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Introduction

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 Can a Breast Augmentation Accomplish?

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.
  • You wish to incorporate Breast Augmentation into a comprehensive Mommy Makeover

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

Breast Lift with Implants

If you wish to achieve a larger breast size in conjunction with a greater degree of projection and more rejuvenated breast shape, you may benefit from a comprehensive Breast Augmentation with Lift procedure—commonly referred to as a Breast Lift with Implants. For the right candidate, a Breast Augmentation with Lift can yield the benefits of both breast surgeries in one all-encompassing procedure, increasing breast volume while lifting the breasts to a more youthful position on the chest wall. This is done to reshape the breasts and minimize the appearance of sag for an improved breast contour overall.

After listening to your aesthetic goals, Dr. Tong can help you determine whether a Breast Lift with Implants is the best procedure to attain your desired look.

Saline vs. Silicone Implants

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.
Saline Silicone
Risk of 'ripping'
Higher, especially in thin patients
Very low
Incision length
Shorter (approx. 3 cm)
Longer (approx. 5cm)
Cost
Costs less than silicone
Costs slightly more than saline implants
Feel
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 Natrelle INSPIRA® highly cohesive gel implants 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 photos, 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.

What are the Different Implant Shapes?

Breast implants are available in either a round or form-stable (teardrop) shape. The shape of an implant will affect the way your breasts look as the body naturally moves, with each shape offering a different aesthetic based on the position of your body (upright vs. lying down). While most of the volume in a form-stable implant is at the base, the volume in a round implant is evenly distributed top to bottom. As a result, round implants typically provide a bustier look in the upper breast and behave similarly to a natural breast when lying down—the implant flattens just as natural breast tissue would. In contrast, form-stable implants are firmer to the touch and keep their teardrop shape even while lying flat. In Dr. Tong’s experience, form-stable implants can be an excellent choice for patients who have a relatively small breast size to begin with, due to the subtle enhancement provided by the teardrop shape. However, both shapes can achieve a natural-looking appearance when placed by an experienced plastic surgeon.

Recently, there has been an association found between textured breast implants and a rare form of lymphoma (BIA-ALCL) that occurs around the breast implant. The disease is rare and only associated with textured implants. Smooth implants do not appear to be at risk for development of this type of cancer. The association of BIA-ALCL with textured implants has led to the decision that Dr. Tong will no longer recommend textured implants at this time. This includes teardrop- and anatomic-shaped implants, which all have textured outer surfaces.

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.

How is the Breast Augmentation Procedure Performed?

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.

What is Recovery from Breast Augmentation Like?

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.

In general, the most common breast implant complications include implant rippling, capsular contracture, and implant rupture.

Implant Rippling

The risk of implant rippling, which means the edges of the implant can be seen through the skin, is often minimized by placing the implant under the chest muscle. Using a silicone implant helps to decrease the risk of rippling as its physical characteristics lower the likelihood of visible implant edges when compared to a saline implant. Additionally, choosing an appropriate-sized implant for the existing skin envelope (i.e. not too large) will decrease stretching of the soft tissues that can contribute to rippling. Surgery may be an option if rippling occurs, as long as it’s possible for the implant to be placed under the muscle. Alternatively, a saline implant can be exchanged for a silicone implant if desired.

Malposition

Malposition refers to when one or both breast implants are not in the correct position. This occurs most commonly as the implants are settling, during the postoperative period. The causes may involve asymmetry in how the breast pockets were created, lax tissues in the chest area, or the possibility of the implants being too large for the existing anatomy. In general, malposition is corrected surgically—after the implants have settled in their final position. Malpositioned implants may be too high/low/lateral/medial on one side or even both sides. The strategy for correction depends on which type of malposition exists, but usually involves adjusting the implant pocket to reposition the implant in a more suitable location and in a manner that minimizes the likelihood of the problem repeating.

Capsular Contracture

The formation of scar tissue around an implant, termed capsular contracture, is less likely with under-the-muscle placement when compared to insertion over the muscle. Using an incision in the breast fold also decreases the risk of capsular contracture when compared to a periareolar (“nipple”) incision. If capsular contracture is significant, it may cause asymmetry, firmness, or even discomfort. The correction requires surgery to remove scar tissue. The implant is also usually replaced.

Asymmetry

Asymmetry occurs when the breasts are uneven due to their size, shape, or their position. Asymmetry  caused by positioning issues has been described in the previous section on malposition, and asymmetry caused by capsular contracture has also been discussed. Size asymmetry may occur if a patient’s natural breasts are different sizes originally, or if the chest wall is uneven between both sides. Surgeons will usually use different sized implants to correct the asymmetry if the initial difference is significant.  Using different sized implants is typically successful, but in some cases, the difference cannot be adequately corrected due to the marked difference between each chest wall, and/or tissue quantity and quality. Shape asymmetry is usually caused by differences in the distribution, amount, or quantity of breast tissue itself. In cases wherein the initial differences are significant, the surgeon may recommend a breast lift and/or reduction procedure at the time of breast implant placement. In all cases of breast asymmetry following augmentation, the general strategy consists of allowing the implants to settle and the tissues to heal, followed by the surgical correction of asymmetry through a combination of implant repositioning, replacement, lifting, reduction, or removal of scar tissue, as deemed appropriate by the surgeon.  

Implant Rupture

Implant rupture—wherein the implant suffers a leak or break—is typically a long-term issue. An implant is a non-living device, and it does not have the capacity to heal or regenerate. Just like any other implant placed in humans (e.g. artificial hip joint, heart valve), there is a finite lifespan to an implant. As microscopic wear and tear occur over the years, a small break can occur in the implant shell. If the implant is saline-filled, the saltwater will leak out and be absorbed by the body. With the newest generation of silicone implants—highly cohesive gel implants—the silicone acts more like a solid than a liquid. These gummy bear implants have the least likelihood of leakage between all existing implants. Monitoring of silicone breast implant rupture consists of radiological (MRI) imaging to check the condition of the implant. If an implant is suspected to be ruptured, surgical removal and replacement (if desired) is the usual course of action.

Dr. Tong will discuss how to reduce the risk of breast implant complications during your consultation. In the event that problems do arise—or if you have had surgery done elsewhere—implant rippling, implant rupture, asymmetry, malposition, and capsular contracture can all be resolved with Breast Revision Surgery.

Can I Breastfeed With Breast Implants?

Breastfeeding after you have had Breast Augmentation is certainly possible. Although there are risks associated with the surgery that may alter your ability to breastfeed, Dr. Tong is able to perform the surgery using techniques that maximally preserve the potential for nursing. If you have breastfed in the past, it is very likely you will retain nursing function after Breast Augmentation when these techniques are utilized. Depending on your anatomy and desired result, alteration of the technique may or may not be required. As an example, placing the implant through the breast fold incision (inframammary approach) would be recommended, while an areolar incision would NOT be recommended. Placing the implant under the muscle would also be beneficial, as would choosing an implant that does not significantly exceed your breasts’ base width. If you have never attempted breastfeeding and have future plans to breastfeed, it is important that you communicate your desires to Dr. Tong before surgery so that he can utilize the optimal techniques.

Breast Augmentation and Pregnancy

On a related note to breastfeeding, it is important to understand that pregnancy can potentially impact the appearance of the breasts. These changes can occur whether or not you have undergone breast augmentation. The physical changes caused by pregnancy and breastfeeding include increased skin laxity, sagging, and a decrease in breast volume. If you have breast implants, these changes can alter the results of the procedure and compromise your breast aesthetic. For this reason, the timing of potential pregnancy should be taken into account when deciding to undergo breast augmentation. If you anticipate becoming pregnant in the near future, Dr. Tong recommends you consider postponing your surgical plans until after childbearing. ‘In the near future’ is a relative term that each patient will need to decide for themselves. A young woman who has no plans for pregnancy in the near future may decide to undergo surgery now, while a patient who is planning pregnancy in the next year may decide to wait until all childbearing is complete.

Not all women who become pregnant after breast augmentation will have alterations to the appearance. In fact, most patients who have previously undergone breast augmentation do not need further surgery. In cases where augmented breasts do change noticeably after pregnancy, plastic surgery can correct the changes. Procedures include replacing the implant with a different size and/or performing a breast lift. Although the timing may not work for younger patients, postponing surgery until after childbearing would be the best strategy to avoid the need for subsequent procedures.

Are Breast Augmentation Scars Noticeable?

While any type of surgery will likely leave some type of scar, Dr. Tong takes extra care to place the incisions for Breast Augmentation in discreet locations for inconspicuous post-surgical scarring. The typical incision sites for the procedure exist either along the breast fold (inframammary incision), around the areola (periareolar incision), or within a fold of the underarm (transaxillary incision). All three of the incision sites used for Breast Augmentation are purposely placed within the natural contours of the breasts, and most patients report that scars are virtually undetectable or well-hidden under a bra or bikini once healing is complete.

All scars will go through phases of maturation after surgery. In the initial few weeks, the incision line may not be noticeable at all because little scar tissue has developed. Over the next several months, the scar may actually become more pink, raised, and even slightly firmer. This stage represents the phase wherein the body is laying down scar tissue to make the incision site as strong as possible. After this stage, the scar begins to settle. During this phase, the scar will become lighter in colour, softer, and less noticeable.

The degree to which the scar fades largely depends on how a person tends to heal. Dr. Tong will suture the incisions to maximize the incision appearance. Following Dr. Tong’s post-operative instructions on proper wound care also helps to diminish the visibility of any scarring. This advice may include continuing to apply scar gels and silicone strips.

How Long Do Breast Implants Last?

It is important to understand that a breast implant does not last forever. In the past (before highly cohesive gel implants), most surgeons would estimate the lifespan of an implant to be between 10-15 years. Currently, the newer form-stable implants (highly cohesive gel implants, i.e. gummy bear implants) are thought to last significantly longer than the older style of implants. In some cases, breast implants can span decades of use, but it is not uncommon for complications to arise (i.e. implant leaking, rupture, capsular contracture, etc.) after a certain number of years.

The lifespan of a breast implant is different for each patient and may depend on the type of implant. The most important factor with regard to the longevity of breast implants is the ability to recognize when they need replacing. With saline implants, patients will typically experience a noticeable deflation in size or shape when there is a leak or rupture. In contrast, implants made from silicone can often keep their shape in the event of a complication—especially newer form-stable (“gummy bear”) implants composed of cohesive gel—but some surface abnormalities may still be apparent. The newer ‘gummy bear’ implants contain a silicone core that behaves like a solid; therefore, if the shell were to acquire a small defect (usually due to wear and tear over the years), the likelihood of silicone leaking out would be minimal. Special imaging tests, such as ultrasound or MRI, may be utilized from time to time to monitor the status of a breast implant when no obvious symptoms are notable.

The bottom line is that even implants that perform normally for many years may need to be replaced at some point, due to wear and tear issues. Some women will take a proactive strategy— they decide to have their implants replaced after a certain amount of time (e.g. 10-15 years) before a leakage occurs. The advantage of this strategy is that the patient has control over when the surgery occurs and can plan accordingly. Additionally, the implants would still be intact, making the surgery much more straightforward. Other patients may wait until a leakage/rupture occurs. This strategy has the advantage of ‘maximizing’ the useful lifespan of the implant; however, when the leakage is noted, there is some urgency to remove the implant and the procedure is usually less straightforward in nature.

Do Breast Implants Interfere with Mammograms?

Although breast implants have been known to make traditional mammogram readings slightly more difficult, there are a number of newer techniques that can be employed to obtain accurate results for breast implant patients. If your implant is located under the chest muscle, your mammographer can utilize an “implant displacement” approach, which involves pulling the breast tissue forward while the implant is pushed in another direction to gain additional x-ray images and a more comprehensive reading. When the implant is in a subglandular position (over the muscle), or the implant displacement technique doesn’t produce a satisfactory outcome, an MRI can be used to provide a clearer picture of the breast tissue surrounding the implant. Whether your implant is placed above or below the chest muscle, a definitive mammogram reading is certainly possible as long as you make your mammography team aware of your breast implants when booking your appointment.

How Much Does Breast Augmentation Cost?

While the price of Breast Augmentation ultimately depends on the details of your treatment plan, the cost of the procedure at our practice generally ranges from $7,500 to $8,500. This figure includes the fees for anesthesia, post-operative care, and other related expenses. Factors that usually affect the cost of Breast Augmentation include:

  • The type of implants utilized
  • Whether a Breast Lift was performed in conjunction with the procedure
  • The complexity of your Breast Augmentation
  • The surgical technique used

After Dr. Tong has the opportunity to assess your needs in a consultation, our office will be able to provide a personalized quote that is unique to your procedure. In addition to accepting major payment methods, Dr. Tong offers plastic surgery financing through some of the leading patient lending companies in the nation, including Medicard® and Crelogix®. If you are interested in paying for your Breast Augmentation over a period of time rather than in a lump sum, these options can offer qualified applicants a range of payment plans with low monthly installments to bring the cost of cosmetic surgery into budget. Please contact our office to learn more about the costs of surgery, or to speak to a member of our team.

Fat Transfer Breast Augmentation

If you are looking for an alternative to breast implants, fat transfer breast augmentation offers a unique solution to attain an increase in breast size using a patient’s own tissue. This technique uses excess fat cells from another part of the body—commonly the abdomen, hips, or buttocks—and repurposes the purified tissue for injection into the breasts. The advantages can be numerous, including that the breasts look and feel completely natural—usually indistinguishable from large breasts developed naturally—there is no need for removal or replacement of an implant in the future, and there is no risk of the potential complications associated with breast implants. In addition, you will acquire a slimmer appearance in the area where the fat is taken because the harvest procedure is no different from having liposuction.

The result can be soft and natural-looking breasts that are achieved without the need for an implant. There are some limitations to fat transfer breast augmentation. Some of the transferred fat may not end up being viable, which will result in a smaller degree of augmentation. Hence, there is some degree of unpredictability as to whether your final result can be achieved with a single procedure. Women who desire more than a two bra-cup size increase (e.g. from an A-cup to a D-cup) may also require more than one session to achieve their goal. Dr. Tong can perform Fat Transfer Breast Augmentation as a stand-alone enhancement procedure, or as a complement to standard Breast Augmentation to smooth the implant edges as well as reduce implant rippling or dimpling. To learn more about the fat transfer technique, please visit our page and don’t hesitate to inquire with Dr. Tong about the procedure.

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

What the procedure does
Enhances breast volume (size and fullness) and shape
Duration of the result
Permanent, but implants may need replacement in the future (10-20 years)
Length of time to perform the procedure
1-1.5 hours
Type of anesthetic most commonly used
General anesthesia
Length of time off of work
5 – 7 days
Time to get back to exercise
2 weeks light exercise, 4-6 weeks heavy exercise
Pitfalls your Plastic Surgeon should avoid
  • Over dissection of pocket leading to ‘bottoming out’ or ‘lateral drift"
  • Inappropriate implant size selection
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