Breast Augmentation

Breast augmentation involves placement of an implant to increase the fullness and projection of the breasts. Every woman has an ideal image of how they would like their breasts to look and this is a very personal decision.Some common reasons for breast augmentation are to:

• Enlarge a naturally smaller breast
• Restore fullness following pregnancy or weight loss
• Achieve better symmetry in breast size and shape
• Help balance the breast appearance with other body proportions

When considering breast augmentation, there are several factors to think about. These include:

• What type of implant is desired for the breast enhancement
• Where the incisions are made to allow the implants to be placed behind the breast.
• Where is the implant placed, either above the chest muscles, or below the chest muscles.
• What size implant will safely achieve the desired breast appearance.

1. IMPLANT TYPE
   The first decision is whether to use silicone gel or saline implants. In general, many women find the silicone gel implants have a more natural look and feel, compared to the saline implants. Saline implants are essentially a silicone shell filled with sterile salt water and can potentially be placed through smaller incisions.

2. INCISIONS
   An important goal is to make your incisions as unnoticeable as possible, however, there will always be a visible scar after surgery. The most popular incision sites include the lower border of the areola (peri-areolar incision), where there is a natural colour change from the areola pigment to the breast skin, or through a small incision in the breast crease (inframammary crease), where the shape of the breast helps to cover this area. The implant type and size, and your breast size and shape, can influence which method may be best suited for you.

3. PLACEMENT
   The breast implants can be placed on top or underneath the chest muscles (pectoralis major muscle). Part of this decision depends on the aesthetic goals you have for your breasts and your starting breast size. Placing the implants directly below the muscle provides more coverage over the upper portion of the implant. This can potentially create a more natural breast appearance. There is a spectrum of looks that can be achieved, from a natural breast appearance to a very augmented look to the breast. One of the main goals during your consultation is to determine where you feel your ideal breast appearance is on this spectrum.

4. IMPLANT SIZE
   The size of the implants for your breast enhancement is one of the most important and exciting decisions for you to make. Your ideal breast size, shape and appearance is a very personal decision, and through your consultation, one of our focuses is to provide you with a safe range of implant sizes that would be compatible with your chest and body proportions. As part of your consultation, with the use of sizers and a custom sizing bra, you can visualize in the office how the different size implants will augment your breast appearance, and help ensure you achieve the beautiful look you desire.

Breast Augmentation is performed as an outpatient procedure at a private surgical facility. This procedure will take approximately 2 hours and you will return home the same day. While a breast augmentation yields larger breasts right away, the final results may take several weeks to a few months as the swelling subsides, the skin stretches, implants settle, and scar matures. All patients wear a Surgical Couture bra by LaBratory, to support their breast during the healing period. The implants initially will be sitting unnaturally high, but with time, the implants will drop down into a more natural position. Some patients wear a bandeau to help guide the implants into their final position. There will be a gauze dressing over the incisions which can be left on for up to two weeks. Immediately after surgery, you will be taken into a recovery area for close monitoring and will be permitted to go home with a responsible adult when you are stable for discharge, typically after an hour. It is important that you have someone that will stay with you for the first 24 hours. Patients can start to shower the next day after surgery. You will receive a prescription for pain medication and antibiotics before or on the day of surgery. It is recommended that you set an alarm for the first two days of surgery every 4-6 hours so that you remember to take your pain medication regularly. You will be given detailed postoperative instructions that you should follow carefully.

Possible complications include hematoma (blood collection), seroma (fluid collection), sensory changes to the nipple, breast or nipple asymmetry, infection, nipple necrosis, DVT and PE. A scar forms internally surrounding the implant that is called a capsule. This may harden or tighten, a process known as capsular contracture. Breast implants may have to be changed or replaced if they are damaged (a saline implant deflates or a silicone implant ruptures). These risks are low and will be explained to you by Dr. Ho during your consultation.

Acute pain typically subsides after one to five days, but you may experience some discomfort from time to time for the first few weeks. You may also experience some altered skin or nipple sensation that can you may find uncomfortable while your nerves adjust after surgery. You will be able to start driving one week after surgery if you are no longer taking pain medication.

We recommend that you wear your medical brassiere during the recovery period to ensure optimal comfort and support of the breasts.  It is important to refrain from exercise and heavy lifting during your recovery period in order to limit complications. Because it is possible to bleed into the pocket around the breast implants for the first several days, take it easy until you have permission to increase your activity level. You will be able to return to upper body workouts (pectoralis and lattisimus) 6 weeks post-op.

When thinking about time off work, or away from social commitments, 2 weeks is most likely a safer window of down time. The final results can appear gradually over the first few months as the implants settle into the correct position and the swelling subsides. Scar tape and massage of the incision is used for the first 6 weeks. All stitches used are dissolvable and are placed under the skin so there are no stitches to remove. The incisions will continue to fade over the first year.