BREAST AUGMENTATION AT POWER PLASTIC SURGERY

When it comes to breast augmentation, you’ll want the best. As the most performed plastic surgery procedure each year, not all breast augmentations are created equal. Whether it’s complications or simply not the results you were hoping for, revision is a very real part of breast augmentation. This means your breast augmentation begins with determining the best options for you with the experience you need in a breast augmentation expert. That’s why it’s important to look at your options with a board certified plastic surgeon who can make your breast augmentation results the best they can be.

For most women, breast augmentation is a way to boost their confidence in their figure. You deserve to love your breasts, and Dr. Stephanie Power is a leading breast augmentation plastic surgeon in the Toronto area with experience helping women achieve their ideal results and their ideal body.

"My patients are real women.
Mothers and next-door neighbors, not models."

- DR. STEPHANIE POWER

What is Breast Augmentation?

Breast augmentation is a way to boost your confidence through enhancing your breast size and shape. It involves the placement of implants inside the breasts through surgical incisions. Many women consider breast augmentation as a way to enhance their natural breasts while others opt for breast augmentation as a way to restore their breasts after pregnancy or weight loss. Some women even opt for breast augmentation if their breasts are asymmetrical. There are a few different factors that will determine your breast augmentation results, and you’ll discuss these with Dr. Power during your consultation.

Implant Type

The two types of implants are saline and silicone. Saline implants can come with benefits like a lower cost and smaller placement incision.  If a saline implant ruptures, you will notice loss of volume and the salt water is resorbed by your body. Rippling is more common though with saline implants, particularly in thin patients.  On the other hand, silicone implants can come with benefits like a more natural feel but require some monitoring for silent ruptures. Form stable implants are a type of silicone implant that are filled with a material similar to a gummy bear. These are one of the newest options for implant technology. This means the silicone filling won’t leak or migrate in the event of a rupture and can feel extremely similar to natural breast tissue.

Implant Size

Implants are sized differently than bra cup sizes, so an important part of your consultation will be trying on sizers to determine the best size for your goals. Some measurements that will determine your best implant size include your breast base diameter since a smaller chest can mean that certain implants will look more prominent. Whether you’re hoping for a more natural look or an augmented one, finding the right implant size for your goals is an important step.

Implant Shape

Breast implants have been made in both round and anatomical or teardrop shapes.  Many women decide to get breast implants to increase fullness of the upper breast.  Round implants remain the most popular shape of implant. Teardrop implants were created to mimic the natural shape of the breast with greater fullness in the lower pole.  The challenge with teardrop implants though is risk that the implant may rotate or shift.  They were only available with a textured surface to lower risk of the implant rotating in the body. There have been safety concerns about textured implants and teardrop implants are not currently an option.  Implant size and placement also affect shape, so the best choice for you will depend on your presentation and goals.

Incision Placement

There are two main incision options for your procedure. The two most common ones are inframammary (below the breast crease) and periareolar (around the nipple). Each option will leave scarring, The inframammary scars are hidden within the breast fold as the implants settle into position.  Periareolar scars are concealed along the lower border of the areola. Each option also comes with some benefits, and the right option for you might depend on factors like your chosen implant and placement preference. In some cases, implants can be placed through a transaxillary (through the armpit) or umbilical (belly button) incision.

Implant Placement

Implants can be placed either on top of or underneath the chest muscle. Each option comes with some benefits— placing the implants on top of the chest muscle can give greater cleavage but isn’t recommended for women who don’t have much breast tissue or have a smaller chest. Placing the implants below the chest muscle can be a good option for a more natural result but can cause visible movement if you work out with upper body movements. This can also make your recovery more substantial.

How is Breast Augmentation Performed?

Breast augmentation is performed under general anesthesia. Firstly, your chosen incision is made, and a pocket is created in the breast tissue. Then, the implant is carefully placed either on top of the chest muscle or underneath it. If you opt for saline implants, these can be placed through a smaller incision and then filled with saline solution. In the case of silicone implants, these are pre-filled and placed as a whole.  The incision length for silicone implants may also be reduced if an implant funnel is used for insertion.  Once the implants are in place, your incisions are closed and made ready for recovery.

Breast Augmentation Recovery

You’ll receive detailed instructions to follow to make sure that your recovery is smooth and successful. Since your surgery will be performed under general anesthesia, you’ll need to arrange for someone to take you home and stay with you for 24 hours. You can expect about one to two weeks of recovery. You’ll be given prescription medications to fill so you can manage swelling and discomfort, the worst of which is usually over the first few days of recovery. You should plan on wearing a surgical bra for around 6 weeks after surgery to support your new implants, but you can return to work or school within one week or so. You’ll return for follow-up appointments to check your progress and ask any questions you may have. You’ll also receive Dr. Power’s contact information for any questions you have at home.

Procedures to Enhance Your Breast Augmentation

The most popular option to include with your breast augmentation is a breast lift. Sometimes called a breast lift with implants, this combination is a great option if you also have sagging caused by weight loss, aging, or breastfeeding. Breast augmentation is a regular part of a mommy makeover procedure in order to restore volume in the breasts through implants.

Breast Augmentation FAQs

Whou2019s a good candidate for breast augmentation?

The best candidates for breast augmentation are women who are in overall good health and have realistic expectations from breast augmentation. Most women who opt for breast augmentation are looking to improve their confidence with larger breasts and feel like their natural breasts don’t flatter their figure. Other women opt for breast augmentation as a way to restore their figure after pregnancy and breastfeeding.

Can I breastfeed after breast augmentation?

Breast implants themselves don’t affect your ability to breastfeed. However, some women have trouble breastfeeding after breast augmentation because of changes in nipple sensitivity. Fortunately, certain incision patterns can make it more likely that you can successfully breastfeed after breast augmentation, so Dr. Power can recommend your best options.

What is natural breast augmentation?

Natural breast augmentation is a term for a fat transfer procedure that augments the breast using your own fatty tissue. Although this is a great option for some women, it doesn’t achieve the same results as breast implant surgery. Sometimes, it can be effectively paired with implants if you don’t have sufficient breast tissue to cover the implants. Dr. Power can discuss your best options during your consultation.

Do breast implants need to be replaced after 10 years?

You’ll likely hear that your implants will need to be replaced every 10 years, but this isn’t the case. Breast implants are designed to be lifelong medical devices and don’t need to be replaced as long as you’re happy with your results and aren’t experiencing any complications.

Do breast implants interfere with breast cancer screening?

You’ll need to take special steps during breast cancer screening if you opt for breast implants. When scheduling your screening, you should make sure your technicians know that you’ll need specialized imaging to view your breasts with implants in place. Dr. Power can recommend your best options for breast cancer screening after implants during your consultation.

Do breast implants cause cancer?

There’s no evidence to suggest that breast implants cause cancer. In the last few years, a link has emerged between textured implants and an extremely rare form of lymphoma (anaplastic large cell lymphoma). Some numbers suggest this risk is 1 in 3800 to 1 in 30,000 women with textured implants. Textured implants are no longer an option. .ALCL is treatable with the right steps so Dr. Power will make sure you understand the potential risks during your consultation.

What is capsular contracture?

Capsular contracture is a possible complication with any implant surgery. It happens when the body recognizes the implant as a foreign body and creates a capsule of scar tissue around it. In some extreme cases, this can cause the implants to shift out of place and become hard and uncomfortable. In this case, the scar tissue may require release or removal. Risk of capsular contracture can be reduced with the right surgical techniques and aftercare steps, so Dr. Power will discuss the risks with you.

What are different types of implants?

Implants may be categorized based on filler, shape, and size.nAll breast implants have a silicone shell as the outer layer.nThey may be filled with either saline (salt water) or silicone.nSome patients prefer silicone implants for a more natural feel vs. saline implants, however some studies have shown no difference when they are placed under the pectoralis major muscle.nThere are many generations of silicone implants. Current silicone implants are made of cohesive gel, which is form stable. This means there is lower risk of bleeding through the implant shell and if implant failure or rupture occurs, it is contained within the implant pocket.nImplant shape may either be round (most commonly) or anatomic (tear-drop shaped).nThe concern regarding anatomic implants is that they may shift in the pocket, which could lead to secondary aesthetic concerns.

What are different incisions for breast augmentation surgery?

Implants may be placed through different skin incisions.nThe two most common approaches are inframammary vs. periareolar.nPlacement through an inframammary incision results in a short scar hidden in the fold below the breast.nThe periareolar approach leaves a scar at the lower half of the areola-skin junction, which is generally inconspicuous once healed.nSome studies have shown lower capsular contracture rates and fewer complications if revision surgery is needed following the inframammary approach.nLess commonly implants may be placed through transaxillary (underarm incision) or umbilical (belly button) approaches.nThese approaches make implant positioning more difficult due to less visibility during surgery.nThere is also increased risk of bleeding since it is more difficult to carefully control during surgery due to the remote access.nScars in the underarm region may also be more visible when wearing certain clothing (e.g. tank tops, sleeveless dresses) and should be carefully considered before opting for this technique.

What are different planes for breast implant placement and how is this determined?

Implants may be placed either above or below the pectoralis major (chest) muscle.nSeveral factors are considered when selecting implant placement, including body habitus and amount of natural breast and soft tissues, aesthetic goals, and level of athleticism.nIf patients are quite slender and do not have adequate breast tissue to provide coverage for the implant, placement under the pectoralis major muscle (submuscular plane) may be recommended to improve the aesthetic result.nIf an implant is placed above the muscle in a patient with little natural breast tissue, there may be higher risk of implant visibility, rippling, and dissatisfaction with aesthetic outcome.nIf patients have adequate breast tissue to provide implant coverage – generally corresponding to 2cm of tissue when pinching the upper pole of the breast – implants may be placed above the muscle.nThis is referred to as the subglandular (under breast tissue, above muscle) plane.nFor patients who are quite physically active in upper body activities (for example, rowing, personal training), it is important to know that submuscular implants will shift with contraction of the pectoralis muscle.nIf wearing form-fitting clothing, you may notice movement of the implants when performing these activities.

What to expect during consultation for breast augmentation?

During consultation, a detailed history will be performed. This will focus on your aesthetic concerns and surgical goals.nIt is also important to know about your past medical history, pregnancy history, whether you have breastfed or wish to breastfeed in the future, and whether there is any personal or family history of breast disease or cancer.nA detailed physical examination will also performed to assess breast and thorax measurements, which will help to determine appropriate implant measurements.nDr. Power will also inquire regarding weight history and lifestyle. If significant weight gain or loss is experienced after surgery, breast appearance may also change.

How is implant size selected?

Implant size determination is one of the most important considerations.nDr. Power will ask about your goals and desired look following augmentation.nCup sizes vary widely between bra manufacturers and are not standardized measurements.nYou will have a range of sizers to try on pre-operatively. This is not an exact science however, since the implant fits differently when inserted surgically vs. within your bra on top of your natural breast tissue.nDr. Power will also discuss the rice test, which is another tool that may guide size selection.nAt home you may fill a cut-off nylon stocking with rice to the desired size when placed in your bra.nAvoid tying the nylon too tightly so that the rice moves freely and molds easier.nYou may then bring the rice to your clinical appointment. It will be measured and a corresponding implant size discussed.nDr. Power will ensure that there are no surgical concerns regarding desired implant size. For example, the desired size may be considered too large based on clinical examination and potentially too tight for the implant pocket. This could increase the risk of healing complications or suboptimal aesthetic result.

What to expect the day of breast augmentation surgery?

You should begin fasting (no food or drink) at midnight prior to surgery.nIf you take any prescription medications, please discuss with Dr. Power whether they should be taken on the morning of surgery with limited sips of water.nSomeone must accompany you on the day of surgery to drive you home afterwards once discharged.nYou will be advised regarding the time to present at the private OR facilities at 199 Avenue RoadnYou will be assigned a locker for personal belongings when you check in for surgery.nRoutine vitals will be checked and you will meet the anesthesiologist who will be performing your general anesthetic and OR nurses.nDr. Power will see you before surgery to perform surgical markings, answer any remaining questions, and review post-operative instructions.nOnce you are taken to the operating room, a checklist will be performed based on standardized operating room guidelines to confirm patient and surgery details and you will be put to sleep shortly thereafter.

What to expect after breast augmentation surgery?

You will wake up from surgery in the recovery room.nPain medication is administered during surgery and will be supplemented in the recovery room if any discomfort is experienced.nDr. Power will have provided a prescription for post-operative pain medication prior to surgery. It is recommended to fill the prescription in advance to avoid needing to stop at the pharmacy on the way home.nYou will be discharged an hour or two after surgery once drinking well and medically fit.nPlease arrange to have someone stay with you for 24 hours after the general anesthetic to ensure personal safety.nYou may require prescription pain medication for a few days following surgery and may then transition to Tylenol plain or extra-strength as needed.nYou may resume showering the day after surgery.nA detailed instruction sheet will be provided outlining appropriate incision care and activity restrictions.nIt is important to wear a sports bra full-time (even when sleeping) for one month following surgery.

What is the anticipated recovery after breast implants?

Patients returning to office-based work or academic programs are usually able to return within a few days to one week after surgery.nOnce no longer taking prescription pain medication and comfortable performing upper body movements, you may resume driving.nTo lower risk of bleeding, it is recommended to avoid strenuous activity, heavy lifting, and exercise for one month after breast augmentation.nAlthough the risk of bleeding decreases as more time passes after breast augmentation, avoiding activities that increase your blood pressure and heart rate is important during this time period.nThere will be swelling following breast implant surgery. Although final results will not be apparent until one year post-operatively, the majority of swelling will settle within the first few months.

What are potential complications of breast augmentation?

Early complications of breast augmentation include bleeding, bruising, hematoma formation (collection of blood or ongoing bleeding into the implant pocket), and infection.nThere is also risk of altered nipple sensation, delayed wound healing, hypertrophic (thickened) scarring, and potential need for revision surgery.nAesthetic complications include rippling, implant distortion, malposition, and capsular contracture.nCapsular contracture refers to scar tissue that develops around the implant since it is a foreign body.nIt ranges from a mild capsule that does not cause any distortion of the implant or pain to an implant that is fixed, painful, and high on the chest wall.nRevision surgery may be required to address moderate to severe capsular contracture.nDevice failure may also occur, ranging from an asymptomatic silicone leak noted only on imaging (“silent rupture”) to a deflated saline implant which is fully decompressed and flattened.nImplant failure may be related to ongoing friction at an implant fold or potentially valve failure on a saline implant.nThere is no “lifespan” of a breast implant. If a patient remains pleased with the aesthetic appearance and does not report any symptoms, it may be observed over time. Revision surgery is not required unless complications or concerns arise.

Are there any risks associated with larger breast implants?

Larger implants generally lead to more ptosis (lowered position on the chest wall) over time than smaller ones.nThey may also lead to greater thinning of your natural breast tissue over time.nSome studies have found lower capsular contracture rates for implants 350cc or less.

Is there a link between breast implants and lymphoma?

This has been a hot topic over the last few years.nThere does appear to be a very rare association between breast implants and an uncommon type of lymphoma – anaplastic large cell lymphoma (ALCL)nFortunately the risk is extremely low and the particular type of lymphoma is treatable.nSome reports have shown less than 100 cases worldwide.nIt may occur in approximately 1-3 per million breast augmentations performed.nImplant-related ALCL has been documented following cosmetic breast augmentation as well as breast cancer reconstructions.nIt is important for any patient who develops late swelling or pain of one breast a year or more after breast augmentation to discuss the very low but potential risk of ALCL with your surgeon.

Is there increased risk of developing autoimmune disease from silicone breast implants?

Fortunately not, although this was a major concern many years ago and remains a frequently asked question.

How many follow ups are required after breast implant surgery?

Patients generally return for routine follow up visits one day after surgery to rule out any bleeding, then at one week, three months, and one year post-operatively.nPatients are welcome to schedule additional follow up at any time if concerns arise.

Do breast implants affect screening for breast cancer?

Studies have interestingly found lower incidence of breast cancer in patients with breast implants.nAugmented patients generally have less natural breast tissue than non-augmented patients, which may partially explain this finding.nSome theories have questioned a protective effect of silicone.nStudies have not found any delay in breast cancer detection following breast implant surgery.nIt may actually be easier to palpate any abnormalities on self-breast examination, since there is a firm implant backing to press against.nResearch has shown that patients with breast implants often detect breast tumors at a smaller size than patients without implants.nThis may be attributed to frequent self-examinations when massaging the breast implants.nSpecial mammogram views are required following breast augmentation. It is important to find a breast screening center that is accustomed to imaging patients with breast implants to ensure the breast tissue is appropriately visualized.nGiven that breast augmentation is the most commonly performed cosmetic surgery, these centers are becoming increasingly widespread.

Do you have to replace breast implants every 10 years?

This is a common myth regarding breast augmentation. Breast implants may remain in place as long as there are no medical or aesthetic concerns. Routine replacement is not indicated

Can breast implants change nipple sensitivity?

There is risk of increased or decreased nipple sensation following breast augmentation. The majority of cases resolve over time, however some studies quote up to 15% risk of permanent sensation changes. The risk may be lower with smaller implant sizes and when placed below the pectoralis muscle through an incision in the inframammary fold.

Should I avoid breast implants if Iu2019m an athlete involved in contact sports?

Playing contact sports is not a contraindication for breast augmentation and does not increase risk of implant rupture. Contact sports may be resumed once you have healed well following breast augmentation. You may generally resume exercise and routine sports after one month following breast implant surgery.

Am I too skinny or athletic for breast implants?

Slender patients with limited breast tissue may still undergo breast augmentation. Implants are generally placed below the pectoralis muscle to lower risk of aesthetic complications (for example, implant visibility, rippling, and palpability) and to give a more natural result. The pectoralis muscle provides extra coverage for the implant, which gives a more natural result. It is important to discuss your aesthetic goals when selecting implant size. Athletic patients may also be candidates for breast augmentation. Many athletic patients often have limited breast tissue in the upper pole. Submuscular implants may also be recommended based on clinical presentation. It is important to consider that submuscular implants will shift with pectoralis muscle contraction. If you are quite active in upper body work-outs or rowing, for example, you will note shifting of the implants with pectoralis contraction, which may be apparent through tight clothing.

Can breast implants rupture and cause silicone poisoning?

Fortunately not. Silicone breast implants have evolved over time. Early generations demonstrated thin shells with low viscosity silicone. These implants were prone to rupture and leakage. The latest generation of silicone implants are made of cohesive gel. The silicone does not bleed through the implant shell or migrate if rupture occurs. If the implant shell is compromised, it is generally an incidental finding noted on imaging (ultrasound or MRI). The silicone will not travel throughout the body.

Are fat injections an alternative to breast implants?

Fat grafting is an option for breast augmentation, however does not achieve equivalent results to breast implants. The procedure involves suctioning fat from regions of excess fatty tissue (most commonly the abdomen) and then carefully preparing the fat for re-injection into the breasts. Once the injected fat has reestablished a new blood supply, the tissue may feel quite natural however the size and shape do not match results achieved from breast implants. There are risks of fat grafting in the breasts, including regions of fat necrosis (which are firm areas where the fat has not established an adequate blood supply) and limitations on size. There was initial concern whether injected fat may interfere with detection of breast cancer or cause microcalcifications, leading to false positives on breast imaging. Others questioned whether injected fat stem cells may induce breast cancer. Studies thus far have demonstrated that fat injections appear safe for both reconstructive and cosmetic cases. It may be useful in smaller volume for contouring, for example, to mask implant visibility or rippling in select cases.

"The reception and check-in were warm, polite and efficient, and extra courtesies were extended as the patient had mobility challenges. Dr. Power is highly professional and personable in her manner. She carefully informed us of the procedure in an easily understandable way."

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