Are you interested in Breast Augmentation? Toronto plastic surgeons agree that breast implants are among the most popular procedures performed. Patients are almost always thrilled with the results, but when a Breast Augmentation is done poorly, it can be a very difficult experience. It is absolutely crucial to choose a board-certified plastic surgeon with proper training credentials and experience. This is not a cookie cutter operation. Breast implant surgery should be thought of as a process to match a patient with the appropriate implant type, size, and surgical approach, based on her wishes and anatomical findings. Dr. Lawrence Tong can guide you through the process of making your decision.
What a Breast Augmentation Does
Breast Augmentation will help you attain a fuller breast size and more pleasing breast shape. It can be used to improve unevenness, and also provide a small amount of lift. Breast implant surgery is accomplished by placing a breast implant underneath the soft tissues of the chest (most commonly under the muscle). The implant may either be filled with silicone or saline.
Who is a Candidate for Breast Implants?
You could benefit from Breast Augmentation if:
- You desire a larger breast size
- You want to fill out a bikini or swimsuit
- You have uneven breast sizes
- You have lost cup size because of pregnancy, breast feeding, weight loss, or aging
- You have a slight amount of breast drooping with volume loss.
Other Criteria for Candidates:
- Patients should be generally fit and relatively healthy— Dr. Tong always makes an assessment of your general health and suitability before undergoing any type of surgery.
- Smokers should quit smoking at least 2 weeks prior to surgery
- Patients who are breast feeding should wait 4-8 weeks after finishing breast feeding before having surgery so that the true breast size can be determined
- A patient should have realistic expectations about what can be accomplished though Breast Augmentation
Saline vs. Silicone Breast Implants
Breast implants come in two varieties: silicone and saline.
Saline breast implants are filled with IV fluid. They require a smaller incision for placement and are less expensive. They tend to feel slightly less natural than silicone breast implants and may not be appropriate for very thin patients due to a higher risk of rippling. Silicone breast implants are filled with silicone gel. They feel the most natural and are appropriate for patients who want the least risk of rippling. They are more expensive than saline implants and require a slightly longer incision for placement.
Each type of implant has its own advantages over the other, summarized below. Your choice of implant type may be influenced by these differences; you may also have other personal factors that lead you to your decision. During your consultation, Dr. Tong will do a thorough evaluation and make suggestions to help guide you through the process.
Regardless of which type of implant you choose, patients should understand that breast implants may deflate in the long term. The deflation risk is estimated at 1% per year they have been placed, and most patients have an average implant ‘lifespan’ of 10-20 years. Dr. Tong discusses the details regarding these possibilities at the time of consultation.
Summary of the Differences Between Saline and Silicone
Risk of 'ripping'
Higher, especially in thin patients
Shorter (approx. 3 cm)
Longer (approx. 5cm)
Costs less than silicone
Costs slightly more than saline implants
Soft, but not ‘flesh like’
Soft and ‘flesh like’
Average implant lifespan
10-15 years (replacement covered by warranty)
10-15 years (replacement covered by warranty)
The two major manufacturers of breast implants are Allergan and Mentor. Both companies offer excellent and comparable product lines. Dr. Tong believes that both product lines are more or less identical in nature, and he is happy to use either for your breast surgery.
Gummy Bear Breast Implants
Within the silicone implant category, there are two types of implants: moderately cohesive and highly cohesive silicone gel implants. The highly cohesive gel implants are the newest variety. The silicone inside a highly cohesive implant does not flow or leak, even when the implant shell is compromised. This implant has been termed the ‘gummy bear’ implant in the media.
Due to its firmer consistency and ability to hold shape, the gummy bear implants are manufactured as a ‘teardrop’ shape (which is not possible with regular silicone implants). The gummy bear implant is slightly firmer and moves less naturally when compared to a regular silicone implant. The gummy bear implants are slightly more expensive than regular silicone implants.
In December 2011, Allergan introduced a new type of gummy bear implant which has some new features. Most notably, the new Allergan Inpsira™ line of highly cohesive gel implants features implants that have a smooth shell surface. The smooth surface provides a much more mobile augmented breast when compared to the current gummy bear implants. Another significant difference is that the smooth gummy bear only comes in a round shape. Both the newer and current gummy bear implants have certain advantages and disadvantages: the current gummy bear implants have a slightly more natural teardrop shape but less mobility, the newer gummy bear implants move much more naturally but have a slightly more rounded look. Both are good options for breast augmentation because the concerns about silicone leakage are significantly reduced.
Determining which type is better for you depends on a number of factors which Dr. Tong will evaluate and go over, so that you can make an educated choice about silicone breast implants.
Should My Implant Be Placed Over or Under the Muscle?
In the majority of cases, Dr. Tong will recommend breast implant placement underneath the muscle (submuscular).
The benefits of going under the muscle include:
- A more natural look and feel
- Less risk of capsular contracture (implants becoming firm from scar tissue)
- A better mammogram image can be obtained
- The muscle can deter the drooping process because it ‘holds’ the implant in place, preventing some of the weighing down effect on the skin
Placing the implant over the muscle is termed a subglandular placement, and it sits between the breast and muscle. In some cases, going over the muscle is recommended, such as with female body builders.
How to Choose a Breast Implant Size
During your consultation, Dr. Tong will find out about your goals, take anatomical measurements of your chest, and establish a range of implants from which you can choose. Choosing a breast implant size is a very personal decision. The process starts with you. Think about what you hope to achieve with Breast Augmentation. Collect photos that you would like to emulate and bring them to your consultation. This will give Dr. Tong a good idea of what you want to attain from Breast Augmentation.
Additionally, by viewing our Breast Augmentation before and after photographs, and trialing implant sizers in the office, Dr. Tong will help you select your ‘perfect’ breast implant size. This tried and true method has worked tremendously well during Dr. Tong’s years of cosmetic surgery practice in the United States.
Breast Implant Incisions
Any surgical procedure will leave some type of scar. A plastic surgeon specializes in obtaining the least visible scars and putting them in the least visible places.
The most common Breast Augmentation incision is in the breast fold (the inframammary incision). It hides extremely well and generally heals beautifully. Wearing any type of clothing will cover it. In the nude, the scar may be slightly visible when a patient lifts the breast upward.
Other options for Breast Augmentation incisions:
- Transaxillary: through the armpit
- Periareolar: at the edge of the areola (the darker skin around the nipple)
- If a Breast Lift is performed simultaneously with Breast Augmentation, no additional incisions are required aside from the Breast Lift incisions
These incisions all work tremendously well in the right patient, and Dr. Tong will discuss all incision options thoroughly with you.
Details of the Breast Augmentation Procedure
Breast implant surgery is performed under deep IV sedation or general anesthesia. You are asleep and totally unaware of your surroundings during the procedure. The surgery is performed at Dr. Tong’s private practice facility, at 199 Avenue Road in downtown Toronto.
First, an incision made at the pre-determined incision site, either in the breast fold, armpit, or at the edge of the nipple/areola complex. Dr. Tong surgically creates a space (the implant pocket, usually under the chest muscle (submuscular), or sometimes over the chest muscle (subglandular). He inserts the implant into the pocket through the incision. After insertion, the bed is positioned so that you sitting upright (while you are still asleep). This allows Dr. Tong to judge the implant position and size in the most precise manner. Dr. Tong will make adjustments as needed to obtain the optimal appearance for you. He places a few stitches to close the incision and the anesthetist will gently wake you up from anesthesia.
Recovery from Breast Augmentation
Immediately following your breast implant surgery, our registered nurses will monitor you in the recovery area, as the residual effects of anesthesia wear off. Once completely worn off, Dr. Tong will allow you to go home accompanied by a friend or family member.
We encourage you to relax once at home. You may do non-strenuous activities such as reading, watching television, and making small meals, but nothing that is more physical. Your diet will consist of clear fluids initially, progressing to a regular diet over the next 24-48 hours. Expect to feel tight and sore in the chest for 1-2 weeks; your pain medication will help with the discomfort during this time. Most patients return to (non-strenuous) work in 5-7 days.
Dr. Tong will see you one week after surgery to remove stitches and to assess how you are progressing. He will teach you breast implant massage exercises at that time. Patients are usually allowed to start light exercise (e.g. walking) at 1-2 weeks after surgery. Strenuous activity (weight lifting, aerobics, jogging, yoga, pilates, martial arts) may generally be started at 4-6 weeks after surgery. Dr. Tong will inform you of activity restrictions as you progress. Subsequent visits to monitor your progress will occur at 6 weeks and 6 months after surgery, at which time post-op photos will also be taken.
In the beginning, your breasts will look ‘high’ or ‘artificial’ and feel tight. This is entirely normal, and it takes between 3-6 months for them to fully settle. As the settling occurs, you will gradually notice that the breasts take on a much more natural look, shape, and position.
Risks and Complications of Breast Augmentation
As with any surgery, there are risks involved with having Breast Augmentation. Although the procedure has a low risk profile, Dr. Tong will make sure to go over the pertinent potential problems associated with Breast Augmentation at the time of your consultation.
Get Educated about Breast Augmentation
There is a lot of information to digest during your Breast Augmentation consultation and Dr. Tong will make sure that you are informed at every step. The initial consultation may take over one hour to complete. You will never be rushed. We feel that the better-educated patient will make better choices about their surgery and their surgeon.
To learn more about how Toronto Breast Augmentation surgeon Dr. Lawrence Tong can help you with your Breast Augmentation goals, set up a consultation with Dr. Tong by giving us a call at (416) 972-0999. Alternatively, let us give you a call; just fill out our contact form and we will contact you on the same or the next business day. No physician referral is needed.
See Dr. Tong’s work in our Breast Augmentation photo gallery.
Breast Augmentation at a Glance
- Over dissection of pocket leading to ‘bottoming out’ or ‘lateral drift"
- Inappropriate implant size selection