Medical Treatment Look and Feel Sexier

The synopsis

Integral to the mind and soul of every woman is the perception of their appearance. How you look has a profound impact on your psyche and without that satisfaction, you may never achieve the self-fulfillment you deserve.

According to the University of Florida study led by Dr. Figueroa-Haas in 2007[1], women who have had breast augmentation surgery experienced a boost in their self-esteem to top levels.

How to enhance your breasts

  • A routine surgical procedure involving placement of implants to add volume to your breasts.

Breast augmentation enables you to

  • Feel sexier and more attractive.
  • Enjoy wearing the clothes you’ve always wanted to wear, and know that you look great in them without a padded bra.
  • Turn heads at the beach.
  • Look more feminine or reclaim lost femininity.
  • Be admired for your improved body contour.
  • Not be embarrassed about the asymmetry of your breasts.
  • Replace the volume lost from pregnancy and breastfeeding.
  • Have a body you can feel fantastic about.

Your commitment to enhancing your curves

You have made a commitment to improving your appearance that will enable you to experience the contentment of heightened confidence, beauty, and self-esteem. Breast enlargement is a decision you can make for yourself to enrich your personal and professional life.

Imagine how your life would be with a beautiful, more proportionate body contour that you feel good about. We are leading breast augmentation experts who achieve natural-looking results with a mastery of advanced surgical techniques, including the ability to reduce risks and expedite results.

The Edelstein Cosmetic difference

Dr. Edelstein has designed the breast augmentation procedure to make it safer and to have a less intensive recovery period. All of the surgeons at Edelstein Cosmetic perform these special, exclusive techniques. Collectively, we have performed nearly 3000 breast augmentation procedures. The advanced surgical skill of our surgeons allows us to achieve:

Less risk of capsular contracture

We have been able to reduce the rate of capsular contracture, one of the most problematic risks of breast augmentation, to just 1% compared to many studies in literature where the rate is 10%, or even a whopping 25% as recorded by a Health Canada study.

Breast Augmentation At A Glance

  • No Needed Massage
  • Rapid Surgery Recovery
  • Under or Muscle Over
  • Saline $7665 Implants
  • Silicone $8195+ Implants

No post-surgery massage needed for “No Massage Breast Augmentation”

Less risk of capsular contracture means that our patients do not routinely do post-operative massage. Massage usually starts one week after surgery, when everything is still raw inside. Massage may actually increase the risk of bleeding and, therefore, capsular contracture!

As a result, you’ll only need to perform massage after your breast augmentation if it is recommended, which is very rare. You’ll still be monitored by us during the initial recovery period and if it seems that one breast is not softening normally, then massage may be recommended.

Bloodless breast augmentation and drain-free recovery

A fiberoptic lighted retractor is used to allow for a clear view of the operating area.

Before the breast implant is placed in the body, your surgeon meticulously cauterizes every blood vessel in the area of insertion, eliminating any blood loss and build up of fluid during recovery. In addition to aiding your recovery, you do not need drains after surgery even when the incision is placed in the armpit (trans-axillary). Your surgeon does this for wherever the incisions are placed, whether it is in the breast fold (infra-mammary), in the armpit or around the areola (peri-areolar). Bloodless breast augmentation is an original innovation of Dr. Edelstein and as such, he has developed methods to implant through all three of these major incision types. The advanced technique is a tribute to Dr. Edelstein’s commitment to designing a procedure that is safer and shortens the recovery process for patients.

Rapid recovery

You most likely want to recover from your breast augmentation surgery and get back to your normal schedule as quickly as possible. The faster the better and the sooner you’ll be able to see your results, which is why we perform rapid recovery breast augmentation. The rapid recovery technique has allowed many of our patients to return to normal non-strenuous activities within a short period of time.

We seek to make your recovery as quick as possible by doing the following:

  • By prescribing proactive medications to prepare your body before surgery even begins.
  • By minimizing or totally eliminating the use of strong pain medications to reduce postoperative nausea and vomiting.
  • By minimizing the amount of time that you spend under anaesthesia, thereby decreasing recovery issues (nausea and/or vomiting) associated with their use. This leads to less tissue trauma, inflammation and bleeding, as well as works to cut down on pain and reduce the risk of complications, particularly capsular contracture. Less risk of capsular contracture means that our patients do not routinely do post-operative massage. You’ll only need to perform massage after your breast augmentation if it is recommended, which is rare.
  • By selecting proportionately sized implants with dimensional planning.
  • By minimizing the use of medical devices (like drainage tubes or pain pumps).
  • By following your surgeon’s post-operative healing regimen.

If you are not happy about something, and you know it will bring out a 'better you', then go for it! Do it for yourself. Miss Prestin - Toronto, Ontario

Choose the right breast implant size with dimensional breast augmentation

You want attractive sexy breasts, not just bigger breasts. Dr Edelstein has studied breast augmentation techniques for more than 15 years, and has learned the techniques and approaches to virtually every type of breast augmentation surgery. We do not believe in the "one size fits all" approach and each and every patient is treated as a unique individual to deliver the best possible outcome for their particular situation. To achieve a highly satisfying outcome, a sophisticated technique known as dimensional breast augmentation is used for the most natural looking breast implants.

Dimensional breast augmentation is designed to consistently achieve the most natural–looking result so you won’t look disproportionate or “plastic”. It is a formula that is complemented by the keen artistic eye of our breast surgeons, offering you a custom surgical experience from your initial consultation to recovery. Dimensional breast augmentation is a method based on the measurements of your original, pre-surgery body contour and your desired outcome. It considers such variables as your height, weight, breast width, breast height, distance between nipple and breast fold, as well as your desired cup size to determine the most suitable implant size, type and specific surgical technique.

With dimensional breast augmentation, you will enjoy an improvement that is a pleasing enhancement of the harmonious proportions of your overall body contours. It has improved the rate of satisfaction considerably for our patients. You’ll be less confused about what implant size to get and less hesitant about your surgery. (In fact, a better mindset going into surgery has actually been scientifically proven to improve your rate of recovery!)

You will receive this cutting-edge technique at no additional cost with your breast augmentation.

The No-Touch Technique with the Keller Funnel™

You may have heard about The Keller Funnel™, and it is available to you if you’d like it.

The Keller Funnel™ is a single-use medical device that is designed to make the insertion of cohesive gel silicone breast implants easier, due to an internal hydrophilic coating that becomes very slippery when hydrated. It can be used for textured or smooth implant surfaces.

The implant is passed from the sterile container it comes in, directly into the Keller Funnel™, and then slides through it into the space created inside the breast. In this way, the implant never touches the surgeon’s gloved hands, nor the skin of the patient’s breast. This is known as the “No Touch Technique”.

The Keller Funnel is believed to reduce the risk of capsular contracture, although the risk of capsular contracture is already extremely low for our patients—only 1%, which is exponentially lower than the current average of 10%-25%!

Call (416) 256-5614 to book your medical consultation for breast augmentation Canada, and experience the difference a true expert can make. We are known for achieving great results, so much so that other physicians and their wives come to Edelstein Cosmetic for breast augmentation...and lawyers, too!

Are you a candidate?

Breast augmentation is designed for women who are seeking improvement, rather than perfection, in their appearance. You may be a good candidate for the procedure if you’re healthy and want to enhance the size of your breasts. You can try one of these techniques at home to see if you like how you look with larger breasts, and what size you would like to be:

The rice (or water) test: Get a baggie and a measuring cup. Fill the baggie with various quantities of rice (or water). You can keep a note of the amount in the measuring cup, defined by milliliters, as they are equivalent to cubic centimetres. Cubic centimetres, or CCs is how breast implant sizes are measured. Tie the baggie, place it into your bra and put on a tight-fitting T-shirt. You can experiment with different sizes so you can start to appreciate how you will look with various implant sizes. However, you should keep in mind that the baggie will make you look a bit bigger than a breast implant of the same size, since the implant will be more compressed when it is inside the body.

Talk to a friend: Many women have friends or acquaintances who have undergone breast augmentation. Knowing their breast augmentation size may help you in choosing what will be best for you. However, it is important not to just go with the most popular breast implant size, but rather the size that looks good on you.

Look at photographs: There are a variety of websites that show before and after photos. During your consultation with your plastic surgeon, you’ll be able to look at before and after photos of our patients as well. These can help since they are various breast size pictures. Usually they tell you what implant size was used (in CCs). Keep in mind that every woman is unique, and that photos of one particular woman may not necessarily represent the result you will obtain with the same implant size because of such factors as your body type, measurements and bone structure.

Your consultation

Your consultation is the best time to discuss your needs and learn as much as possible about your breast augmentation procedure. Complete honesty about your lifestyle (including whether or not you smoke, drink or currently take any medications, vitamins, supplements and/or drugs) during the consultation is extremely important as well.

We will work with you to ensure that you receive the safest and most effective form of breast augmentation. At your pre-operative consultation, your surgeon will take a number of measurements of your breast and chest dimensions, as well as your height and weight. These measurements greatly help in determining which implant size is right for your particular body size. Known as dimensional breast augmentation, determining implant size according to your pre-surgery body measurements will help achieve harmonious proportions for a more natural-looking result.

Some things that will be determined during your consultation:

The most popular question women ask when it comes to breast augmentation is, “What size do I choose?”. Breast implant sizes are measured in cubic centimetres (cc), which refers to the amount of filling inside the shell. You’ll be able to try on an appropriately sized non-padded bra with a variety of sizers so you can see which looks best. There’s no need to bring any sample bras with you, as we have several in various sizes that you can try. Consider your lifestyle when deciding. If you are physically active, a larger size may not be practical. If you’re technologically savvy, digitally alter a photo of you to illustrate the size you’d like then bring the altered photo in to show your surgeon.At your pre-operative visit, you will have the opportunity to try on a variety of sample implants (these are known as breast implant sizers) to see which size best suits your taste. Popular breast implant sizes include 300cc breast implants and 350cc breast implants. We have a selection of bras in a range of sizes that you can try on. Bring a tight-fitting T-shirt to this appointment so you can see how you’ll look with the sizers.

There are 801 implant combinations of breast implants available, and you’ll have the freedom to select the right kind for you with your surgeon’s help. Choose from a wide variety of:

  • Shapes: round or teardrop/anatomical.
  • Textures: this refers to the surface of the implant shell and can be smooth or textured.
  • Filling type: saline or silicone gel (all breast implants are created with a silicone shell.) Cohesive silicone gel implants are admired for their softer texture that closely resembles your natural breast tissue. The filling is not liquid, as was the case for older silicone breast implants, but rather has the same consistency of a gummy bear, so nothing oozes out in the event of a rupture. Saline implants are filled with a saltwater solution. They are less popular, but if you prefer them they are still available to you as an option. They are typically filled to the desired volume with saline after they are placed in the body.
  • Profile or projection: this is the amount of projection the implants create from the body.

Your plastic surgeon will help you decide which incision option is best for you with the goal of achieving your personal expectations and desired results. You can choose from the following:

  • partially around the areola (peri-areolar)
  • in the breast fold (infra-mammary)
  • in the armpit (trans-axillary)

You’ll decide on whether your implants will be placed above or below the chest muscle. Keep in mind that there is no single approach that is ideal for every patient. We will help you decide which implant pocket placement is best for you prior to surgery, taking special care to select one that will achieve your personal goals and expectations.

Preparing

This is a general guideline that may help you better understand how to prepare for your breast augmentation procedure. Don't worry—the team at Edelstein Cosmetic will guide you through all the steps required to prepare you for your surgery, so that you'll never feel neglected.

Personal arrangements when preparing for your surgery

Plan for a friend or family member to drive you home from the appointment. They should also be available to stay with you at your home for the first night of recovery.

It’s a good idea to make extra food and have plenty of snacks and fluids on hand. Arranging for childcare and taking time off work for recovery is also advised.

Fill all necessary prescriptions and put them in a convenient location (such as a bedside table). There is a pharmacy in Humber River Hospital and also one a block away from our private surgical facility, so a family member or friend can fill any prescriptions while they wait for you on the day of your surgery as well.

You may want to ask your surgeon for advice on when you can begin exercising and driving again.

Two weeks before your surgery

Medication: You should not take any products containing aspirin, anti-inflammatories (like Advil, Motrin or ibuprofen), vitamin E or blood thinners (such as Warfarin, Anacrot or Coumadin) in the 14 days leading up to your appointment. Tylenol is safe, but any medications that thin the blood greatly increase the risk of bleeding and can complicate surgery. Birth control pills and estrogen replacement therapy should be stopped for four to six weeks before surgery as well in patients who are having the procedure in combination with liposuction or a tummy tuck (abdominoplasty). The use of these medications has been known to increase the risk of developing blood clots in the legs.

Herbal, natural, diet or other alternative products should also be avoided. These include ginseng, St. John’s wort, ginkgo biloba and others. Your surgeon and anesthesiologist should be made aware of all medications you currently take as well.

Smoking and illness

Smoking must also be stopped for at least four weeks before and after surgery when breast augmentation is being combined with a tummy tuck or breast lift. Patients who smoke during this period of time risk experiencing skin loss and poor wound healing. Edelstein Cosmetic should be notified if you develop an infection, cold or flu before surgery.

Other instructions and tips

As mentioned above, you should be sure to discuss current medication use with your surgeon. Most daily-use prescription medications (like blood pressure or cardiac pills) can be taken on the morning of surgery with a small sip of water, but many other drugs and supplements can cause serious complications. It’s essential to follow your surgeon’s instructions on which medications to avoid during the weeks leading up to the procedure.

Stick to a healthy diet and avoid alcohol for a few days before surgery.

The day before your surgery

Exercise is greatly beneficial to general health, but it’s important to refrain from vigorous activity the day before. On the night before, you won’t be allowed to eat or drink after midnight or in the morning (surgeries are often cancelled if a patient doesn’t follow this rule). You should remove all make-up, nail polish, skin care products (like oils, lotions, creams, moisturizers or deodorant) and carefully wash the surgical area with antimicrobial soap in the shower.

The day of your surgery

On the day of your surgery, take any required medication. You may also brush your teeth, but do not swallow more than a sip or two of water. It’s a good idea to wear comfortable, loose-fitting clothes and flat, slip-on shoes to the surgical facility. Sweat pants, buttoned or zippered shirts are ideal as they allow you to easily take off and put on your clothes. Do not wear a pull-over garment if you’re having facial surgery. If you’re undergoing any breast surgery, you should bring a wireless bra into the operating room. Leave all valuables (including money and jewelry) at home.

An anti-nauseant is prescribed and is to be taken in the morning at home the day of your surgery, as is extended release Tylenol to help ease discomfort. A complete set of post-operative care instructions will be provided to you. Follow them to help expedite your recovery even more. The post-surgical exercise restrictions are particularly important.

Your surgery

Breast augmentation surgery is typically performed under general anesthesia, meaning that you’ll be asleep throughout your operation. The entire surgery typically takes 1.5 hours.

Your surgeon starts the surgery by making a precise and meticulous incision. The incision is usually three to four centimetres (one to one and a half inches) in length. A permanent scar remains where the incision was placed. Every effort is made to ensure that the scar is as inconspicuous as possible. Any blunt dissection surgical techniques (like putting a finger in and sweeping it around to open up the pocket) are avoided and all operative dissection is performed under direct vision with the usage of advanced instruments. Any action that causes unnecessary bleeding is avoided and muscle relaxants are administered in order to minimize trauma to the chest muscle. Because of this, you’ll most likely be able to forgo drains and medical devices that complicate and prolong healing. Your plastic surgeon uses extreme precision and gentleness in order to minimize any damage to the surrounding breast tissue. The only instrument that is used during your surgery is something called a forceps electrocautery. This instrument is used to not just create the pocket (space) for the implant, but to also seal blood vessels to eliminate bleeding.

A fiberoptic lighted retractor allows for a complete view of everything so that the incisions and implants are placed precisely in optimal locations.

Absorbable stitches are then used to close the incision, a gauze bandage applied, and you will be provided with a support bra.

Infra-mammary incision

The infra-mammary incision is probably the most popular type. It is placed at or slightly above the crease under the breast. This is one of the most common incisions because it allows for the most direct access to the breast implant pocket, making accurate placement of the implants quite predictable. It also leaves the actual breast tissue completely undisturbed, minimizing any effects on breast feeding and nipple sensation.

Your plastic surgeon uses a fiberoptic lighted retractor that allows for a clear view of the operating area. Use of the lighted retractor ensures proper implant placement, a shorter recovery time and a marked decrease in the risk of complications that arise from unnecessary tissue damage.

Peri-areolar incision

The peri-areolar incision is made along the lower border of the pigmented skin around the nipple (the areola). This second type of incision is commonly used in women with a poorly defined fold under the breast, as long as their nipple size is not too small. It is another popular incision and usually heals quite well, resulting in an almost “invisible” surgery scar. A fiberoptic lighted retractor is used for this incision type as well.

Trans-axillary incision

The third type of incision is placed high in the armpit and is called trans-axillary. The benefit of this incision is that it eliminates scars on the breast itself for “scarless breast augmentation”. Women with poorly defined folds under the breast and small nipples make for a good candidate for this type of incision. Although a scar is avoided on the breast, it is important to remember that there will be a scar in the armpit. This may become an issue when wearing certain sleeveless tops or bathing suits. A scope (endoscope) is often used to perform the procedure to improve predictability. Our surgeons can place your choice of saline or silicone cohesive gel implants through the trans-axillary/armpit incision, and no drains are needed after your surgery. This is done with an endoscope.

An endoscope consists of a tubular probe featuring a camera and light. The images captured by the probe are magnified and displayed on a viewing screen that your plastic surgeon is able to see throughout the procedure. Your plastic surgeon can make accurate internal incisions and achieve precise breast implant positioning for a more natural and beautiful enhancement. Without the use of endoscopic equipment, surgeons have to work “blind” while opening the implant pocket and sometimes making unnecessary incisions. The “blind” approach means that the surgeon inserts a large instrument to bluntly open the pocket then place the implant by “feeling around”. Coupled with the force of blunt dissection, these cause more tissue damage and bleeding, which consequently must be controlled with drains the patient must deal with after surgery.

A note on the trans-umbilical incision

The trans-umbilical incision is made at the navel. Once a small incision is made, a path is cut under the skin toward the breasts to allow for the insertion of an endoscope. The breast implants are positioned in the chest via this tube. While it is easier to place the implants over the muscle using this method, it is also possible (although much more difficult) to place them under the muscle if desired.

The primary benefit for the trans-umbilical incision is the minimal visible scarring. The scar is short, often just one to two centimetres long, and is placed within the navel, far from the breasts. For most patients, however, the limitations and difficulties of a trans-umbilical breast augmentation will outweigh the reduced scarring, which is why we do not offer this incision.

Inaccurate implant positioning: Since the incision is so far from the placement site, it is significantly more difficult to position the implants accurately. This dramatically increases the odds of ending up with asymmetry or unnatural-looking results. When the incision is in the infra-mammary or peri-areolar position, implant placement is not only easier to do, but also improves the final result.

Only saline implants: Another drawback is the length of the incision. Because it is so short, only a saline implant shell can be placed, which is then filled after it is positioned in the body. This limits your choice of implants. Silicone cohesive gel implants are too large to go through the endoscope without sustaining damage. Saline breast implants tend to be less natural-feeling than cohesive silicone gel implants and also increase the risk of visible rippling, particularly when placed over the muscle.

A different approach is necessary with revision surgery: A final negative point is that surgical corrections are almost impossible to perform through this incision. Any revision surgeries, whether to correct placement, excessive internal scarring, rippling, rupture or for replacement, must often use a different approach, which require a more extensive incision.

The trans-umbilical approach is often not recommended due to its difficulties in achieving natural, satisfying results.

A note on the trans-abdominal incision

The trans-abdominal incision utilizes the same incision made during a tummy tuck (abdominoplasty). This incision is normally lower down on the stomach, far from the breasts. Once the mid-section is addressed with abdominoplasty, a pocket is created through the incision and the breast implants placed. The advantages of this incision is that it makes an additional incision unnecessary for patients undergoing a tummy tuck simultaneously. However, there are some key disadvantages to this incision placement and it is not recommended.

A higher rate of placement errors and bleeding: Because the incision is so far from the breasts and the surgeon is unable to easily see what they’re doing, it makes the placement of the implants far more difficult. This dramatically increases the risk of positioning the implants incorrectly, leading to an unnatural appearance and other complications. It also increases the risk of bleeding.

A more invasive surgery and higher risk of bottoming out: When you access the breast via the trans-abdominal incision, it requires you to make a much wider tunnel from the abdomen into the breast. This disrupts the infra-mammary fold much more than the small incision your surgeon would normally make in the fold. Disruption of the fold can lead to bottoming out.

Sub-mammary pocket implant placement

In sub-mammary implant placement (also known as sub-glandular), the breast implant is placed between the breast tissue and the chest muscle.

This position is frequently recommended for women who already have a fair amount of breast tissue. They may also have a mild degree of breast droopiness (ptosis). A moderate amount of breast tissue will help conceal an implant placed in a sub-mammary pocket. In addition, a mild amount of breast droopiness can be corrected.

Sub-mammary pocket placement is also recommended for women with unusually shaped breasts, as the implants will help to change the shape of the breast better than implants placed in a sub-pectoral pocket.

Finally, professional, competitive body builders and fitness models are usually better off with implants placed above the chest muscle as well.

Dual plane pocket implant placement

Dual plane is a term coined by a Texan plastic surgeon back in the late 90s and is defined as placement of the implant behind the pectoralis major muscle and partially behind the breast tissue overlying the muscle, so it sits on two levels inside the chest. This is why it’s called “dual plane”. The top 2/3 of the breast implant is placed below the pectoral muscle. The muscle provides more coverage so that the implant is less visible and less palpable, lowering the chance of rippling and a visible upper border (the breasts won’t look like they’re bolted on as much). It gives the breast that nice natural slope. The bottom 1/3 of the implant is placed under the breast itself in the sub-glandular position. This allows the breast tissue to drape around the implant, contouring itself to the roundness and thereby adopting a pleasing fullness that better emulates a natural breast shape.

Alteration of some of the pectoralis major muscle is also performed to achieve optimal improvement of the breast as well as allowing for a subtle lift for patients with minor drooping (ptosis). Dual plane was designed so that the benefits of both subglandular and submuscular placement could be obtained for the patient.

This type of implant placement can be performed with any incision (infra-mammary, trans-axillary, or peri-areolar) and has been found to provide more benefits for patients in the study, Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types[2].

There are several varieties of dual plane augmentations that subtly differ one from the next (there are types 1-3). You will receive the most suitable one depending on your goals and the expertise of your surgeon. However, for certain patients, such as those with sagging breasts, sub-mammary placement may be preferred.

Advantages of dual plane placement include a lower risk of capsular contracture (a condition that is characterized by an undesirable hardening of the breasts), and making mammograms easier to read (which can be beneficial for a woman with a family history of breast cancer).

There is a third type of placement: complete sub-pectoral or sub-muscular placement. This involves the implant placed entirely under the chest muscle. Because of its related disadvantages, our surgeons perform complete submuscular coverage only for breast reconstruction purposes.

Following your surgery

The healing time following surgery varies according to each patient. The following represents a general idea of what to expect after your surgery. Individual patients may experience variations from this course. The team at Edelstein Cosmetic will help you through your recovery and will be there for you at all times.

The first few hours after surgery

When you awake from your surgery you will be in the recovery room, where you’ll remain for a few hours under the watchful eye of your dedicated team of nurses and doctors. You will have a bra on, and possibly a tensor band wrapped around the upper portion of your breasts. If you are not staying overnight (as is the case for most patients), you will be able to go home when you have fully recovered from the sedation. You will be given a prescription for pain medication and antibiotics. It is extremely important you take the antibiotics to prevent infection during your breast surgery recovery time.

first 24 hours

A few patients react negatively to the anesthetic after surgery. You may feel nauseous and vomit. This usually lasts less than 24 hours and should be treated with lots of fluids, Gravol and rest.

Although it is best to sleep on your side or back initially, sleeping on your front should not cause injury or rupture to the implant.

Immediately following surgery, you’ll find that your newly enhanced breasts appear very full and swollen, especially in the upper portion above the nipples. Your skin will most likely look very tight, and your nipples may point slightly downward as well. The shape and overall appearance of your breasts appear will probably appear unnatural. This is because when breast implants are first put into your body, they typically sit higher up in the chest as it’s the path of least resistance–your body requires some time to adjust to their presence, regardless of whether they’re sub-mammary or sub-muscular. (They will become more natural in appearance over time, usually by about three to four months after surgery.)

The second day

You’ll be able to take showers from the second day after your surgery. When taking a shower, remove the bra (and tensor bandage, if necessary). Take off the gauze and Vaseline mesh that is taped over your incision. The small white tapes (steri-strips) that are under the gauze directly over your incision should be left on.

Wet and soap yourself everywhere, including the tapes and your incisions. Use mild soap such as Dove, Ivory, or Zest. Pat yourself dry using a towel (do not rub) and put your bra and tensor back on. You don’t need to cover the small white tapes over your incision. This daily routine will help keep the incisions clean, and will promote wound healing.

It is VERY uncommon, but a soft drain may be placed under your breast that will be removed within a day or two. This helps to minimize the risk of blood collecting around the implant in patients who appear to bleed a lot during the surgery. However, this is unusual, even when the incision is placed in the armpit (trans-axillary).

The first three days

For the first three days you should try to restrict your arm movements. Move your arms slowly and avoid sudden jerky movements of the chest and breast area to prevent complications from occurring.

We encourage you not to spend all your time in bed during your recovery. This will minimize the risk of deep clots in your leg veins.

After three days

You will be able to resume relatively normal non-strenuous activities, however avoid lifting.

The third to fifth day

Maximum swelling occurs at this time.

After five days to a week

You may be able to go back to desk work, although this can vary from person to person.

You may need to wait a little longer if your work is physically challenging.

Although implants can rupture in extreme circumstances (e.g. high speed car accident), normal physical activities and contact will not significantly increase the risk of rupture and should be enjoyed within reason.

A week to 10 days

If you are advised to do massage, it would be a week to 10 days after your surgery. This is because your body is still recovering from the trauma of surgery. It is still “raw” inside, and massaging your breasts too early may cause bleeding, increasing the risk of capsular contracture. It also hurts! When textured implants are used, it is also important that the texturing on the implant integrates, or attaches to, your own tissues. Massage will interfere with this and could lead to fluid collections called seromas, or rotation of a tear-drop (anatomic) implant.

If you are instructed to do massage exercises, it is important to remember that a slow steady stretch is more effective than a quick jerky movement. Don’t worry about injuring the implant, you cannot cause a rupture with these breast exercises.

Press the breasts slowly and maximally inwards (towards your breast bone) and hold for 10 seconds, then release.

Repeat 4 times.

Press the breasts apart slowly and maximally outwards and hold for 10 seconds, then release. Repeat four times.

Repeat for downward movement.

Repeat for upward movement.

Perform these exercise two times per day after your surgery. Your surgeon will keep a close eye on you. If your surgeon thinks that one breast is not softening normally, only then will a treatment regime that includes massage, prescription medication, and several supplements be recommended.

The purpose of breast massage after augmentation exercises is to keep the scar tissue that forms around your breast implants following surgery as soft and pliable as possible. You can help soften the internal scar, minimize the risk of significant capsular contracture and maximize the likelihood of a soft, natural feel and appearance to your breast. However, since we are able to achieve beautiful, natural-looking results and our rate of capsular contracture is so low, you do not need to do any massage unless your surgeon tells you so. 99% of our patients are advised not to massage, a recommendation we have been giving for over eight years.

After 10 days to two weeks

The ends of sutures may be trimmed if necessary. Some patients may receive extra support from a tensor bandage, wrapped around the chest at the top of the breasts. This bandage would be worn for the first two weeks.

By the end of two weeks

Most bruising and swelling will resolve by this time. You may also feel discomfort and pain, which is generally well controlled by pain medications. Most patients experience a moderate degree of discomfort for up to 7-14 days.

After two weeks

You will be able to submerge yourself in a bath, swimming pool, or whirlpool after two weeks. If you have been wearing a tensor bandage wrapped around your chest, it will be removed.

After three weeks

You may begin your regular exercise routine 3 weeks after surgery, except upper body weight training. You will also be able to resume sexual activities at this time.

After six weeks

You may being upper body weight training and push-ups. Particularly when implants are placed under the chest muscle, upper body weight training before 6 weeks could cause bleeding and subsequent hardening (capsular contracture).

After eight weeks

It’s essential you wear a soft cotton sportsbra, without underwire, to provide support for your breasts throughout the first eight weeks of recovery. You should wear your bra day and night. This prevents the implants from falling to the sides or “bottoming out” (when the implants move unfavourably downward). Although this complication isn’t common, some patients develop weaker scar tissue, providing less internal support for the implant. Surgeons are unable to determine who is at risk for this issue until implant displacement occurs, which would necessitate revision surgery (capsulorrhaphy). Wearing a bra helps to provide extra support during the healing process.

Underwire bras can cause unnecessary complications and should be avoided for the first two months following surgery. These complications include irritation caused by the wire rubbing against the skin (something that you may not notice due to possible numbness). Patients who have an infra-mammary incision should be especially careful as an underwire bra is capable of displacing the implants if it is worn too often or too soon. The underwire is often improperly shaped and provides inadequate support of the breast shortly after surgery.

Once it’s time to begin shopping for new bras, patients will find that they have to greatly adjust their previous size and style choices. Many bras no longer fit comfortably after breast augmentation due to the changes in shape that come with implants. On the other hand, many bras that didn’t work for you before may now look great! When picking a bra, women should keep a few key fitting tips in mind:

  • A band that rides up in the back is a sign of a poor fit. The band of the bra should remain at the same level as the front.
  • Bra straps should not have to be shortened in order to lift the breasts. If this is the case a smaller size may offer a better fit.
  • Any excess space between the nipple and the cup of the bra is a sign of a bad fit.
  • Patients may want to consider being re-measured to find out their perfect fit.

After three to four months

By this time, your breasts will have “dropped and fluffed”. “Drop and fluff” refers to the gradual movement and change in shape that occurs to breast implants following surgery. As your body accommodates to your new implants, you’ll notice that your breasts will gradually look more and more natural–the way you hoped they’d be! Over the course of about three to four months, your body creates new skin to accommodate the additional volume of your implants. This natural process is called “tissue expansion”, and relieves the tightness you may be experiencing. It allows for the implants to settle more into a better position with the help of gravity. A gradual redistribution of volume from the upper to the lower breast occurs, resulting in an enlargement and rounding out of the lower breast.

Although it’s often called “dropping”, it is more like “redistribution”. The “fluffing” part refers to the impression that the lower breast enlarges and that your skin softens with the creation of new tissues. The extent to which this occurs depends on several factors, including the implant size, the tightness of your skin, and your body shape.

Patients who experience this phenomenon at a higher rate typically:

  • have a smaller body frame
  • are tighter skinned
  • haven’t had children

This is in comparison to a larger breasted, post-partum woman. Patients who have had implants placed in the sub-muscular position may find that their dropping and fluffing is more dramatic.

Follow-ups and monitoring for anything unusual

The quality of your results may be compromised if you fail to return for any scheduled post-op visits, or follow the pre- and post-operative instructions and breast augmentation recovery tips provided to you.

Don’t hesitate to report any unusual or concerning changes while healing. If you are unable to contact your plastic surgeon and you have an urgent post-operative concern, contact the plastic surgeon on call through the hospital paging system, or, proceed to your local emergency department.

Implants do not cause cancer but may obscure its detection. Mammograms should be performed at a facility familiar with the special techniques needed for implants. You will need to let your mammogram technician know about your augmentation during future check-ups. Though the implants won’t interfere with your mammograms, it’s important to inform your technician so he or she can use a special technique that provides accurate readings.

Your results

Following surgery, scars are red and a little raised, but over three to six months they usually get lighter in colour and flatten out, becoming silvery thin lines that are barely noticeable. For all incision placements, the breast augmentation scars are usually very well hidden within the natural contours of your body.

You’ll probably be highly satisfied with the results of your procedure. To maintain beneficial results and be sure of your complete safety following the treatment, be sure to attend all the follow-up examinations with your surgeon.

The price of your breast augmentation, broken down

The prices for breast augmentation surgery can vary widely depending on the five W’s:

1. Who is going to perform your surgery.

2. What type of implant you’re going to receive.

3. When you’re going to get the surgery done (some places may increase your cost of breast augmentation in Canada if you were quoted a while ago).

4. Where the surgery is scheduled (at a hospital or private clinic).

5. Why you’re going to have the surgery (is it your first time or will this be another one to correct results from a previous surgery?).

And the how: How is the surgery going to be performed (sub-mammary or sub-muscular, infra-mammary or peri-areolar, etc.).

As a result, you’ll notice huge variations in price even for surgeons within a single city, a difference that may be marked by the thousands of dollars.

There are many factors that contribute to the cost of your surgery. Generally speaking, some specific factors include the following:

Breast implant prices

This is the cost of breast implants in Canada only. Currently, there are two breast implant manufacturers in Canada that offer Health Canada-approved implants: Allergan and Mentor. Both companies actively participate in the improvement of breast implant design, cooperating with the FDA to achieve higher standards of safety for consumers. There are a wide variety of breast implants available to you, including Allergan’s INSPIRA® range, an innovative line of 300 implant options that offer you a customized fit to enhance the natural looking results. Usually, the only factor that may increase the average cost of breast implants in Canada is if they are cohesive gel or anatomical (tear-drop) shaped implants. This is a premium that is applied by the manufacturer, rather than the surgeon.

Other features of the implants, namely their size and shell texture, do not influence breast implant cost. So, for example, a 400cc implant won’t be more expensive than a 300cc implant of the same type–size doesn’t matter when it comes to the price of breast implants in Canada!

Anesthesia fees

These fees cover the cost of the anesthetist, whose presence is required during and immediately after your surgery, and the anesthesia administered.

Hospital or private surgical facility fees

These fees cover the cost of where your surgery is scheduled to take place.

Surgeon fees

In addition to your actual surgery, these fees also cover all pre-operative and post-operative follow-up appointments with your surgeon.

Medical tests and other related miscellaneous costs

Miscellaneous costs include the compression garment and any supplies you’ll need while you recover (such as sterile bandages).

When you receive a quote for surgery, make sure that all of these costs are included in your quote and that there are no other fees associated with your surgery. This will enable you to know exactly how much you need to pay.

Please note that you’ll also need to purchase prescribed medications at a drugstore to help you through your recovery.

The cleavage you can expect following your breast augmentation

Cleavage is the term used to define the distance (or gap) between the breasts. What we typically think of as attractive cleavage is called “narrow”, with the breasts naturally closer together. Many women who choose to undergo breast augmentation desire narrow cleavage, but this cannot always be accomplished if the breasts are naturally widely separated.

Your cleavage after surgery

  • Depends on your natural, pre-surgery cleavage.
  • Can be enhanced but not by too much to prevent complications.
  • We perform techniques to help enhance cleavage while still maintain a natural-looking improvement.

Post-operative cleavage will always be determined by the natural distance that exists between the inner edges of a woman’s breasts and the distance between her nipples. When performing surgery, although your surgeon can cheat the implants closer together a small amount, your implants must be centered more or less beneath your nipples. Placing them elsewhere will lead to an unnatural appearance. This means that patients will have cleavage similar to their natural state even after their augmentation results become visible.

The problem with overly close implants

It may seem like narrow cleavage could be achieved by placing the implants closer together, but this isn’t the case. If the implants are positioned too close to one another (or too close to the vertical midline of the chest) in a patient with naturally wide cleavage the nipples will end up pointing outward on the outer side of the breasts. Instead of helping to improve the patient’s cleavage this surgical approach would create an unnatural and aesthetically displeasing outcome.

Placing the implants too close together can also lead to implants that are visible through the skin or rippled in appearance. Slim patients will have the most dramatic complications in these cases since they have thin skin covering their midline chest bone and a lack of fatty tissue hiding the implant.

Finally, when the implants are placed under the chest muscle (sub-pectoral), there is only so far the implants can be placed closer together because the muscle actually inserts along the entire edge of the chest bone (sternum) and can’t be completely stripped off (you need the pectoralis muscle to move your arm!).

The problem with overly large implants

The placement of large implants meant to close the distance between wider cleavage can also create unpleasant results. If overly large implants are used the inner edge of the product will rest underneath the chest bone’s thin skin and can, again, become visible or look rippled. Patients, especially those with narrow chests, will also be troubled by implants that extend too far into the outer edge of the breast. This leads to the breast bulging in the underarm area.

The proper approach to breast augmentation and cleavage

Our plastic surgeons are skilled at enhancing the breasts of women with both narrow and wide cleavage. During the consultation, your surgeon takes chest and breast measurements that allow them to place the implants as close together as possible without causing the kind of complications described above. The end goal of a breast augmentation is always to create beautiful, natural results and this cannot be accomplished by improperly placing implants. Because of this, your surgeon is always careful to centre the implants underneath the areola. They will also offset the implant distance in women with nipples that are naturally far apart or facing outward on the chest. Proper implant placement is also dictated by how the muscles attach to the breast bone since the devices must be inserted underneath the muscle.

Not every patient will have the same cleavage depth and width after their augmentation is finished. Your surgeon is typically able to predict the surgical outcome before the procedure by assessing various factors. Cleavage will depend, in large part, on breastbone prominence, the shape of a patient’s chest wall, the amount of fatty tissue covering their sternum and the softness of the contour that joins the sternum and breasts. Pre-operative nipple positioning, breast orientation and separation also play a key role in predicting the results that augmentation can provide.

While it’s a myth that implants will always create noticeable cleavage, some women may see improvement if they have an average chest wall size. Just the same, your surgeon cannot guarantee enhanced cleavage for every one of his patients since personal anatomy varies between every person.

Your results: do you want to look natural or obviously enhanced?

If you’re interested in breast augmentation, it’s likely that your primary concern is exactly how you will look once all is said and done. Depending on the approach taken by your plastic surgeon, your breasts can appear either natural or noticeably enhanced. The difference between these two looks is caused by factors such as implant size, type and placement.

What makes natural-looking results

  • A size that doesn’t appear too large for a woman’s overall figure—it should be proportionate.
  • A properly contoured shape that, rather than being perfectly round, mirrors the “teardrop” shape of a natural breast.
  • Skin that is free of any “rippling” effect.
  • Hidden and/or properly healed incision scars.
  • Proper breast spacing, height, and realistic looking cleavage.

What makes obviously enhanced-looking results (“fake”)

  • A chest that appears too large in proportion to the rest of the body.
  • Unnaturally wide breast positioning.
  • Breasts that are positioned too high on the chest.
  • Overly prominent cleavage (especially while wearing a bra).
  • Overly rounded breasts that look “bolted on”.

The right breast implant type

Choosing the right implant size is one of the most important parts of the breast augmentation procedure. Using a scientific formula known as dimensional breast augmentation, our plastic surgeons combine your desired results with a careful assessment of your body type to select a range of implant sizes for you. The implant should be picked in accordance with your figure and the natural limits of your chest size in order to create an aesthetically pleasing outcome that appears as natural as possible.

Of course, if you prefer to look obviously enhanced, then you are free to choose a size that goes beyond what has been suggested.

The shape of the implant must also be considered. Various implant profile types (high, moderate, or low profile) can be used in order to create the type of look best suited to your figure. Generally speaking, higher profiles tend to make your breasts project more from your body while lower profiles create a softer, more natural look.

The right breast implant placement

Where the implant is placed in the body also has an enormous impact on the end result. In order to create the most natural appearance possible, your surgeon typically chooses to place the implant behind the pectoral muscle (sub-pectoral/sub-muscular) in patients who are naturally thin and/or have little of their own breast tissue. This approach allows the chest muscles to partially cover the implant, better hiding the device for a more natural look. The implants will also be placed at an appropriate internal height and horizontal position in order to achieve your desirable enhancement.

Placing the implants under the breast itself (sub-mammary) gives a rounder “faker-looking” breast augmentation. It’s important that if a sub-mammary pocket is chosen, you have enough upper breast tissue to cover the implant properly so that you don’t see an obvious upper edge to the implant.

Natural looking results will avoid creating an abnormally wide space between the breasts. It will also ensure that they are not positioned too high, a position that tends to create an overly full, artificial appearance.

The importance of balance for natural-looking results

The most important factor contributing to natural-looking results is maintaining a sense of balance.

Your unique physiology will have a significant impact on the approach taken to your breast augmentation procedure. Since every woman’s body is different, your surgeon must consider features like your skin quality, the degree of drooping (or ptosis) already affecting your breasts, and the amount of natural breast tissue you have before choosing a plan of action. A customized augmentation procedure seeks to enhance the breasts in proportion to your body, ensuring that you receive the kind of natural looking results you desire.

Which look is right for you?

Every woman has different tastes, meaning that there is no objectively “right” type of breast augmentation for everyone. While some patients want their enhancement to be subtle and tailored to the shape of their body, others may wish for a more noticeable look. Neither goal is more “correct” than the other.

It is important to note, though, that your body type plays a large role in how your surgeon will approach the augmentation procedure. The shape and size of your natural breasts, amount of sagging or drooping (ptosis), the integrity and amount of your breast tissue, and the long-term effects inherent to certain surgical techniques will also be used to determine the type of procedure you’re best suited for. A skilled and experienced cosmetic surgeon will never put your health in jeopardy but will work with you to create exactly the kind of results you desire. Whether that involves a noticeably enhanced or natural looking outcome is completely up to you.

Risks

As with any surgical procedure, no matter how routine it may be, breast augmentation comes with the possibility of side effects. Many patients who receive breast implants do not experience any serious complications as a result of their surgery, but some do and it’s important to know about these potential risks before going forward.

Implants can lead to the development of complications or adverse effects in roughly 1% of all patients, causing problems that may need to be addressed through further surgery or medical attention. Patients are usually advised to discuss these risks with their plastic surgeon before deciding to move ahead with the procedure. To determine if breast augmentation is suitable, weigh the benefits against the potential for complications.

With all surgeries, there is a risk of bleeding. Bleeding around the implant usually occurs within a few hours after surgery, enlarging the breast quite noticeably (hematoma). Fortunately, our surgeon can’t recall ever taking someone back to the operating room for this problem. Seroma is a condition involving the collection of clear tissue fluid around the implant that may need to be drained. Both are uncommon.

Temporary bruising and/or swelling is common. Usually, pain affecting the nipple and breast subsides quickly. Rashes on or around the breast, delayed wound healing, and changes in normal sensation (which are usually temporary) can also occur.

Infection

While infection can occur with any surgery, the rate for breast augmentation is estimated to be 1.1% to 2.5%, based on multiple studies that have been conducted thus far. (However, there is a lack of consensus on how to actually define “infection”, therefore, it is difficult to really say whether this figure is accurate.) There are a few factors that impact the risk of infection for breast surgery, whether it is for aesthetic or functional reasons. These include Diabetes, smoking, high BMI, prior breast surgery and steroid therapy.

Factors contributing to infection that are specifically related to the surgery are the following:

  • Placement of peri-areolar incision (partially around the areola)—this is the most common cause of infection due to harmful bacteria located on the skin or breast duct/tissue.
  • Contamination of the operating room.
  • Contamination of the implant or saline (from the manufacturer).
  • The patient has an existing infection somewhere else on their body.
  • The occurrence of a hematoma or seroma.
  • The placement of drains increases the risk of infection by five times.
  • The duration of the procedure may also be a factor, but this requires further research.

Symptoms

Usual symptoms of bacterial infection include pain and tenderness, swelling, and erythema. Sometimes, there may also be a fever and purulent discharge (pus). Infection usually occurs within the first month (in two thirds of cases), the average being at the eleventh-day mark. However, infection can also occur in the months to years after breast augmentation.

The diagnosis of infection is not always straightforward. It can exist just on the surface of the skin (simple cellulitis), be a superficial surgical site infection, or be a deep infection around the implant. A thorough medical examination must be performed, which typically includes a white blood cell count, swabs of discharge (pus) and blood culture (to check for sepsis).

An ultrasound of the breast can also be performed to check for fluid surrounding the implant, however even if there is no fluid present, there still may be an infection. That’s why it’s important to look out for other symptoms.

Infection treatment

If either a skin or superficial site infection is suspected, oral antibiotics may be sufficient in treating it. In the case of a deep infection around the implant, antibiotics administered by IV tends to be more effective. You may require surgery if the following occurs:

  • There is a lack of response to antibiotics within 48 hours.
  • The infection is not resolved within about a week.
  • There is a threatened exposure of the implant.
  • There is inflammation of the entire body (sepsis).

Surgery to resolve an infection involves removing the implant. Any fluid present is submitted for testing (microbiology and pathology). A drain is inserted. There is no need to remove the implant (capsulectomy), unless there is a biofilm. Following surgery, antibiotics are administered by IV for two weeks, and then a new implant is placed after a specific infection-free period. Generally, this is in the range of about three to six months.

Preventing infections

Our plastic surgeons take the greatest of care when performing your breast augmentation. There is good evidence that the following techniques contribute to good practices in preventing infection, to which our surgeons adhere:

  • Proper skin prep for surgery
  • Thorough hand/forearm wash
  • Clean surgical attire
  • Proper ventilation in the operating room
  • Minimize in/out traffic (especially when implant is exposed)
  • In addition, pre-op prophylactic antibiotics should also be administered as there is good evidence to support them. It is common practice to prescribe antibiotics post-op, although there is more evidence supporting pre-op antibiotics.

Capsular contracture

Capsular contracture involves scarring and tightening around the implant, causing the breast to feel firm and sometimes look abnormally round or elevated. This can sometimes be treated without surgery, but if the problem persists, may require another operation.

Rupture and/or deflation

One of the most notable risks of breast implants is rupture/deflation.

A breast implant rupture refers to a process where the outer shell of the implant is broken, creating a hole or tear that allows the substance inside the implant (either saline or silicone gel) to release. Ruptures can be caused by a number of different factors. Some of these include surgical mistakes (like improper placement, over handling during treatment, under- or overfilling saline implants or accidental damage from surgical tools), natural causes (such as physical trauma, general wear and tear, or by capsular contracture) and complications from medical procedures like mammogram compression or biopsy and fluid drainage affecting the breast.

Breastfeeding

While women can continue to breastfeed safely with breast implants, as there is no risk of silicone being transferred to breast milk, breast augmentation surgery can adversely affect milk production. This may make breastfeeding more difficult.

Aesthetic problems

While qualified surgeons are able to provide patients with the type of results they seek, some aesthetic and/or textural problems can develop regardless of how well surgery has been performed. In some cases, patients will be left with asymmetrical breasts (uneven shape, size or height), a “rippling” or wrinkling effect that can be felt or seen, or an unattractive scar.

Symmastia, aka Uni-Boob or Breadloafing: breasts that appear as if joined together in the middle.

For the majority of women, there is a natural space between the right and left breast. This space creates a separation between the two breasts, so that they may both be defined as separate mounds. More importantly, it also defines the cleavage. Regardless of the size of your breast implants, it is important that this space remains for a more natural appearance.

, if you notice that the space between your breasts has disappeared following your breast augmentation or the skin in the area is raised to a certain extent, then you have developed symmastia (a condition that can also exist congenitally). Informally referred to as “breadloafing”, symmastia is a very rare risk of breast augmentation that can occur due to improper implant placement probably caused by one or more of the following:

  • A failed attempt at enhancing cleavage.
  • The cutting of tissues that let the implant drift out from its intended position, most often because the pocket was too large for the implant.
  • Excessively large implants, particularly in thin patients who have thin skin (as the skin can be pulled away from the chest bone).
  • The weakening and stretching of tissue that separates the breasts.
  • Patients with chest wall abnormalities are also at a higher risk of developing symmastia.

The severity of symmastia varies, and it often causes the nipple/areola to appear off to the side of each breast. The condition can be safely corrected with surgery, but of course preventing it from occurring in the first place is always best.

6 ways our plastic surgeons prevent symmastia

1. Choosing an implant of the right size and shape for your body. The larger and wider the breast implant, the higher the risk of symmastia. While you can still get larger breast implants, it is important to understand that doing so can increase the risk. Having said this however, our plastic surgeons have performed breast augmentation on several patients who have chosen implants that are rather large for their body type, without any problems at all. This is because of their surgical skill and expertise.

2. Positioning the implants properly in the body using accurate surgical techniques and instruments. Blunt dissection and creating incisions in the body “blind” can increase the risk of symmastia, as they are not precise.

3. Creating a pocket for the implant that avoids an over-dissection of tissue in the cleavage area. The pocket should be “just right”–not too big and not too small. This involves an accurate surgical plan devised prior to performing surgery.

4. Placing implants under the chest muscle. The chest muscles insert into the chest bone on either side of the midline. When the implant is placed under the muscle, it is almost impossible to get symmastia.

5. Placing implants without trying to put them too close together, in a failed attempt to create cleavage.

6. Adapting surgical techniques for patients with chests that “cave in” (chest wall deformity).


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