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Breast Augmentation

Breast augmentation is the most popular plastic surgical procedure in North America. According to the American Society of Plastic Surgeons, 300,000 breast augmentations were performed in 2017, which is an increase of 3% over 2016.

Are you planning to get implants? Do some research first — as an informed patient, you’ll experience an improved surgical experience and better perceived results.

The first question most women ask is how much? Let's answer that question first because it's the easiest: The cost of breast augmentation varies depending on where you reside. It may cost from $8,500 to $11,000; there are a difference in the prices offered depending on several factors, such as anesthesia fees, surgeon’s fee, surgical facility fees and the cost of post-surgery garments. Several surgeons offer financing options if your budget is too restrictive.

So, now that that's out of the way, let's get more in depth!

Breast implants for breast augmentation.

What are breast implants made of?

There are different types of breast implants. Saline breast implants are filled with sterile salt water, providing a uniform shape, firmness and feel. Gummy bear breast implants are filled with silicone gel. The gel is a little thicker and more cohesive than traditional silicone gel implants. They also feel a bit more like natural breast tissue. So, which breast implants are the best ones to use for my breast augmentation surgery?

Silicone and saline implants differ in material and consistency. Silicone implants are often preferred because of their natural look and feel. The silicone filling is much like natural breast tissue and fat so generally the end result looks and feels natural. A disadvantage is that you will need a slightly longer incision to introduce the implant (4-4.5 cm), and you often don’t know if it ruptures, which can be problematic.

However, you can also get natural and feeling results with saline implants, which are comprised of a solid silicone shell filled with sterile salt water. Less commonly, they may be pre-filled, although it’s more common that they are filled at the time of surgery, once the shells are placed inside the patient’s chest. Doctors say that the advantage of this breast implant type is that it requires a smaller incision than silicone implants. Saline implants need a smaller incision during the breast augmentation surgery (about 3 cm), and if it leaks you will know, making removal and/or replacement faster. How do you know? Well the obvious is that one of your breasts will begin to get smaller, but a more subtle clue is the breast will start to feel softer. If this happens, call your surgeon immediately.

Knowing the advantages and disadvantages of both you would know which will suit you better.

Breast Implant Profiles

Breast implants don't just come in different sizes and shapes (teardrop or round) — they also come in different heights. The height of a breast implant is known as its "profile". Choosing the right profile is crucial for your successful breast augmentation result.

Breast implant profiles

The profile or projection of a breast implant is based on how far the implant projects outward from the body, or specifically, your chest wall. This is determined by the width of its base and how much of the base occupies your chest wall, as well as its height (how far it stands out from your body). For example, a 350CC breast implant with a wider base width will be flatter than one with a narrower base width of the same size. This is because despite carrying the same volume, the implant is shaped differently. The higher the implant profile, the narrower its base and the more outward projection there is.

The Importance of Choosing the Right Breast Implant Profile

The profile of your breast implants will determine how your overall breast shape will look — particularly how your breasts will look from the side. This is why it's important that you choose the right one. Your breast augmentation surgeon can help you pick the profile that will achieve your desired improvement.

Mentor and Allergan breast implant profiles

In Canada, the two most prominent implant manufacturers are Mentor and Allergan. Both offer a range of breast implant profiles.

Mentor breast implant profiles

Mentor® manufactures saline and silicone breast implants.

Mentor MemoryGel® silicone breast implants

MODERATE or CLASSIC: This has the widest base width.
MODERATE PLUS: A slightly higher profile but still wide base width.
HIGH: Moderate base width and higher projection outward from the body.
ULTRA HIGH: The narrowest base width and highest projection.

Mentor saline breast implants

MODERATE (ROUND STYLE 1600): This has the widest base and least projection, to provide a full, rounded shape.
MODERATE PLUS (ROUND STYLE 2000): A similar base but with a slightly higher profile.
SILTEX® TEXTURE MODERATE (ROUND STYLE 2600): This has a moderate profile but a textured surface.
HIGH (ROUND STYLE 3000): This has a narrower base for the greatest projection from the chest wall.
MODERATE (TEARDROP STYLE 2900): Moderate projection due to a wider base.
HIGH (TEARDROP STYLE 2700): A prominent silhouette due to great projection from the chest wall.

Breast implant round and teardrop shape

Allergan NATRELLE® breast implant profiles

MODERATE (STYLE 10): The flattest profile. This comes in sizes 120cc to 800cc.
MODERATE PLUS (STYLE 15): Narrower base with more projection. This comes in sizes 155cc to 752cc.
HIGH (STYLE 20): A more prominent profile. This comes in sizes 120cc to 800cc.
EXTRA-HIGH (STYLE 40): The most projection with the narrowest base. This comes in sizes 120cc to 800cc.

Allergan INSPIRA® breast implant

LOW (STYLE SRL): The flattest profile. This comes in sizes 110cc to 610cc.
LOW PLUS (STYLE SRLP): Narrower base with more projection. This comes in sizes 125cc to 640cc.
MODERATE (STYLE SRM): A more prominent profile. This comes in sizes 140cc to 755cc.
FULL (STYLE SRF): The most projection with the narrowest base. This comes in sizes 180cc to 770cc.
EXTRA-FULL (STYLE SRX): The most projection with the narrowest base. This comes in sizes 200cc to 800cc.

The two most commonly selected profiles are moderate and high.

Other breast implant manufacturers include Sientra and Ideal Implant.

Sientra high-strength cohesive silicone gel (HSC and HSC+) implants are available in High, Moderate Plus, Moderate, and Low Projection profiles. Ideal Implant is only available at this time in high-profile.

Consider your breast width, too

You may want a wider implant base to avoid overly projecting breasts. However, the right profile for you is partially dependent on the width of your natural breasts. The base width of an implant should roughly match your own breasts. This is because if you get an implant that's too wide, it will extend beyond your breast circumference and its outline will become more visible when viewed straight on. It can also distort the shape of your breasts, making for an unnatural result. Overly wide implants may increase the risk of symmastia, or "uniboob", where the breasts join together and become one.

What look do you want to achieve? Each implant profile is designed to not only complement a patient's breasts, but also achieve their desired improvement.

Lower implant profiles are more suitable to achieve:

  • More fullness in the side of the breasts, also known as "side boobs"
  • More fullness in the upper portion of the breasts
  • Softer breasts
  • Softer breasts

Higher implant profiles are more suitable to achieve:

  • Pointier breasts
  • Rounder breasts
  • Firmer breasts
  • A more "enhanced" look
  • Can also decrease mild to moderate sagging

Sometimes, it's not just about size

The size of your implants will determine how large your breasts will be after surgery, but implant profile will determine what your overall breast shape will be. Sometimes, picking a different profile yields better results than selecting a bigger size.

Choosing the Right Breast Implant Placement

Breast implant placement is an important factor to consider in breast augmentation. Breast implants can be placed directly under the breast tissue, or under both the breast tissue and pectoralis major muscle in the chest.

What is the pectoralis major?

The pectoralis major is a muscle located on the breast bone and ribs, connected to the upper arm. Fan-shaped, it is responsible for moving the arm. When we talk about going “under” or “over”, we refer to the position of the breast implant in relation to the pectoralis major muscle. "Going under" means that it’s under the muscle. Going over means it’s over the muscle (and only under breast tissue).

But wait — there’s more to it.

Let’s get technical

“There are pros and cons for each implant placement,” Dr. Mahmood Kara, a board certified plastic surgeon based in Toronto, Canada, explains. “The most suitable placement for an individual patient really depends on their body, what results they want, and what is the safest for them.”

Subglandular or submammary

The breast implant is placed completely under breast tissue only. The pectoralis major muscle is not touched during surgery. This placement was the only option available for decades, from the time when breast augmentation was first attempted in the early 1900s, up to the late 1960s.

Advantages

Generally speaking, there is less discomfort and pain associated with this placement, something that is particularly noticeable in the first few days after surgery. This is because the muscle is not affected (any surgery that modifies the muscles tends to cause greater discomfort in recovery, and often longer downtime).

Another advantage is that it usually gives a more natural looking result. After all, you don’t have any breast tissue under your muscle. However, this is debatable, because at the end of the day, your results are largely dependent on the skill of your surgeon.

Mildly to moderately sagging breasts can also be made perkier with this placement.

Disadvantages

The risk of visible implant edges and rippling may be higher because there is less tissue coverage. However, if you have an “inch to pinch” of tissue in your upper breast area, then this is normally not an issue. You’ll have sufficient coverage to minimize this risk.

A round, “bolted on” appearance may result, although this isn’t a disadvantage for some patients since this look is actually preferred.

Mammograms and breast cancer testing may be more difficult to perform, since the implants will have to be "moved out of the way" to examine all the breast tissue.

Dual plane

When most plastic surgeons talk about subpectoral or submuscular placement for aesthetic plastic surgery, they refer to partial rather than total coverage of the implant by the muscle. This is called dual plane. Dual plane is basically a variation of going partially under breast tissue and muscle, with a specific area of muscles divided and altered to accommodate the implant. Usually, only the top third of the implant is covered by muscle.

Advantages

This breast augmentation placement can correct mild sagging because the implant is supported by muscle, preventing it from filling too much of the loose tissue affecting the lower portion of the breast.

It provides a more natural look in those patients with sufficient breast tissue because it takes on a more natural ski-slope shape.

Because both muscle and breast tissue cover the implant, there is less risk of visible edges or rippling.

Disadvantages

Sometimes, the muscle is not accurately modified, leading to a distorted breast shape. However, this risk is rare when the procedure is performed by a plastic surgeon experienced in this technique.

Compared to subglandular placement, there is more pain and discomfort experienced during the early stages of recovery.

Surgical modification of the muscle tends to result in more discomfort and pain during the first few days of recovery. However, prescribed pain medication should be sufficient in easing this.

When flexing the pectoralis major muscle, there may be some distortion of the implant. While it is generally minor, this could be a concern for bodybuilders and fitness models who are considering breast enhancement.

True subpectoral or submuscular

The breast implant is placed completely under breast tissue and muscle. True subpectoral placement is usually only used for breast reconstruction patients who do not have any of their own natural breast tissue. The procedure is often more complicated because it involves a staged approach, in which a tissue expander is used to first make room for the implant. The expander is inflated with saline to increase its size slowly over a few months. Once the desired size is reached, the expander is removed and replaced with an implant. This is the procedure that actress Angelina Jolie had performed after her double mastectomy.

Which breast implant placement is right for you?

The most important factor to consider when determining the right placement for you is the thickness of your natural breast tissue. Your surgeon will assess your goals and examine your breast tissue during your consultation. Remember the “inch to pinch” test: if you have an inch or more of tissue to pinch in your upper breasts, then subglandular breast implant placement is probably more suitable regardless of whether you’re getting saline or silicone implants.

Breast Augmentation Incision Placement

There are many things to consider when planning your breast augmentation surgery. The location of the incision is one of the most discussed. Your plastic surgeon must tell you the pros and cons of the different places where your breast incision can go, and you’ll know which incision will be best for you.

Breast implant incision placement

The peri-areolar incision is located partially around the areola. It is preferred by many surgeons because it allows for the most accurate positioning of the implant. It also leaves a barely visible scar because it's well hidden by the texture and colour of the areola border. However, it may increase the risk of compromising nipple sensitivity.

The inframammary incision (in the breast fold) is another popular incision because it also allows for fairly accurate implant positioning. The scar may be more obvious, but it's easily hidden by bras and bikinis.

The transaxillary approach (in the armpit) leaves the skin on the breast totally untouched, and the resulting scar is well hidden within the confines of the armpit. However, it is not favoured by many surgeons because it makes breast implant placement more difficult. In addition, saline implants and smaller silicone implants can only be placed through this incision.

Beautiful results can be achieved with any incision and the associated risks are low if you choose the right surgeon for your surgery.

Endoscopic breast augmentation makes it easier

Surgeon with endoscope

Endoscopic breast augmentation is one of the procedures you can choose for your breast enhancement. During the endoscopic breast augmentation surgery the plastic surgeon utilizes an endoscope; an instrument that incorporates special viewing technology that enables the surgeon to view images of the patient's internal body structure through small incisions. This allows the surgeon to position the breast implants within the patient's chest wall with ease, ability, and minimal scarring. The same basic techniques of a regular breast augmentation procedure are incorporated. The benefit of an endoscopic breast augmentation is that the patient gets fewer scars.

Measuring breast implant size.

Factors to Consider When Choosing Size

Breast implants come in sizes, based on the amount of volume the implant holds. The measurement is in cubic centimetres, and it can go from as little as 50cc to 800cc and over. There are four things women should consider before deciding on how much of an augmentation to have:

  • The size of your natural breasts and the amount of breast tissue you have.
  • Your body measurements, including your chest wall.
  • The elasticity of your skin.
  • Your goals

Choosing your new breast size can be a difficult decision, especially if you don’t know how to accurately measure your chest or the difference between B, C or D cups; allow your surgeon to help you choose the best implants for your surgery. You surgeon can help guide you in choosing the best size of implants for your body type. Look at before and after photos; you may find a result that matches the image in your mind and you can show our surgeon exactly what you want your new boobs to look like.

How Can My Breast Implants Have the Most Natural Look and Feel?

During surgery the breast implants will be placed in a subpectoral or subglandular position to create a natural appearance. The initial amount of natural breast tissue is also essential in determining how results will look. If you have little to no natural tissue, it will be difficult to achieve a natural look and feel, obviously. While there is no recipe for an ideal breast implant result, if you want natural looking results, the real key is finding a plastic surgeon with not just experience, but attention to detail and exceptional training.

So, how do you find the right plastic surgeon?

Searching online is probably the most convenient and easiest way to find a plastic surgeon.

Plastic surgeon doing consultation

Once you’ve found one, meet with them first for a consultation. The first time going to a plastic surgeon, you'll need to ask all the pertinent questions and dissipate any doubts you might have. The fact that you'll be entrusting them with your health should give you the confidence to ask direct questions, because you are essentially trusting them with your body. You don’t want to make an incorrect decision on your surgeon. Here is what we recommend you ask:

Credentials, certifications, and experience. You need to know the full background of your surgeon, leave no stone unturned. Be vigilant.

Partners, assistants, nurses and other medical staff. You should know who will be performing the surgery with the surgeon.

Places of work, previous patients and before/after pictures. You need to know where you’ll have your surgery, what kind of experience his previous patients had, and what was the end result of their surgeries.

Type of implants, scarring, complications, surgery time, recovery and post-op checkups. You need to be informed on what kind of implant your surgeon uses and why, where and how big will the scars be, what are possible complications, how long the surgery is, how long the recovery after surgery is, and what kind of post-op checkups are necessary.

Pricing, quality and warranty. Yes warranty. Get an exact quote of your procedure, with a very detailed report on costs (anesthesia, hospital fees and the like). You don’t want any surprises. Ask about the quality of their job and what kind of warranty the implants or the procedure has.

Availability for surgery. Ask about the surgeon's schedule and when the best time to have your surgery is.

How Do I Know if I’m a Good Candidate for Breast Enlargement Surgery?

Women often have very different reasons for wanting or needing breast implants; it can be because their breasts sag or lose their firmness, they need reconstructive surgery or simply because they want to have bigger breasts to improve their body image. The reason for having the breast augmentation procedure will vary from woman to woman; the truly important thing is to figure out whether you are a candidate for breast augmentation, as not every woman can have implants. Meet with a board certified plastic surgeon who will examine you in order to assess if you are a viable candidate for this surgery.

Do I have to wait until I’ve had children to have breast surgery?

This will mainly depend on you and how soon you want the surgery versus how soon you want kids. Having breast implants will not stop you from doing any of the motherly activities such as breastfeeding; many women who have had breast enhancement breastfeed their children without problem.

I want to get a boob job, but I’m afraid I might be too old, I’m in my early 50’s. Can I still have breast enhancement surgery?

It’s not uncommon for patients to be in their late 40s, early 50s and beyond. Any woman who has decided to get their desired body and opted for breast augmentation may be a candidate. There are many older patients who couldn’t be happier with the results, and they are thriving! The surgery has given them invigorated self esteem and they even feel younger now than they did before surgery. Your age shouldn’t be a problem for your surgery as long as you are healthy and suffer from no conditions such as high blood pressure or heart failure.

Woman with bright, young eyes after eyelid lift.

What You Need to Do Before Your Breast Augmentation

Once you’ve had your primary consultation with your surgeon, chose your implants and got your lab work done, it's time to start preparing. The date for your surgery will be set, and there are a couple of things you need to do in order to improve your recovery rate and minimize risks. Here’s what you should do:

  • Tell your doctor about any medication you might be taking.
  • Arrange for pet/child care in advance, plan for a week or two after your breast augmentation.
  • Stay healthy and don’t smoke for a couple of weeks before your procedure.
  • Avoid drinking alcohol for two weeks prior to your procedure.
  • Prepare a post-op recovery table; on it, put all your medication, books, movies, TV remote, and anything else you might need to pass time during your recovery.
  • Stock your fridge and cabinets, buy your after surgery bra and fill out the prescription you’ll need for after your procedure.
  • Have someone available to drive you to and from the procedure.
  • Arrange for someone to stay with you for at least a few days after the surgery; if you have no family members available, there are nurses that can be hired.
  • Buy gauze for changing your bandages and anything else your surgeon may have requested before hand and keep them close.
  • Organize your clothes; the most comfortable shirts and pants should be in an easy to reach drawer, wear only button down shirts to avoid lifting up your arms.
  • Take a shower, wash your hair and wear comfortable and baggy clothes on the day of the surgery.
  • Don’t use any beauty products or deodorant on the day of the surgery.
  • Make a list of any questions that have come up at the last minute and ask your surgeon before you go ahead with surgery.

What to Know for After Your Breast Augmentation

Immediately after your breast enlargement surgery you’ll begin taking prescribed pain medication to help ease the pain during your recovery; most women are allowed to go home the same day of the surgery. We strongly suggest having someone reliable to pick you up from the clinic or hospital, as you will be disoriented and in no condition to make your own way home. This is particularly important since general anesthesia is typically administered during surgery.

Simply put, you need to focus on recovery. When the implants have been placed beneath the muscle it is common to feel as though you have done one thousand push-ups when you first wake up. This is because of the stretching the chest muscles sustained during surgery. After your breast augmentation surgery, the next step is the recovery phase which will be guided by your surgeon every step of the way. It is vital that you follow your surgeon’s instructions completely.

Each patient will have a different recovery period depending on how well they listen to their doctor’s instructions, and how their body reacts to the implants. It is important to remember that more often than not a poor recovery might jeopardize the whole breast augmentation, it doesn’t matter how skilled your surgeon is, if you don’t take care of yourself and do what your plastic surgeon recommends, you may endanger the whole breast enhancement procedure.

During the first several weeks of recovery after your breast augmentation surgery you should wear a compression bra or a sports bra; your plastic surgeon will recommend the best one for your specific needs. This compression helps ensure that your incisions heal well, with minimal scarring and that the implants stay in place while the tissue around them heals properly. Underwire bras are not recommended because they can irritate the incision site of your augmentation, especially if it was done in the inframammary fold under the breast. Your breasts may stay distended and sore for a while after your augmentation surgery; final size and shape of your new breasts will not set in for several months, so relax and focus on your recovery. Many surgeons recommend wearing the compression bra every day and night for at least 4 weeks. While we know it’s not that comfortable to wear it for so long, but you must understand that it’s part of the process to ensure you have a complete and full recovery.

Once your breast augmentation surgery is complete, you will begin the recovery phase to ensure that your body has time to heal and look its best. This recovery requires that patients minimize physical activity for 3 to 7 days before slowly resuming more strenuous tasks.

Having said that, however, the amount of downtime required and the amount of time needed to make a full recovery that allows you to resume all normal activity ultimately depends on:

  • your general physical state
  • where the incision is placed
  • the size of implants used
  • whether the breast implant was placed above or below the pectoral muscle
  • most importantly, how you follow your surgeon’s post-op instructions

Your surgeon will guide you through the entire process step-by-step and they’ll explain how long your recovery time might be depending on the variables of your own breast enhancement.

A Word on Massage

Some surgeons recommend massaging the breasts after an initial recovery period has passed. This is because massage has been found to limit your risk of the soft tissue capsule shrinking and squeezing on the implant (a complication known as capsular contracture). Also, it is believed to be a good way to help your scars heal properly and to settle the implant. We recommend waiting a week or two after breast augmentation to start your massage therapy if recommended by your surgeon. This allows the stitches to properly heal and your tissues to become strong enough so massage doesn’t cause any more soreness or pain.

What is capsular contracture?

Capsular contracture refers to the hardening of scar tissue around breast implants; this compresses the implant and hardens/deforms it, which can be uncomfortable and in some cases even painful. Capsular contracture can occur around any kind of object implanted in the body. In the rare event that capsular contracture occurs, it can be resolved as is the case with most complications. Surgery can be performed to remove the capsule, and new implants might be needed which means you can change their size, shape or filling.

Having Fun

Couple having fun

We recommend waiting at least 3 weeks post-op before restarting regular sexual activity; having sex any sooner could result in healing issues. Here are some helpful tips for your partner that will make your first sexual experience after surgery enjoyable:

Playing with the implants before the 6 week mark or so could dislodge them, so keep it gentle and hands off!

No jiggling the breasts before 12 weeks or so. We know your partner loves to see your girls bounce, but doing it too early might cause displacement or other complications.

Don’t try any positions that might leave your breasts hanging downward or to the side before you are 12 weeks post-op.

Be advised, some women might have heightened sensitivity in their nipples while others might have their sensitivity reduced. Experiment to see where in the sensitivity spectrum you fall.

Consult with your surgeon before doing anything soon after your breast augmentation. If you are not sure or feel hesitant on what to do, and just have fun!

Mammograms

Woman getting mammogram

Some women are concerned about getting mammograms with implants. You can and should get mammograms as advised by your doctor. Screening for breast cancer is very important and it is recommended that women over 40 have yearly mammograms and other cancer screening tests. After breast augmentation, the screening could be a bit more difficult because the implants can make it hard to see tumors on the mammograms. However, if you see a specialist or a tech who has experience in doing mammograms for women with implants, then you can be screened without issue.

Mammograms may be painful and uncomfortable with or without implants, but early detection of cancer can save your life.

Woman with long blonde hair smiling in bra.

Be an Informed Patient

If you are planning to undergo breast augmentation, do your research. Although it is an elective surgical procedure that’s relatively safe with a high success rate, it is still surgery after all. Any surgery can be traumatic to the body, and the more informed you are, the smoother and more satisfying your experience will be.