Breast Enhancement

The decision to have breast enhancement surgery is an intensely personal one. Not everyone will understand your reasons for choosing to undergo an elective procedure of this nature. Some patients are seeking relief from the physical discomfort of large heavy breasts. Others are seeking to restore the appearance of the breasts after pregnancy, disease or weight loss. Young women may feel embarrassed by the size or shape of their breasts, or by discrepancy in breast size. Whatever the reasons for considering this type of surgery, you need to have a clear understanding of what you want to achieve with the surgery and be realistic in your expectations. Remember, the most important reason to do a procedure is to make you feel better about yourself.

Breast Procedures

Breast Augmentation
Breast Lift
Breast Reduction
Male Breast Correction
Saline vs.Silcone

Bilateral Augmentation Mammoplasty

Breast augmentation or augmentation mammoplasty, is a surgical procedure to increase the size of the breasts by insertion of an implant or prostheses behind the breast.   The implant may be placed either directly behind the breast (subglandular) or underneath the breast and the pectoralis major chest wall muscle (submuscular).   At the time of your consultation, your doctor will discuss with you, which is the appropriate placement for you.

Reasons for Breast Augmentation

Most commonly, breast augmentation is done to increase the size of the breast.   This may be desired for women who have never developed what they feel is an adequate size of breast, or to restore the volume of the breast after weight loss, pregnancy, and/or breast-feeding.   Augmentation of the breast can be done to one side only, in order to correct asymmetry or unevenness of the breasts.   The appropriately selected breast implant can make the breast appear to have a nicer contour, or look less "saggy". Some times the breast has an abnormal shape. With a very large nipple, and a very small breast.   This deformity is called a "tuberous breast" and there can be dramatic improvement in appearance by doing a breast augmentation.   Some time a breast augmentation can camouflage deformities of the rib cage, or breastbone.

In Canada today, there is a wide choice of implants available.   Saline filled or "salt water" implants are a silicone envelope that is filled by the surgeon with IV fluid normal saline after it is inserted into the pocket or space created at the time of surgery.   These implants are readily available to the surgeon and have been used for many years with excellent results in many patients

Some patients, however, will benefit from the use of silicone implants.   The silicone implants used today are called "cohesive", meaning that the silicone gel used to fill the implant tends to stay together, much like a gummy bear, even if the envelope becomes disrupted over time.   Patients who are very thin, or who need some correction in the shape of the breast may be candidates for silicone implants.   This will be discussed with you at the time of your consultation.

For more information, go to Saline vs. Silicone

Any surgery that requires an incision leaves a permanent scar.   The goal of plastic surgery is to keep these scars to a minimum.   The incisions used for breast augmentation can be placed in the crease or fold underneath the breast, in the lower half of the colored skin around the nipple (the areola), or in the armpit (axillary approach).   The size of the incision varies, depending on the type and size of implant used (smaller for saline implants which are inserted mostly empty) and the patient's physique.

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Mastopexy or Breast Lift

TempPic1Many women may request improvement in the shape or contour of the breast.   This may be due to the effects of pregnancy, nursing, weight loss or gravity.   For some women, the breast has never developed with an attractive shape.   Others have a large nipple that they feel is disproportionate. A breast lift or mastopexy is a surgical procedure that can lift and/or reshape the breasts.   At the same time, the size of the nipple skin (the areola) can be reduced.   This procedure may be combined with the insertion of an implant to restore lost volume to the breast. Because this operation involves the removal skin there will be scars as a result of this operation. Depending on the amount of skin to be removed, and whether or not an implant is being used, scars and techniques will vary. Your surgeon will discuss this with you at the time of the consultation.

Preparing for Surgery

Instructions will be provided to you with regards to preparing for surgery. If you are taking any medications, please bring this to the doctor's attention at the time of the consultation. Many herbal preparations may interfere with clotting, and these need to be discontinues prior to surgery. Depending on your age and family history, a mammogram may be required prior to the surgery. You will have pre-operative blood work done, and patients over forty are required to have an EKG.

Most of the time the surgery is done on an outpatient basis. If you are from a long distance, or are having any other procedures done you may be kept over night. This should be discussed with your surgeon.

Most commonly the operation is done under a general anesthetic, or local anesthetic with sedation. Either way you will not be able to drive yourself home. Recovery is a gradual process and you will need to plan to take one to two weeks off work. If your job is very physical, you may require a longer time off work. You should not make any travel arrangements for at least a month after surgery.

After Surgery

After surgery, you will have either a tape dressing or a surgical bra and gauze dressing.   There may be some small tubes inserted into the breast at the time of surgery to take away any build up of blood or fluid.   These are usually removed the day after surgery.  

A bra with dressings inside is worn night and day for the first 2 - 3 weeks.   There is a considerable amount of swelling and some bruising after surgery and it takes time for the shape to "settle".   Some techniques of breast surgery are designed to have shorter scars and this may mean that there is some gathering or puckering along the incision line, which can take several weeks to smoothen out.   The quality of the scars will improve over a period of several months,

Potential Complications

As with any surgical procedure, there is a may be localized collection of blood (hematoma) or build up of fluid in the area of surgery.   Infection is very unlikely but can occur.   There may be problems with the wound healing, although if you are a non-smoker, this is not very likely.   Decreased sensitivity of the nipple can occur, but is usually temporary.   Occasionally, patients will develop a thick ropey scar that may need some special care.   There is no increased incidence of breast cancer after breast surgery.   Should you have another pregnancy, you would likely be able to breast feed although the benefits of the procedure may be lost.

The information contained in this brochure is background information to help you prepare for your consultation with a surgeon.   Because of individual variations, some of the information given to you at the time your consultation may differ from what is provided here and your doctor's information should be considered more correct.   There is an inherent risk with any surgical procedure, and the result of any surgical procedure cannot be guaranteed.

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Breast Reduction

Women with very large heavy breasts often experience medical problems related to the size and weight of their breasts. These problems include back and shoulder pain, rashes underneath or between the breasts and painful depressions across the shoulder from the brassiere straps cutting in. A surgical procedure known as a breast reduction or reduction mammoplasty can alleviate many of these problems and at the same time improve the size and the appearance of the breast. In most cases where the breasts are large, there is also some degree of ptosis or droopiness of the breasts. This is also corrected at the same time. This operation is designed to remove breast tissue and excess skin and elevate the nipple complex to an appropriate position, but leaves no scars above the nipple itself.

If the breast size is appropriate for an individuals height and weight, but the breasts have become loose and fallen, an operation known as mastopexy or breast tightening can be done to improve the shape and appearance of the breast.

Because of the problems large breasts can cause the breast reduction is usually covered by the provincial health insurance plans. Thus, these procedures are done in a public hospital.
Breast tightening, or mastopexy is considered cosmetic and would be done at the Cosmetic Surgery Hospital.

Thousands of breast surgeries are performed successfully each year. Nevertheless, post operative complications such as infection or a localized collection of blood ( hematoma) can occur, although rarely. To decrease the risk of a hematoma vitamin E and aspirin containing drugs should be discontinued at least three weeks before and after surgery.

Most women have some degree of difference between the breasts prior to surgery and they are often unaware of it. Asymmetry, or both breasts not appearing alike, can occur after the surgery despite all the measures that are taken before and during surgery to prevent this. A second minor surgery can easily correct any significant occurrence. Poor healing may necessitate subsequent scar revision. Smokers should be aware that nicotine could delay healing.

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Male Breast Correction (Gynaecomastia)

Details coming soon.





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Silicone vs. Saline Implants

In the last decade and a half, there has been much controversy of the use of silicone breast implants. This lead to the withdrawal of silicone breast implants from Canada because of possible health risks attributed to the implants, or more specifically the silicone gel used to fill the implants. After conducting extensive studies, both in North America and abroad, no association has been found between breast implants and any known disease. In Canada today, there is a wide choice of implants available.   Saline filled or "salt water" implants are a silicone envelope that is filled by the surgeon with IV fluid normal saline after it is inserted into the pocket or space created at the time of surgery.   These implants are readily available to the surgeon and have been used for many years with excellent results in many patients.

Saline implants will give a rounded look to the breast and are a good choice when the breast is already well shaped but lacks volume.   Because the saline implants are put in essentially empty, a smaller incision can be used that with the gel implants.    If the breast tissue is very thin, the irregularities in the implant will show up as rippling underneath the skin and breast tissue.   This is a reason to consider placing the implant underneath the pectoralis major muscle.   Even then, rippling can still be an issue for some individuals.   Saline implants feel much less natural.   Silicone gel implants (also known as cohesive gel or simply as gels) feel much more natural and have a smoother contour than saline implants.   In addition, cohesive gel can re-shape the breast and make it appear much more lifted than the round implants can.  

Patients need to be aware that any implant can fail with time.   There are few products that are manufactured that we use twenty four hours a day, seven days a week, year in and year out that we do not expect to repair or replace with time.   Rupture rates vary with different implants and this can be a factor in your choice of implants.   With saline implants, since the filling material is salt water, it will be absorbed away into your system, and the breast will appear much flatter.   Ideally, the implant should be replaced relatively soon after deflation so that he space created for the implant does not shrink down too much in size.

With the new cohesive gel implants, it is very difficult to detect a break in the envelope or shell of the implant.   If there is a break, the filling material clings to itself, although there might be microscopic shedding of some silicone molecules.   It is felt that because the filling material is more firm than the older implants, and the envelope stronger, there is less wear and tear on the envelope.   As time goes by we hope to see a far lower rupture rate with the cohesive gels.   Magnetic Resonance Imaging (MRI) is the most accurate way to detect a rupture, but it is very expensive and hard to get.   Therefore, consideration should be given to routine replacement of silicone gel implants.

Cost may also be a consideration in the selection of implants.   Silicone gel implants are more expensive, and this is why most surgeons charge more for performing a breast augmentation with silicone gel implants.

All implants come with some kind of guarantee by the manufacturers.   These vary according the the manufacturer.   With some an "extended warranty is available.   This can be discussed with your surgeon at the time of your consultation.

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