Breast Augmentation

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What defines excellence in breast enhancement and augmentation? An artist’s eye for symmetry and balance. A delicate touch and skilled hand. A board-certified plastic surgeon who listens to patients, and understands and fulfills their dreams and wishes.

The Natural Breast

Creation of The Natural Breast
James Romano, MD


I continuously receive compliments about The Natural Breast results I obtain. This is because I never take for granted how women trust me to operate on a most important part of their body; the breast. Whether this involves breast enlargement, breast reduction, breast lift, or breast deformities I am totally committed to create the most Natural Breast result your body will allow. I met with one of my patients operated on 12 years ago and she offered this compliment “Dr. Romano I married soon after my augmentation and my husband still does not know I have breast implants.” This is my goal; to look and feel natural with an imperceptible incision and to have these qualities last forever. Here is my distinctive formula to create this:


The natural breast needs to look natural. This means smooth on the top (not bulging), roundness to the bottom and the nipple in the middle of the breast mound, proportioned, and meeting your aesthetic goal. Many times, when patients say they like the “Baywatch” look or like their nipples to “point up” I have to explain how I clearly consider these as deformities created by doctors where the implants are intentionally placed too high or too low respectively. In order to obtain The Natural Breast, I do numerous things rarely done by other doctors. This goal means that it takes extra time in consultation and in surgery and in follow-up, but my patients and I are always thankful for the superior results this obtains.


The things I do different that create the most Natural Breast are:


  1. Consultation
    1. This is a lengthy detailed conversation with me, answering all your questions, and determining clearly your expectations and lifestyle
    2. A detailed physical exam describing what your anatomy will allow me to do safely and predictably to obtain such a result
    3. Sizing. This means using five different criteria to determine what cup size will be best:
      1. Measuring your breast dimensions, stretchability and chest wall position and recording this on a chart.
      2. Trying on specially made round or contoured breast implant silicone sizers in a bra with your own clothing on top.
      3. Reviewing photographs that are used only to get a sense of shape and size and proportion you like.
      4. Making an anatomic assessment of your body proportions and the relationship of your shoulders:breasts:hips and how this fits your body
      5. Determining your “aesthetic vision” and making sure that you know that “I see what you see” as the basis of going forward in our “partnership” to obtain the best possible result
      6. 14 Point Program. This is a ritual of extreme attention and dedication to a number of antibacterial and anti-infection maneuvers to prevent capsular contracture.
  2. Surgery
    1. Anesthesiologist. This is a handpicked excellent board-certified anesthesiologist experienced in cosmetic surgery patients who knows all my very detailed requests and requirements (for no nausea, pain on wakening, grogginess or bruising)
    2. Facility. The surgery is done only in a certified outpatient hospital operating room, not in the corner of some office.
    3. Incisions. I use a very concealed cosmetic incision that will allow me to see everything, loose only a teaspoon of blood, and insure minimal trauma to tissues.
    4. Intraoperative. The “saline test” where I place a temporary disposable inflatable implant that matches the dimensions we anticipate, then inflate this to match the size and shape we determined in the office.
    5. Sit up. There is a hinge in the OR table which allows the anesthesiologist to sit you up while asleep during surgery. This is where I determine if this is the size you want to be, adjust the pocket as necessary and create symmetry. This is the most important step in creating the “natural breast”. I ensure the nipple is in the middle and the bottom is rounded and smooth to the top. I don’t quit until all this is done and your result is as perfect as your body will allow.
    6. Permanent implant selection. In the surgery center itself, I have a personal and complete “inventory” of all the different sizes and shapes of implants and choose the one that matches the size of the saline test. Here I am not limited, unlike most doctors, that pick a number size, bring only two implants to surgery and put them in without the above steps.
    7. Insertion of implant. Use of “Keller Funnel” is a specific device designed to insert the implant under total sterile conditions; it goes from the manufacturers box into this special funnel that inserts it into your body so that the implant never touches your skin or any gloves and thus lessens the risk of bacterial contact and contracture.
  3. Postoperative
    1. Use of a stabilizing band or bra after surgery to encourage the implants to create the final shape we desire and heal in the right place
    2. Diligent and frequent follow up to make sure you are healing correctly, doing the massaging exercises, and that we have met your expectations
    3. Attention to your breast health. Teaching you about breast self-exam, mammograms, compression exercises, and not forgetting about forever monitoring for anything unusual in your breasts.

Collectively these contribute to creation of The Natural Breast.

Breast Augmentation

Breast augmentation tubular surgery is one of the most popular procedures performed in cosmetic surgery. As a leading expert in this area, Dr. Romano points out that there are many different anatomic features of small breasts that must be addressed prior to breast augmentation. These features include not only the size of the breast, but also the breasts’ asymmetry, the size and distribution of the breast tissue, the tightness of the skin, and the chest wall shape. Dr. Romano uses careful consideration and review of your anatomy and your expectations to put a plan together with you. There are numerous techniques, types of implants, and types of incisions to consider; which is why Dr. Romano’s has developed a technique that is more artistic, more natural, and safer than ever before. Not only does this surgery increase the size of your breasts, but also provides a very beautiful and natural shape.


Additionally, a wide array of implants is available—from saline to silicone, from fuzzy to smooth, from round to anatomic. Women can collaborate with Dr. Romano to choose from different incisions, different types of implants, and different locations for placement, such as sub-mammary, sub-pectoral, dual plane, or total sub-muscular. Fortunately gel fill materials have evolved to be very safe, feel natural, and cause less contracture. It is comforting to note that Dr. Romano has performed thousands of these procedures with consistently beautiful, natural results and many, many pleased patients.

Dr. Romano Explains

Breast enlargement surgery is a truly amazing surgery both for my patients and for me. In no other area of cosmetic surgery do I so consistently witness such a profound change in body image that women consistently tell me, “Dr. Romano, this surgery has changed my life.”


I am always humbled by how many women present with so many different breast anatomy features, and they’re all so reasonable for seeking improvement. I am also very humbled about how important this surgery is, in such an important area.

Breast enlargement surgery is one of the most popular procedures performed in cosmetic surgery at this time, and it is researched heavily by patients and partners alike. Therefore, this consultation takes a long time for you and me, as it should. There are many different anatomic features of small breasts that must be addressed prior to surgery.Surgery involves a relatively short procedure under a light general anesthetic and is performed in a hospital setting. The surgery is safe and predictable. Virtually immediately after surgery you see your result, and it just gets better with time. All of the stitches are dissolvable, and the recovery is rapid; you can return to work in several days and to some physical exercise within the first week.


Surgery to enlarge the breast is very common in my practice. I have performed thousands of these procedures with consistently beautiful and natural results. I have special expertise in this procedure and spend a great deal of time discussing your anatomy, listening to your expectations, and interpreting for you what your anatomy and body will safely and predictably allow me to do. In addition I build a system into every surgery that, initially, allows you to recover much more quickly and, secondly, preserves your surgical results. This system includes a special diet, vitamins, supplements, special garments, breast exercises, skin products, physical training, and knowing what to avoid. Together all of this allows me to create results that are consistently very beautiful, quick to heal, and exceptionally natural. I use minimal incisions, especially in an area of such great importance to women. I am delighted to surgically provide you with such a profound body-image change, one that has so consistently pleased my patients and changed their lives.

The New Ideal Implant

The arrival of the new IDEAL IMPLANT®


After years of research and testing, as well as consulting many women and plastic surgeons, we have accomplished a design of a saline-filled breast implant, now known as the IDEAL IMPLANT®.


  • Recently approved by the FDA
  • Lowered edges, allowing it to contour better to the best wall
  • Designed to combine the best of both saline and silicone implants
  • The natural result of silicone with the safety of saline


Now available in the office of Dr James Romano, the IDEAL IMPLANT ® Structured Breast Implant is a new saline implant for women that desire this over silicone. It has the natural feel that women want. After years of development and refinement, including contributions of clinical expertise from plastic surgeons, the IDEAL IMPLANT was approved by FDA and Health Canada. It is only available through a limited Network of board certified or eligible plastic surgeons and Dr. Romano was the first in the bay area to offer this. Essentially, it combines both the natural feel and the saline filler that some women want.

In its design, The IDEAL IMPLANT has a series of implant shells nested together and twoseparate chambers that hold the saline. This internal structure controls movement of the saline and supports the implant edges to reduce folding and wrinkling. In addition, the implant has been designed to contour to the natural curve of the chest wall. The IDEAL IMPLANT, has been in clinical use since 2009.

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