James R. Payne M.D.
Aesthetic Plastic Surgery

1334 Nelson Avenue
Modesto, CA 95350
209.524.9904 T
209.524.4 1 0 1 F

Ask the Doctor

This option allows the patient to have direct contact with the physician. It is intended to provide helpful information to the client and allow them to reach out directly to the doctor about issues important to them. This form of communication is not intended to replace a formal interview and examination and should not be construed as definitive medical commentary and advice. TO ASK THE DOCTOR A QUESTION CLICK here OR SEND AN EMAIL TO drpayne@jamesrpaynemd.com WITH THE SUBJECT LINE Ask the Doctor.

How are silicone implants different than saline implants?

Dr. Payne discusses this in detail with all his breast augmentation patients. In general, silicone implants are more expensive than saline implants. Saline and silicone implants tend to look the same when placed into patients so you cannot look at most women with breast implants and figure out who has saline and who has silicone. Dr. Payne believes the main difference between the two types of implants is that silicone feels softer and more natural than saline. If women compare breasts after surgery often the women who chose saline will feel that they like silicone better. However, when silicone implants were mostly banned between 1992 and 2007 Dr. Payne found that his saline implant patients were mostly happy and he had very few of them complaining about the feel of the saline implants.

If a saline implant leaks it simply has the saline (salt water) in the implant leak into the surrounding body tissue without any harm or injury. If a silicone implant breaks or leaks the silicone usually stays inside the scar capsule that surrounds the implant and does not mix in with the breast tissue. In this case there is very little danger to the patient because of a broken implant. In some cases, however, the silicone can mix in with the breast tissue and this could cause lumps, pain, and changes in the mammograms making cancer detection more difficult. The vast majority of silicone implant patients however do not develop complicated problems because of a broken silicone implant and most of these patients can simply have their old implants taken out and a new one placed.

Finally, implants now come in a variety of styles both saline and silicone. They can be round or shaped. They can have different profiles. The surface of the implant can be smooth or textured. The degree of stiffness to the silicone gel which fills the implant can vary as well as other differences. Dr. Payne talks to patients about this when he sees them for a breast implant consultation. He also shows them different examples of implants so patients understand how these differences can impact their surgical results.

How long after surgery can I return to work or exercise?

Most patients can return to work within one week of surgery unless they do hard physical labor such as lifting or operating heavy machinery. These people sometimes need to be off work 2-3 weeks or longer. For those patients that like to exercise most of them can resume light exercise within the first week after surgery. Dr. Payne starts patient out on easy to do cardio exercises and then progresses to weight lifting if they include that in their activity. Patients who enjoy yoga can usually resume most of the activity required with yoga but may need to refrain from anything that makes their breasts hurt for a few weeks after surgery. The majority of patients are back doing a fairly demanding exercise program within 4 weeks of surgery.

Is it better to put breast implants on top of the muscle (subglandular) or under the muscle (subpectoral)?

There are pros and cons to both approaches. Dr. Payne usually puts implants under the muscle for several reasons. First, implants placed under the muscle feel more natural than those placed on top of the muscle. In patients with thin skin and breast tissue implants placed on top of the muscle can more easily be seen and felt through the skin which is unnatural. They also are more likely to cause visible rippling of the breast which most patients very much do not like. Second, Dr. Payne believes that the risk of capsular contracture is lower when the implants are placed under the muscle. Capsular contracture is a condition where scar tissue forms around the implant and then tightens. As the scar tissue tightens the breast becomes firm and unnaturally round and tends to ride higher up on the chest causing noticeable asymmetry between the two breasts. Third, Dr. Payne believes that implants placed under the muscle look softer and more natural than implants placed on top of the muscle. Fourth, Dr. Payne believes that when mammograms are performed looking to detect breast cancer that it is easier for the radiologist to read the mammograms when the implants are placed under the muscle. This means a patient could have a breast cancer with microcalcifications and the implant on top of the muscle might make it harder for the radiologist to see these than if the implant had been put under the muscle.

Dr. Payne believes that the three main advantages of implants placed on top of the muscle is that for the first few days after surgery the patient has less pain than if the implants had gone under the muscle. If patients take the medication they are given after surgery this usually doesn’t make much difference one way or the other. Most patients are fairly comfortable following a breast augmentation operation within 3-5 days after surgery. A second reason is that implants placed on top of the muscle look more “fake” which is something that some women like. Remember that as time passes the breast fat and tissue will thin out and that an implant placed on top of the muscle might look good for a while but then some years later it might start to ripple and look bad. A third reason to go on top of the muscle is that if a woman is an athlete who competes in various activities where the arms are used (e.g. golf or tennis) it is possible that implants placed under the muscle might interfere with her athletic abilities whereas an implant placed on top of the muscle might be less likely to do this.

How long do breast implants last once they are placed into my breasts?

Dr. Payne believes that for both saline and silicone implants the majority of patients will have implants that do not leak or rupture for 10 or more years. Remember there is a warranty that comes with the implants provided by the implant companies regarding implant leak or rupture. Our staff or Dr. Payne will discuss this with you at the time of your consultation or you can contact us via phone or email for details.

What is the Lifestyle facelift that I see advertised on television?

This is an operation that is marketed to the general public by a  private company. Dr. Payne will discuss the details of this operation with you at your consultation if you so desire. Dr. Payne's personal view is that this operation may have significant limitations to it for many patients.

After surgery will I be spending the night at Dr. Payne's surgery center or will I be going home?

The great majority of patients will be discharged home the same day of surgery. All patients done in Dr. Payne's facility will go home. If you require an overnight stay, your procedure will be performed at the Stanislaus Surgical Hospital.

Where does Dr. Payne perform his surgery?

For most patients their surgery is performed at Dr. Payne's Surgery Center in his office. The surgery center is Medicare and State of California certified. When you visit the office we will give you a tour of the operating room if you would like. Occasionally patients are operated upon at Stanislaus Surgery Center. This is usually because of insurance issues or overnight stay.

Will I be completely asleep when I have my surgery?

The majority of surgery is done under general anesthesia with the patients fully asleep. Some surgery can be done under local anesthesia with intravenous sedation. Dr. Payne will discuss all your options with you when you have your consultation.

When does Dr. Payne operate?

Dr. Payne usually performs surgery on Tuesday, Wednesday, and Friday although sometimes he is operating every day of the week.

Will I ever have to have my implants replaced?

Dr. Payne tells everyone that they should expect to have their implants removed and replaced at some point in time after the initial surgery. The most common reason to have implants removed is if they rupture or leak. This can be very accurately diagnosed using an MRI scan. Most breast implant patients will have their implants last 10 years or more. The breast implant companies do provide a warranty that covers broken implants. Another reason for implant change might be needed if the patient develops a capsular contracture. With this process the breast can become quite firm and even deformed looking. Some patients will change implants because they want to go bigger or smaller or to switch from saline to silicone implants or vice versa. They might want to make a change to get a different implant that might improve the shape of the breast.

Breast Augmentation Tummy Tuck Facial Cosmetic Surgery

Breast Augmentation

While Dr. Payne is well versed in all aspects of aesthetic plastic surgery, his main area of specialty and interest is in breast augmentation.
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Tummy Tuck

One of the most rewarding procedures in cosmetic surgery, the tummy tuck has dramatic and long-lasting results.
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Facial Cosmetic Surgery

From brow lifts to nasal surgery, Dr. Payne's facial procedures offer some of the most dramatic transformations plastic surgery can provide.
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Breast Lift and Implants Massive Weight Loss Clients Laser and Skin Care Services

Breast Lift & Implants

This high-satisfaction procedure lifts and re-contours the breasts and can be accompanied with implants.
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Massive Weight Loss Clients

Dr. Payne offers various treatments for clients who experience massive weight loss due to traditional methods or bariatric surgery.
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Laser & Skin Care Services

Dr. Payne offers a variety of non-surgical anti-aging procedures and products for reducing wrinkles and rejuvenating the skin.
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Girl in black and white

Men and women alike undergo body changes as they age that cannot be remedied with dieting and exercise. Body contouring procedures can make clients look and feel better from head to toe. The immensely popular tummy tuck, liposuction for a wide variety of body areas, slimming the upper arms, Brazilian butt lifts and other buttock reshaping, lower body lifts, and other treatments may be rendered alone or in combination.

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