Cosmetic And Reconstructive Plastic Surgery
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Breast Augmentation Surgery

What is Breast Augmentation?

Breast augmentation is surgery in which a silicone implant is placed within the breast area to make the breast appear larger. Breast augmentation can also have beneficial effects on breast shape and position, and only requires an inconspicuous scar. It can be combined with a breast lift when significant changes in breast and areola shape are necessary.

Who is a good candidate?

Anyone seeking the cosmetic benefits of breast augmentation can be considered for this surgery, but there are some relative contraindications to surgery. If significant changes in your breast appearance are anticipated (e.g. through weight-change or pregnancy), surgery should be delayed until conditions are stable so that the cosmetic benefits of your surgery are not compromised. Breast augmentation is most productive for women years before planned pregnancy once child-bearing is complete. Cancer surveillance, especially any anticipated need for breast biopsy, must be factored into the decision process if family history or genetic testing suggests you may be at risk. Chronic illnesses should be optimized, and periods of high-stress should be avoided before any elective surgery. Recurrent infections (e.g. dental infections) must be overcome, as circulating bacteria can infect a breast implant.

Consultation essentials

If you are considering breast augmentation, you should understand some unique aspects of this procedure so you can properly share in the decision-making process.

  1. Implants do last forever in some patients, but you must accept the likelihood that further breast surgery will eventually be necessary. This is more likely with saline-filled implants that deflate when they rupture, and with large implants (D size or larger) that will put a bigger strain on your tissues as you age.
  2. “Capsule”, the fibrous wall our bodies form around any foreign body, is a natural consequence of breast implant surgery. Problems can arise when it is too flimsy, allowing the implants to move around too much, or too hard causing deformity and pain. Be sure to discuss this issue at your consultation.
  3. Size matters, as larger implants do cause more strain on tissues and are more likely to necessitate future surgery. It is helpful to bring a photo to your consultation that demonstrates what size you would hope to be after surgery.
  4. Saline implants allow for smaller incisions, but feel ‘fake’ (compared to silicone gel implants) in patients who are very thin or if implant is placed over muscle. Don’t choose a saline implant to avoid silicone, as the shell of a saline implant is made of the same silicone material as gel implants. A saline implant will fully (and dramatically) deflate if a hole develops in the implant. Textured implants are generally avoided in cosmetic cases to reduce the risk of ALCL, a lymphoproliferative disorder that can behave like cancer if not treated.

Alternatives to Breast Augmentation

Fat grafting is an attractive option if you have good ‘donor sites’ with excess fat, and would be satisfied with a one-cup size augmentation. Larger augmentations are possible, but repeat fat graft procedures would be necessary. The option of breast lift must be considered if you are seeking a smaller or higher positioned areola, or tightening of the skin envelope.

Costs

Fees for Breast Augmentation at our Toronto Cosmetic Plastic Surgery office (including facility and anesthetist) range from $7-9,000, depending on the type of implant chosen and the extent of surgery that is necessary.

Preparation for surgery

We provide thorough written instructions on preparation, and will review these with you well before surgery. We provide a bra or compression garment for your use after surgery. This is a day surgery procedure performed under general anesthetic. You will need someone to help you get home, but there are no drains used and showers and dressings changes can begin within a few days.

The Operation

Breast Augmentation Operation 1

Implants may be placed partially under muscle. This helps to hide the rippled texture of even firm gel implants in patients who are very slim. Implants place over muscle are considered when there is an adequate (at least 1 cm thick) layer of padding under the skin to camouflage the implant, or if the patient is a high-demand athlete for whom muscle distortion will be a problem (e.g. body builders).

Breast Augmentation Operation 2

Short incisions are made through the skin to introduce the implant through the areola edge, axilla (armpit) or the fold under the breast.

Variations on Breast Augmentation

Breast asymmetry in which one breast is significantly smaller than the other is a special challenge in which we have great expertise. Tuberous breast deformity can also be improved greatly with breast augmentation combined with special maneuvers to allow the lower pole of the breast to expand.

Revision of Breast Augmentation

Common problems we are referred include capsular contracture, or if inadequate capsule is formed, rotating or shifting implants. Bottoming out, double-bubble, and symmastia are some of the problems we have been asked to treat. We do offer enbloc capsulectomy (with and without breast lift), and augmentation breast lift surgery.

Safety and Risks

Immediate risks from breast implant surgery are very unusual. Long term, implant deflation, hard capsule formation, or breast changes arising from weight-changes or pregnancy may require revision surgery. Breast Implant Illness is considered as a explanation in those rare cases in which people suffer symptoms that defy other explanation, and implant removal may be considered for lack of other options.Anaplastic Large Cell Lymphoma (ALCL) has become a concern in patients with textured implants who develop progressive breast enlargement from fluid accumulation (estimated risk is 1/3000 patients with textured implants).

Recovery process

Breast augmentation allows for an almost immediate return to daily activities, and light exercise can be resumed within two weeks. Chest exercise should be delayed for 6 weeks.

Results

Cosmetic results are evident immediately, although relatively large implants may cause skin tension that takes 6 weeks to relax.Axillary augmentation often results in high-positioned implants that require massage to achieve optimal position.

Bottom Line

We deliver superb results in a safe and supportive private surgical facility. Come in for a consultation, and you will leave wiser, and perhaps scheduled for a beautiful transformation.


FAQs

What are the advantages of a facelift compared to other procedures like fillers?

Facelifts and fillers should be seen as complimentary and not competitors, but it is essential that you get advice from a surgeon who can offer both options. Using fillers or non-surgical techniques when surgery is best will result in bad results and can put your health at risk.

Will facelifts get rid of wrinkles?

After a facelift, there should be a dramatic improvment in wrinkles in the cheek and neck areas, but wrinkles around the eyes and mouth may stand out more in comparison. Be sure to consider whether treatment of these features will be necessary to maintain harmony in your facial appearance.

Can a facelift cause nerve damage?

Facelift surgery can damage motor nerves creating temporary or permanent abnormalities in facial movement. It can also damage large sensory branches resulting in abnormal sensations or pain in areas of your face. An expert surgeon will minimize the risks of these occurences, but it's impossible to eliminate all risks. Every facelift (even every incision) involves small nerve branches being cut, and in some patients this can result in permanent symptoms.

How do you wash your hair after a facelift?

You can go in a shower the day after a facelift. It is best to have someone with you, and a chair or bench to sit on if you feel dizzy - we have known people to faint the first time they shower after surgery. Expect to have a little bleeding, but don't be alarmed. Use of an antibacterial agent like chlorhexidine as a shampoo is our recommendation until scabs along the incision lines are gone.

How do you sleep after a facelift?

We recommend a position with an elevated chest and head. A pile of pillows can be used if a lounge chair is not available. Sleeping with your neck alone flexed by a pillow is not helpful- both chest and head need to be elevated to encourage blood flow, avoid swelling, and minimize pressure and contamination along the incision lines.

Where are the scars from a facelift?

In the past, facelift scars were 'hidden' behind the hairline, but this resulted in the loss of hair-bearing scalp, and a deformity made even worse if the facelift was repeated. It is more common now for incisions to be designed to be hidden along the edge of the hairline and other natural features. The incision used is customized for each patient.


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