconstruction and complex revision of the breast procedures, which informs her meticulous approach to primary breast enhancement, implant placement, and long-term planning.
Ready to explore your options?
What is Breast Augmentation?
Breast augmentation, also known as breast enlargement or augmentation mammoplasty, is a Plastic Surgery surgical procedure designed to enhance the size, shape, and contour of the breasts. Most commonly, breast augmentation is performed using a breast implant (saline implants or silicone implants). In select cases, some patients may ask about fat transfer as an alternative method of breast enhancement.
Patients consider San Francisco breast augmentation for many reasons, including:
- Naturally smaller breasts and a desire for increased breast size
- Loss of breast volume after pregnancy, breastfeeding, or weight loss
- Asymmetry (uneven breast size or shape)
- Changes in breast tissue over time related to aging
- Congenital differences in breast development
- Aesthetic refinement after other breast procedures
Dr. Horton focuses on proportion and longevity, not a “one-size-fits-all” look. Many patients want results that appear like a natural breast, with movement, softness, and a balanced silhouette.
Dr. Horton had breast augmentation herself, and she blogged about it!
Learn more about her experience!
Benefits of Breast Augmentation Surgery
Breast augmentation patients often describe benefits that include both physical and emotional outcomes. Potential benefits include:
- Restoring breast volume after pregnancy, breastfeeding, weight loss, or aging
- Enhancing breast size, projection, and shape for improved body contouring
- Improving symmetry in cases of breast asymmetry
- Creating a fuller upper pole or a more subtle, natural-looking contour depending on preference
- Supporting self-esteem and confidence in clothing, swimwear, and lingerie
- Helping certain patients feel more proportional without relying on padded bras
Some patients also ask whether a breast lift may be needed to improve droop in addition to volume. If needed, Dr. Horton may recommend combining breast augmentation with breast lift surgery (augmentation-mastopexy) to address both shape and nipple position.
Inside The Procedure
Common questions about breast augmentation answered by Dr. Horton
Breast Augmentation Before and After Photos
Explore our extensive gallery of breast augmentation before-and-after photos to see real results from Dr. Karen Horton’s patients and envision what’s possible for your own breast enhancement journey. Visit our Revision Breast Surgery gallery for examples of how current implant results can be improved or enhanced, even years later.
Before & After
Who is a Good Candidate for Breast Augmentation?
You may be a good candidate for breast augmentation in San Francisco if you:
- Are in good overall health
- Have realistic expectations and clear goals
- Want to enhance breast size, balance, or breast appearance
- Have breast asymmetry, volume loss, or naturally smaller breasts
- Are comfortable with the idea that implants may require monitoring and possible future
Trusted Source
Who is a good candidate for breast augmentation?
American Society of Plastic Surgeons
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surgery
During your consultation, Dr. Horton reviews your medical history, examines your breast tissue and chest wall anatomy, discusses your implant options, and designs a specific surgical plan tailored to your lifestyle and unique aesthetic goals.
What Types of Breast Implants Are Available?
All modern breast implants use a silicone shell, which is considered inert and non-reactive. The main differences are what fills the implant (saline or silicone gel) and how firm the gel is.
Dr. Horton typically recommends smooth implants. Textured breast implants have been associated with higher visible rippling and are linked to breast implant associated anaplastic large cell lymphoma (BIA-ALCL), a rare cancer of certain immune cells. (Textured implants are not offered in this practice.)
Saline Implants
Saline implants are filled with sterile saltwater and are FDA-approved for patients age 18 and older. They are inserted empty and filled during surgery, which can allow smaller incisions in some cases.
In reconstructive situations, Dr. Horton may use a permanent, postoperatively adjustable saline device (for example, to address asymmetry after mastectomy or congenital differences). In some cases, saline devices used for reconstruction may later be exchanged for silicone gel implants for an optimal natural feel and breast appearance.
Standard Silicone Implants (“soft gummy bears”)
Silicone gel implants are filled with cohesive gel designed to mimic natural breast tissue. Many patients choose silicone implants because they often provide a more natural feel and less rippling than saline implants. Silicone implants are FDA-approved for patients age 22 and older. In select cases, they are offered to patients under the age of 22 for reconstructive purposes such as congenital breast asymmetry or Poland syndrome correction.
Highly Cohesive Silicone Gel Implants (Firm “Gummy Bear”)
Highly cohesive gel implants maintain their shape more firmly and can be helpful in certain reconstructive scenarios or in patients needing more structure. They can feel much firmer and may carry a small risk of implant “flipping” upside down in the pocket, depending on implant type and pocket design.
Learn More About Silicone Gel Implants
Implant Shape: Round vs. Teardrop
Some patients ask about teardrop (anatomic) implants versus round implants. These implants are generally textured, as smooth implants rotate in the pocket and create deformity when they are not directly upright. Implant availability and candidacy vary. Dr. Horton will discuss breast implant shape options that align with your anatomy, breast tissue, and natural-looking goals.
Dr. Horton helps each patient select the best implant type, shape, and size to achieve their desired breast augmentation results, ensuring a tailored approach to every procedure.
Breast Augmentation Incision Options
Dr. Horton will recommend an incision based on your anatomy, implant type, and long-term planning for future breast procedures.
Inframammary Fold (IMF) Incision
An incision hidden in the breast fold. This is commonly recommended because it supports precise implant placement and tends to preserve breastfeeding function and nipple sensation.
Peri-areolar Incision
An incision usually made along the lower border of the areola. This is less commonly recommended due to potential problems related to nipple sensation, breastfeeding, and capsular contracture risk.
Trans-axillary Incision
An incision in the armpit. This approach may reduce visibility of scarring on the breast, but visualization of the implant pocket can be limited and it is not typically preferred for patients who may want future revision surgery or implant removal—the incision cannot be reused in the future.
Trans-umbilical (TUBA) Incision
An incision in the navel, generally used only for saline implants. This method is rarely used due to limited implant options, poor visualization and pocket control.
Breast Implant Placement Options
Implant placement refers to where the implant sits relative to the chest muscle and chest wall.
Subglandular Placement
Subglandular implant placement places the implant above the pectoralis muscle and beneath the breast tissue. Many patients prefer this option for a natural breast movement pattern and less disruption of chest muscle function. This option is preferred by Dr. Horton for nearly every patient (including herself – read her blog!)
Subfascial Placement
Some surgeons are currently promoting placement above the pectoralis major muscle but below the muscle fascia, termed “subfascial” augmentation. In reality, this is traditional subglandular augmentation, as the surgery is performed in exactly the same manner—but like any trend in the media, surgical procedures are often rebranded, renamed or reintroduced as being “new and improved”.
Submuscular Placement
Submuscular placement positions the implant partially or fully under the chest muscle. This can provide additional coverage for thin patients with limited breast tissue, but may involve more discomfort and can contribute to animation deformity when flexing the chest muscle. Most patients seeking breast implant revision have submuscular implants and choose to convert them to on top of the muscle.
Dr. Horton discusses the pros and cons of each approach and recommends the option that best matches your breast tissue characteristics, lifestyle (including athletic activity), and aesthetic goals.
Breast Augmentation Patient Stories
Hear from our patients!
Patient Story: Anne | Karen Horton, MD
Patient Story: Natalie | Karen Horton, MD
Choosing Your Breast Implant Size
Choosing an implant size is about proportional balance, not just a target cup size. During your consultation, Dr. Horton will review:
- Your height, weight, and frame
- Chest wall width and shape
- Breast tissue thickness and existing breast volume
- Your desired look (natural-looking vs. more augmented)
Patients are encouraged to bring “Wish Pictures,” including:
- “YES” photos showing the breast size and look you want
- “NO” photos showing outcomes you want to avoid
Dr. Horton’s before and after galleries are a good place to start when seeking Wish Pictures. We recommend you screenshot images you are hoping to achieve and bring them with you to your consultation.
How Do I Select the Right Breast Implants?
Read more about choosing the right breast implants in Dr. Horton’s blog!
Preparing for Breast Augmentation
Your process starts with a comprehensive consultation where Dr. Horton reviews your goals, examines breast tissue, and discusses options.
General preparation includes:
– Reviewing medications and supplements to avoid before surgery
– Planning time off and arranging support for the first post-operative night
– Following pre-op instructions carefully
– Discontinuing smoking and nicotine use in any form at least six weeks before surgery
A Note on GLP-1 Medications: If you are currently taking a GLP-1 receptor agonist such as semaglutide or tirzepatide, you must stop taking it at least one month before your tummy tuck surgery. These medications affect gastric motility and anesthesia safety and can negatively influence wound healing after surgery; you will be educated more about these risks and be provided with specific guidance during your consultation. Learn more here.
The Breast Augmentation Procedure
Breast augmentation surgery is typically performed under general anesthesia. Dr. Horton:
1. Makes the planned breast incision
2. Creates the implant pocket
3. Performs implant placement based on the surgical plan (subglandular or submuscular)
4. Uses evidence-informed sterile technique, including antibacterial solution irrigation and no-touch handling methods when appropriate
5. Closes incisions in multiple layers to support healing, prevent complications and minimize scar tissue formation
Dr. Horton uses surgical drains as part of her protocol to help manage fluid, support healing, and reduce risk of complications such as capsular contracture in her approach.
Recovery After Breast Augmentation
Most patients experience swelling, mild discomfort, numbness and tightness early on.
Your post-operative plan may include:
Prescription medication initially, then plain Tylenol (acetaminophen) as directed
Avoiding anti-inflammatory medication such as Ibuprofen, Motrin, Advil or Excedrin (ASA)
Activity restrictions, including avoiding heavy lifting (more than 5 pounds)
Wearing supportive garments as instructed
Scheduled follow-up visits to monitor healing
Your final breast appearance evolves as swelling resolves and tissues settle. Many patients see a meaningful change quickly, but refinement can take months. Your preoperative and post-operative photos may be shared with you securely through the Symplast patient App.
Implant Massage
If instructed by Dr. Horton, implant massage can help reduce the incidence tightening of scar tissue around the implant (capsular contracture).
Dr. Horton had breast augmentation herself, and she blogged about it!
Learn more about her experience!
Risks, Safety, and Long-Term Considerations
All breast implants used by Dr. Karen Horton are FDA-approved and have been demonstrated to be safe through scientific research. However, like any surgical procedure, breast augmentation carries some risks. One of the most common long-term risks is capsular contracture, where scar tissue around the implant tightens, potentially causing discomfort or affecting breast appearance. Dr. Horton’s surgical expertise helps reduce this risk, and she is extensively experienced in performing breast implant revision procedures if needed.
Additional risks associated with breast implants include:
- Breast Implant Illness (BII) – also termed “Systemic Symptoms related to Breast Implants” (SSBI) in the medical literature – read Dr. Horton’s blog series about this condition
- Pain or discomfort
- Breast implant rupture/implant breakdown (saline and silicone)
- Deflation of saline implants
- Silent rupture of silicone implants
- Asymmetry
- Infection
- Change in breast sensation
- Scars
- Breast implant associated anaplastic large cell lymphoma (bia-ALCL) – textured implants only (not offered in our practice) – learn more here
FAQs About Breast Augmentation
Breastfeeding is often possible after breast augmentation, especially when surgical technique and incision selection are designed to preserve glandular tissue and
Trusted Source
The impact of cosmetic breast implants on breastfeeding: a systematic review and meta-analysis
Schiff M, Algert CS, Ampt A, Sywak MS, Roberts CL
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ducts.
If you have significant sagging, implants alone may not achieve the most natural-looking result. Dr. Horton may recommend combining implants with a breast lift.
Regardless of the location of implant placement (under the muscle or not), the fill material (silicone or saline) and the implant size, having a breast augmentation does not interfere with breast self-examination, physician breast exams, mammograms, ultrasound, MRI or any other cancer detection techniques. Dr. Horton shares her mammogram experience after breast augmentation in her blog – read it here!
Breast augmentation will not change your personal risk of breast cancer, nor will implants interfere with cancer screening. If you are over the age of 40 years, you should have a baseline preoperative mammogram before breast augmentation (or any surgery of the breast).
If you are under 40 years, routine mammography screening is not recommended as long as there is no history of breast or ovarian cancer in your immediate family. Dr. Horton will take a complete history at your consultation and will make recommendations for breast imaging or other referrals, if necessary.
When you have implants in place, please notify the mammogram technician and they will perform additional images (known as Eklund displacement view” – or the “horizon view”) to ensure that all breast tissue is fully visualized around the implant.
Mammograms with Breast Implants: Q & A with Dr. Horton
Learn more about mammograms after breast augmentation in this blog by Dr. Karen Horton.
Possibly. Implants are not lifetime devices for every patient, and bodies and styles change over time. Future revision may be needed due to implant aging, implant rupture, capsular contracture, or preference
Trusted Source
What to Know About Breast Implants
FDA
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changes.
Yes! Breast augmentation may be combined with other Plastic Surgery procedures. Specifically, a Mommy Makeover is a customized suite of surgical procedures designed to enhance women’ s confidence. Each Mommy Makeover is unique, but these are some of the procedures typically included:
- Breast lift for shape and positioning
- Liposuction for additional contouring
- Tummy tuck (abdominoplasty) as part of “Mommy Makeover” planning
Temporary changes in nipple sensation are common. Sensation often improves over months to years, but outcomes vary.
The inframammary scar used for breast augmentation usually is a fine, thin line approximately an inch to an inch and a half long. If a breast lift is also performed at the time of augmentation, additional “lollipop” incisions will also be concealed in a bra or bikini top. Dr. Horton recommends medical-grade scar gel, available in her online store, and patients may see a member of the San Francisco Plastic Surgery Team for scar therapy after surgery.
Breast implants have been linked to a very rare type of cancer known as anaplastic large cell lymphoma (ALCL), particularly in patients with textured implants. The risk is extremely low, with estimates ranging between 1 in 2,207 and 1 in 86,029 women with breast
Trusted Source
Questions and Answers about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
FDA
Go to Source
implants.
ALCL is typically treated by removing the implant and surrounding capsule.
Breast implants have not been shown to increase the risk of breast
Trusted Source
Breast implants and cancer: causation, delayed detection, and survival
Hoshaw SJ, Klein PJ, Clark BD, Cook RR, Perkins LL
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cancer.
Studies indicate that women with breast implants are not at higher risk for breast cancer, nor do implants interfere with the accuracy of mammograms or ultrasounds in detecting breast abnormalities.
The cost of breast augmentation varies depending on factors such as the type of implants, surgical technique, and individual patient needs. Dr. Karen Horton provides detailed cost estimates during consultations, ensuring patients understand all aspects of their breast augmentation procedure without listing specific prices online.
About Dr. Karen Horton
Board-Certified Plastic Surgeon | San Francisco Bay Area
Dr. Karen Horton is an internationally Board-Certified Plastic Surgeon specializing in aesthetic and reconstructive breast surgery, body contouring, and facial rejuvenation. Since establishing her boutique private practice in Pacific Heights in 2006, Dr. Horton has earned recognition as one of the region’s most accomplished Plastic Surgeons, combining meticulous surgical technique with a patient-centered philosophy centered on education, empowerment, and beautiful, natural-looking results.
Dr. Horton holds dual Board Certifications in Plastic Surgery:
- Diplomate, American Board of Plastic Surgery (ABPS) — Certified November 16, 2013; Continued Certification through December 31, 2033
- Fellow, Royal College of Physicians and Surgeons of Canada (FRCSC) — Certified June 30, 2005
- Fellow, American College of Surgeons (FACS) — Granted 2011
- ABPS Oral Examiner — Currently serves as an examiner for the American Board of Plastic Surgery, evaluating candidates seeking Board Certification in Plastic Surgery
Dr. Horton specializes in comprehensive breast surgery, including:
- Breast Augmentation with natural-looking results
- Breast Lift (mastopexy) and Breast Reduction
- Breast Reconstruction following mastectomy using both implant and autologous tissue techniques
- Complex Breast Revision Surgery
- Nipple-Sparing Mastectomy with immediate reconstruction
- Microsurgical Breast Reconstruction (DIEP, TUG, and other autologous flap techniques)
Dr. Horton’s philosophy emphasizes beautiful, natural-looking results that enhance each patient’s unique features rather than creating an artificial appearance. “Beautiful Plastic Surgery should be noticeable for the results, not for looking ‘done,'” she explains.
Dr. Horton is a prolific contributor to the medical literature, with over 100 peer-reviewed publications, book chapters, and presentations. Her research and clinical insights have advanced the field of Plastic Surgery. She serves as a Scientific Article Peer Reviewer for the Aesthetic Surgery Journal and is an invited guest speaker at meetings throughout the United States.
Dr. Horton’s approach to Plastic Surgery is rooted in three core principles: EDUCATE, INFORM, and EMPOWER. Rather than simply recommending procedures, she takes time to help patients understand their options, discuss realistic outcomes, and make informed decisions aligned with their aesthetic goals and values.
“The most rewarding part of my practice is seeing patients gain confidence and feel comfortable in their own skin,” Dr. Horton reflects. “I believe that beautiful results come from understanding each patient’s unique anatomy, aesthetic preferences, and life circumstances—not from a one-size-fits-all approach.”
Her boutique practice model ensures that every patient receives individualized attention throughout their surgical journey, from the initial consultation through post-operative care and follow-up. Dr. Horton treats patients as she would treat a dear friend or family member, and she is comfortable gently saying “no” to patients who are not good surgical candidates, explaining her concerns in detail and offering alternative solutions when appropriate.
Dr. Horton is deeply committed to staying current with advances in Plastic Surgery. She:
- Regularly attends national and international Plastic Surgery conferences
- Publishes research and clinical insights in peer-reviewed journals
- Serves as an ABPS Oral Examiner
- Participates in professional society committees and leadership roles
- Mentors surgical fellows and residents
Dr. Horton’s path to becoming a Plastic Surgeon began with a strong foundation in scientific research and medicine:
Undergraduate & Graduate Education:
- Bachelor of Science, First Class Honours — Queen’s University, Kingston, Ontario (1994)
- Master of Science in Molecular Biology/Cancer Research — Queen’s University (1996)
- Doctor of Medicine, First Class Honours — University of Toronto (2000)
Surgical Training:
- Core Surgery Internship — University of Manitoba (2000-2002)
- Plastic Surgery Integrated Residency — University of Manitoba (2002-2005); Chief Resident (2004-2005)
- Senior Clinical Fellowship in Hand and Microsurgery — The Buncke Clinic Institute for Plastic & Reconstructive Surgery, San Francisco (2005-2006)
Her Fellowship training at The Buncke Clinic, one of the world’s premier Microsurgery centers, equipped her with advanced techniques in complex breast reconstruction and microsurgical procedures.
Dr. Horton’s dedication to exceptional Plastic Surgery has earned consistent recognition:
- SFGATE Best of the Bay 2025 — Voted Best Cosmetic/Plastic Surgeon in the Bay Area
- Marin Magazine Top Doctors 2026 — Recognition for Excellence in Plastic Surgery
- Castle Connolly Exceptional Women in Medicine Award (2025, 2024, 2023)
- America’s Best Plastic Surgeons — Newsweek.com (2025, 2024)
- Haute Living San Francisco Cover Feature (November/December 2022) — “Finding Beauty Beyond Boundaries”
- Quad A Accreditation 2025-2027 — San FranciscoPlastic Surgery
Dr. Horton maintains active memberships in leading Plastic Surgery organizations:
- American Society of Plastic Surgeons (ASPS) — Active Member; Social Media Committee (2015-2026)
- The Aesthetic Society — Active Member; Chair, Integrated Marketing Committee (2023-2026)
- American College of Surgeons (ACS) — Fellow (FACS)
- California Society of Plastic Surgeons (CSPS) — Active Member
- American Society for Reconstructive Microsurgery (ASRM) — Active Member
- International Society of Aesthetic Plastic Surgery (ISAPS) — Full Member
As the daughter of a Breast Cancer Surgeon, Dr. Horton has dedicated significant time to complex breast reconstruction for over two decades, offering advanced options including sophisticated microsurgical techniques using the body’s own tissue, nipple-sparing mastectomy with immediate reconstruction, and complex revision surgeries for women seeking improved symmetry and aesthetics.
San Francisco Practice
Dr. Horton’s boutique practice, located in the prestigious Pacific Heights neighborhood of San Francisco, reflects her commitment to personalized, high-quality care. Established in 2006, the practice environment is warm, welcoming, and designed to make patients feel comfortable and supported throughout their surgical journey.
Practice Highlights:
- Established 2006 — Nearly two decades of trusted care in San Francisco
- Boutique Model — Limited patient load ensures individualized attention
- Comprehensive Care — From initial consultation through post-operativefollow-up
- State-of-the-Art Facility — Modern surgical center with advanced equipment
- Experienced Team — Compassionate staff dedicated to patient comfort and safety
- Quad A Accreditation 2025-2027 — Recognized for quality and safety standards
Schedule Your Breast Augmentation Consultation with Dr. Karen Horton
If you’re considering breast augmentation in San Francisco, Dr. Karen Horton invites you to schedule a personalized consultation to discuss your aesthetic goals and explore your options. During your consultation, Dr. Horton will take time to understand your vision, examine your breast tissue and anatomy, review implant options, and design a customized surgical plan tailored to your unique needs and lifestyle. Whether you’re seeking to enhance breast volume, improve symmetry, or restore fullness after pregnancy or weight loss, Dr. Horton’s patient-centered approach ensures you feel educated, informed, and empowered to make the best decision for your body.
Follow Dr. Horton
Connect with Dr. Horton on social media for daily practice updates, patient education, and surgical results:
@drkarenhorton
