Breast augmentation is a surgical procedure where breast implants are inserted into the breasts, providing a fuller and more natural appearing breast. Breast augmentation can be performed in a variety of ways. The most common form of breast augmentation is with saline or silicone gel implants, which are placed under the muscle of the chest wall. Breast implants come in various shapes, sizes, and profiles to achieve different results for each patient.
Some patients may choose to have their surgery done through an incision made around the areola (periareolar), while others may prefer an incision along the natural crease underneath the breast (inframammary). A third option is an incision made in the armpit (transaxillary) that allows for increased visibility during surgery and less scarring afterward. Patients should discuss with their surgeon what type of implant they believe will work best for them before undergoing any procedures involving breast augmentation surgery.
Read on to learn more about Best Plastic Surgeon Toronto Breast Augmentation, Choosing your breast implants
Best Plastic Surgeon Toronto Breast Augmentation
It can be both exciting and intimidating to begin your search for the best plastic surgeon to perform your breast augmentation in Toronto. If you’re like many people, you may find it challenging to sift through or make sense of the wealth of information that’s available online today. With input about credentials, facilities, specializations, and more at play, how can you tell what really makes a surgeon the “best”?
Check Your Surgeon’s Credentials
For the sake of your safety and results, you should always work with a surgeon who is certified by the Royal College and who operates at an accredited facility. Royal College certification (or board certification in the U.S.) requires years of specialized, hands-on training in plastic surgery. It reflects a surgeon’s ability to uphold the highest standards of safety and skill in the operating room.
Memberships in professional societies, such as the Canadian Society of Plastic Surgeons, also reflect advanced experience and peer approval.
Browse Before-And-After Photos
Little speaks more to a surgeon’s abilities than before-and-after photos. As you vet potential surgeons, look through each one’s online gallery and check for natural-looking results, symmetry in the breasts, and sizing that flatters each woman’s body. Look for women whose body types are similar to yours and ask yourself whether their results align with your goals.
Read Real Patient Reviews
Reviews and testimonials from former patients will provide insight into what it’s really like to work with a surgeon. These reviews will give you information you won’t find elsewhere, including personal reflections about the experience and observations about the office, staff, and more. How happy are past patients with their results? What do patients have to say about the surgeon’s approach and personality? How did they feel during and after their visits?
Meet In Person
An in-person consultation will allow you to get a feel for the surgeon’s personality and the atmosphere of the practice. Feel free to ask your surgeon about his or her approach, experience, and vision for your potential procedure. Pay close attention to how well he or she listens to your concerns, provides thoughtful answers, and makes you feel understood and at ease.
Ultimately, the best surgeon for you will be the one who is not only highly qualified but is also supportive, compassionate, and excited about creating uniquely ideal results you’ll feel great about for years to come.
Choosing your breast implants
The sheer number of breast implant variations available to patients and surgeons can lead to confusion; however, careful measurement, proper analysis of your anatomy, and experienced decision-making can help our plastic surgeons give you the best breast enlargement possible.
Unfortunately, some surgical recommendations are made on the basis of marketing, surgeon habit, or profit, rather than careful listening to the patient’s goals and concerns. As leading Minnesota aesthetic plastic surgery providers, our American Board of Plastic Surgery-certified plastic surgeons and experienced nursing staff help patients choose their breast implants with the benefit of extensive expertise and over 50 years of combined experience with thousands of patients.
Since breast augmentation is performed so frequently at Minneapolis Plastic Surgery, Ltd., we maintain an extensive on-site inventory of breast implants in virtually every size and profile, in both two types of cohesive silicone, as well as saline. Your implants don’t have to be ordered in advance, you don’t have to worry about us having the “right ones” in surgery, and on-time delivery is not an issue—they are already here!
Minneapolis Plastic Surgery’s AAAASF-accredited surgical facility is one of the first in the country to offer a complete on-site stock of Allergan Natrelle Inspira (Responsive) cohesive silicone gel implants in all sizes and profiles. Natrelle Inspira Responsive (cohesivity type 1) are higher-fill implants designed to reduce visible implant rippling compared to the previous Allergan Natrelle silicone gel implants.
MPS now also offers a complete (all sizes and profiles) on-site consignment of Inspira Soft-Touch (cohesivity type 2) cohesive silicone gel implants with even more ripple resistance. In the unlikely event your anatomy requires the even-more crosslinked Inspira Cohesive implants (cohesivity type 3–identical to the style 410 cohesivity explained in more detail below), we can have multiple sizes and profiles of implants overnight express delivered to fulfill your requirements.
Types of Breast Implants
Breast implants come in numerous sizes (100cc – 800cc, or about 3 to 27 ounces each), shapes (round, oval, or teardrop “anatomic”), surface characteristics (smooth or textured), and fill material. Most breast implants are filled with saline or silicone gel, and occasionally other materials (though none of these “other materials” are FDA approved at the present time). Silicone gel implants presently come no larger than 800cc, but 800cc saline implants can be “overfilled” to volumes higher than this when requested in select patients.
Since the material inside breast implants is what gives them their “feel,” filler material choices have generated much controversy and media interest, not to mention scientific debate. We can provide both the science and years of expertise to help you determine whether saline or silicone is best for you.
Until March 9th, 2012, only two manufacturers produced breast implants FDA-approved for use in the United States (Mentor Corp., now part of Johnson and Johnson; and Inamed Corp., previously McGhan Medical, now owned by Allergan, Inc.). For the first time in 20 years in the United States, a third company (Sientra) has received FDA approval to sell their Silimed brand of silicone and saline implants, including textured anatomic silicone gel implants.
In the United States, besides the presently-available Mentor, Allergan, and now Silimed implants, several companies have produced investigational implants that are not yet FDA-approved and are implanted only by plastic surgeons associated with the FDA investigation/approval process.
Silicone or Saline? (How about fat?)
At Minneapolis Plastic Surgery we offer both saline and the latest cohesive silicone breast implants.
Saline identical to intravenous fluid was the most common type of breast implant filler material used in the United States from 1992 until November 2006, when the FDA re-approved the use of silicone gel-filled implants for primary elective breast augmentation. Prior to the 1992 FDA restrictions,and again after 2006, silicone gel implants are utilized in over 85 percent of all breast augmentation procedures in the United States, and remain the most commonly used breast implants worldwide.
Other types of filler material have been evaluated over the years prior to the introduction of silicone gel implants in 1963, and one or more problems are associated with these. Paraffin, sponges, and other unusual materials were used in early efforts to enlarge breasts; results were dismal until silicone came into use in the 1960s.
More recently, during the FDA restrictions from 1992-2006, soybean oil-filled implants were studied extensively, and were used in many patients in Europe, as well as a few U.S. patients in FDA studies. Breakdown of the oil, rancid smell, and other concerns ultimately led to withdrawal of this implant (Trilucent™) in the US and in Europe. Fat as implant fill material has the same concern, and is not used.
Fat graft injections of a patient’s own liposuction fat (directly into or beneath the breasts) have been performed by some physicians. Among other names, this has been termed “natural breast augmentation” since the surgeon uses the woman’s own fat tissue (and you have to pay for the liposuction used to obtain the fat)! The American College of Surgeons and the American Society of Plastic Surgeons have been cautious in endorsing breast augmentation via fat grafting because 30-50% of the transferred fat always dies, and can cause microcalcifications, scar tissue lumps, and/or oil cysts within the breast. These can be seen on mammography, and may confuse or obscure diagnosis of early or small breast malignancies.
However, smooth-shell silicone-gel-filled implants are even more homogeneous with breast tissue and provide the softest, most breast-like, and most natural “feel” of any implant. Since the newest generation of silicone gel implants is also cohesive, they cannot leak or deflate. While the vast majority of patients are again choosing silicone implants for their breast enhancement surgery, we believe that the best and most experienced breast surgeons offer their patients a choice of either silicone or saline breast implants. With careful evaluation of the patient’s individual requests and needs, and detailed discussion of the pros and cons of the two surface textures available, our ABPS-certified plastic surgeons can help you choose not only the implant but the location and proper profile for your anatomy.
One final consideration should be noted regarding textured implants (either saline or silicone)—in 2011, an unusual type of lymphoma (BIA-ALCL: Breast Implant Associated-Anaplastic Large Cell Lymphoma—a cancer of the immune system) was reported in small numbers of breast implant patients who developed symptoms including breast enlargement, pain, asymmetry, lump in the breast or armpit, overlying skin rash, hardening of the breast, or a large fluid collection typically developing at least more than one year after receiving an implant, and on average after 8 to 10 years. BIA-ALCL is a rare and highly treatable type of lymphoma that can develop around breast implants. BIA-ALCL occurs most frequently in patients who have breast implants with textured surfaces. This is a cancer of the immune system, not a type of breast cancer. The current lifetime risk of BIA-ALCL is estimated to be 1:3817 – 1:30,000 women with textured implants based upon current confirmed cases and textured implant sales data over the past two decades. When caught early, BIA-ALCL is usually curable.
BIA-ALCL has been found with both silicone and saline implants and both breast cancer reconstruction and cosmetic patients. To date, there are few confirmed BIA-ALCL cases that involve only a smooth implant. BIA-ALCL patients seem to have a reaction to textured devices over many years. Given this information, we are happy to report that the vast majority of MPS breast augmentation patients over the past two decades have received only smooth implants.
Teardrop (Anatomic) or Round?
Breast implants come in round or teardrop (“anatomic”) shapes. While some plastic surgeons prefer the teardrop-shaped implants in some situations, smooth round implants are generally the softest, most natural in appearance (upright and lying down), least likely to be felt externally, and (for saline implants) least likely to leak. Round, smooth implants also cost less than teardrop-shaped textured implants, yet are superior in most cases.
Teardrop-shaped implants must have proper positioning and must stay in that position (sloped part up, rounded part down) to take advantage of their innate shape. (Upside-down teardrop implants really would look weird.) They are textured so that the body’s tissues can adhere to and maintain the proper position of the implants. Thus, the teardrop or textured “anatomic” implants cannot move as the patient changes from a standing to a reclining position. Also, the teardrop implant remains teardrop-shaped when the patient is lying down, whereas the natural breast flattens out and assumes a round appearance. Tissue adherence makes initial positioning critical—textured implants do not settle or drop over time. Post-op tissue swelling and tightness diminish, giving a softer feel, but position (by definition) is determined by initial placement and adherence of the textured surface to the adjacent tissues. The smooth round implant does just what a natural breast does: it is teardrop-shaped when the patient is upright, and flattens and moves slightly to the side when the patient reclines. Thus, the round implant is actually more anatomically realistic than the teardrop, or so-called “anatomic implant.”
Loss of adherence with trauma or activity can allow rotation and distortion of appearance, and this is something noted only with shaped implants, since they are designed to remain in a given position. Loss of that intended positioning can be difficult to correct, as the adherence is now gone, and the implant can freely rotate in its pocket. Round implants do not have this rotational concern, since they look the same in any position. Textured implants should not be “massaged” post-op, as this can prevent adhesion.
Some implant manufacturers and plastic surgeons have suggested that the “anatomic” or teardrop- shaped breast implant has a more natural look than a round implant, and much advertising and marketing has been used to promote “anatomic” implants to the public. These implants are perfectly good devices, but are more expensive than smooth, round implants, and whether or not they are truly more “anatomic” is debatable (see above).
A recent study compared actual women with smooth, round implants to women with textured, teardrop- shaped implants. Mammograms were performed in upright and supine (laying-down) positions, and digital tracings computerized and compared. Both the round and teardrop-shaped implants had a sloped, teardrop shape when the women were upright. In fact, in upright patients, teardrop and round implants were indistinguishable on X-ray. But when a woman is laying down, the natural non-augmented breast flattens, drops slightly to the side of the chest, and assumes a round shape, as does the round smooth implant. The teardrop-shaped implant stays teardrop-shaped in the laying-down position, which makes this unusual appearance actually LESS anatomic or natural than the round implant! Still, in rare situations, the textured or teardrop-shaped implant may be an appropriate choice.
Moderate, moderate plus, or high profile? (or ultra high?)
Both saline and silicone gel breast implants come in three or four profiles: moderate “classic,” moderate plus, and high profile. For example, a 400cc (Mentor style 7000) moderate profile silicone gel implant has a base diameter of 14.5cm and a projection (height) of 3.2cm. The 400cc (Mentor style 1000) moderate plus profile silicone gel implant has a base diameter of 13.1cm and a projection of 4.0cm. The 400cc (Mentor style 4000) high profile silicone gel implant has a base diameter of 12.2cm and a projection of 5.0cm. Mentor also makes an ultra high profile (style 5000) implant with a base of 10.6cm and projection of 5.4cm for the 400cc size. Thus, various dimensions are available to help best match the desired size of implant to the patient’s breast dimensions.
Allergan Natrelle® implants also come in a total of four silicone gel profiles: moderate, moderate-plus, high, and extra-high profiles. To use similar examples, a 390cc (Natrelle style 10) moderate profile silicone gel implant has a base diameter of 13.6cm and projection (height) of 3.8cm. The 397cc (Natrelle style 15) moderate-plus profile silicone gel implant has a base diameter of 13.1cm and a projection of 4.2cm. The 400cc (Natrelle style 20) high profile silicone gel implant has a base diameter of 11.9cm and a projection of 5.0cm. As you can see by comparing these two manufacturers’ implant dimensions, near-equal volumes and profile implants from each company have nearly identical measurements. Allergan also makes an extra-high profile silicone gel implant (Natrelle style 45) with an 11.2cm base and 5.1cm projection for the 400cc size.’
The newest Allergan Natrelle® Inspira implants come in five profiles: low, low plus, moderate, full, and extra full. This allows even more surgical options for every woman’s anatomy and goals. Since Sientra implants also come in many different shapes and sizes, including smooth, textured, round, and teardrop-shaped styles, many more options exist for patient and surgeon choice.
At Minneapolis Plastic Surgery, Ltd. we first measure the patient’s breast dimensions, including base diameter, nipple to crease distance, nipple-to-nipple distance (cleavage diameter) and overall chest circumference, determine what final breast size she wants to achieve, and then see if a properly-chosen implant volume and profile can be surgically combined with her own breast tissues and skin brassiere to yield the desired results. Most of the time it can! In other cases, there , not to mention a very wide gap, unnatural-appearing cleavage.may need to be compromises to achieve a good result, or additional skin shaping and tailoring (via breast lift) may be necessary.
Any surgeon who consistently recommends high-profile implants, for example, “because I like the look of those the best” or “high profile gives more upper pole fullness” [false, BTW] is selling some of his or her patients short. A narrow-chest small-frame petite woman who wants large breasts (but has virtually no breast tissue of her own), may require high profile breast implants to achieve the look she wants. But a tall, wide-breast base, large frame woman who only wants a modest enlargement (or has a fair amount of her own breast tissue), will not be served well by high profile implants—she needs moderate profile implants to get as much base diameter as possible for the small(er) size she has selected, in order to accurately fill her own breast base. Otherwise, she would have a narrow-diameter implant “sliding around” in a large-diameter breast pocket, not to mention a very wide-gap, unnatural-appearing cleavage.
Patients are often told (by some plastic surgeons, and often in on-line forums) that “High profile implants give more upper pole fullness.” Until implants drop over the 6-12 months needed for complete healing and “final” gravity-settled position, this is indeed true. But since smooth round HP implants have narrow widths (and more projection), they also have a less-tall height (vertical diameter) that leads to LESS upper pole fullness when the implants reach their proper position at the creases. Choose the widest (vertically tallest) implant profile that fits the breast base diameter for the most upper pole fullness.
Thus, implant profile is based on each individual patient’s anatomy, pre-operative breast measurements, and requests, not on a particular surgeon’s “habit” or “routine.” We believe it is not the surgeon’s job to decide what a patient should have, and certainly not to “routinely” use only one of the 5 available profiles, but rather to listen to the patient’s requests, examine and carefully measure the patient’s individual anatomy, and then use our experience and expertise to determine how to best achieve her goals, or at least come as close as the anatomy and details allow. One profile does NOT fit all, and the widest profile that “fits” your breast base will give the closest cleavage!
Risks Of BreastAugmentation
When carried out by an expert plastic surgeon, breast augmentation is a very safe procedure with minimal risk of complications. Any type of surgery carries certain risks, and breast augmentation is no different. Your surgeon will discuss the risks and potential complications of breast augmentation at your consultation. This will allow you to weigh up the pros and cons of the procedure before making your decision.
Some of the risks of breast augmentation include (but are not limited to):
Anaesthesia-related complications such as anaphylaxis
Excessive bleeding
Wound infection
Post-operative haematoma formation
Seromas
Implant malposition
Change in nipple sensitivity
Capsular contracture – formation of excessive scar tissue around the implant
Implant rupture
Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL)
Excessive pain that does not improve over the first two weeks
Need for revision surgery
It is essential to bear in mind that many of these risks are very rare. In contrast, others, such as haematoma formation, can be easily managed by a washout procedure with the preservation of the breast implant.
Breast augmentation risks
Breast implants must be approved by the medicines and healthcare products regulatory agency (MHRA) before they are suitable for use in the UK. We also use FDA-approved implants. This means the implants have been shown to be safe and effective. The vast majority of breast augmentation patients do not develop serious complications during or after their procedure.
Several key risks should be borne in mind when considering breast augmentation. Breast implant-associated anaplastic large cell lymphoma is a severe complication of breast augmentation. However, it is extremely rare, with only a handful of cases reported worldwide out of millions of procedures performed. Breast implant illness is a condition some patients believe is due to breast implants. Patients may complain of the following symptoms:
Excessive fatigue
Generalised muscle and joint pains
Skin rashes
Cognitive impairment or ‘brain fog.’
If complications occur after breast augmentation, we would advise you to get in touch with our post-operative nursing team immediately. The next step would be to have an urgent clinical assessment by your surgeon. If you decide to have breast implant removal, we recommend discussing this with your surgeon.
Key points about breast augmentation:
Breast implants are not designed to last for your entire lifetime. It is recommended to have revision breast surgery to remove or replace one, or both breast implants 10 to 15 years after your first procedure.
The appearance of breast implants can change over time due to the influence of significant weight loss, pregnancy or menopause.
Excessively large breast implants could exacerbate breast sagging. A breast lift may be required in combination with breast augmentation to treat saggy breasts.
X-ray mammograms can be more challenging to interpret in the presence of breast implants. However, x-ray technology has significantly improved over the last ten years, making this less of a problem.
We would advise regular checks to monitor for breast implant rupture. Centre for Surgery is one of the few clinics to offer complimentary high-resolution ultrasound scans to monitor the condition of your silicone breast implants. If a potential rupture is detected, we advise having an MRI scan to confirm the diagnosis.
Breastfeeding can, in some cases, be affected by breast augmentation. Although many women can breastfeed normally after surgery, other women may find it more difficult.
Women who have breast augmentation will require regular post-operative reviews to monitor the condition of the breasts and ensure capsular contracture or implant rupture has not occurred.
If you think your breasts or implants appear different in some way after the surgery and/or you have symptoms of pain and discomfort, please get in touch with us to arrange a consultation with your surgeon for further evaluation.
Am I suitable for breast augmentation?
We would recommend women be familiar with the potential risks of breast augmentation before considering their suitability for the procedure:
Patients should be in good physical and mental health with no chronic medical conditions or active bacterial infection. If you have a significant medical condition, discussing this with your doctor at the consultation is essential to determine if any further investigations will be required to confirm your suitability for the procedure.
Patients with a flat chest or have saggy or tubular breasts are ideal candidates for breast enlargement surgery.
We recommend patients stop smoking and avoid excessive amounts of alcohol for at least six weeks before and after the procedure.
The procedure is designed to significantly improve the appearance of your chest for permanent results. Therefore, we recommend being in optimum mental health to embrace the changes after the procedure.
Breast augmentation is not designed to address body image problems such as body dysmorphic disorder or to make you look like a completely different person. It is vital to have realistic expectations about what the surgery can achieve.
It is essential to follow the post-operative instructions in full. Taking at least one week off work to allow breast augmentation recovery will help ensure your healing is as smooth as possible. You should avoid lifting heavy objects and have someone around you to help with everyday tasks.
What happens at the consultation?
The breast augmentation consultation is an ideal opportunity to enquire further about the risks of breast implants. Your surgeon will ask the following questions as part of the clinical assessment:
Your reasons for wanting the procedure and your treatment expectations
Any medical conditions you may have and potential allergies to medicines
What medicines you are currently taking, including any over-the-counter herbal supplements
Whether you have a personal or family history of breast cancer
What does the procedure involve?
Breast augmentation is most commonly carried out under a general anaesthetic to ensure your comfort during and after the procedure. There are three main types of breast augmentation incisions which can be used for breast implant placement, including:
Incisions under the breast crease (inframammary)
Incisions around the nipple (periareolar)
Incisions under the arm (transaxillary)
Once the incision has been made, the surgeon will gently separate the overlying breast tissue from the pectoralis muscle. This leads to creating a breast pocket positioned either on top of the chest muscle or beneath it. The surgeon will then place the implant in the pocket and ensure the implant is correctly centred behind the nipple to prevent implant malposition. The implants are inserted using a breast funnel as part of a ‘no-touch’ technique to minimise implant-related infection. Once the implants are correctly positioned, the incisions will be closed with dissolvable stitches, followed by applying sterile dressings. A post-operative support bra will be applied before the anaesthetist wakes you up. It is normal to have localised swelling and mild post-operative discomfort for up to 2 weeks after the procedure. Any breast augmentation scars will gradually become less noticeable over time, although they will not disappear completely.
If you develop pain, redness or localised warmth around your incisions or you generally feel unwell, we would advise seeking an urgent clinical assessment from your surgeon as these symptoms could be signs of infection.