Breast Augmentation

What Can a Breast Augmentation Accomplish?

Breast Augmentation will help you attain a fuller breast size and more pleasing breast shape. It can be used to improve unevenness, and also provide a small amount of lift. Breast implant surgery is accomplished by placing a breast implant underneath the soft tissues of the chest (most commonly under the muscle). The implant may either be filled with silicone or saline. Alternatively, some patients may also opt to undergo breast augmentation by transferring their own adipose tissue (fat) from one or more areas of the body. This method is appealing to patients who would prefer not to utilize implants for augmentation but it has limitations when compared with using implants, and may not be suitable for all patients. Currently, the vast majority of patients undergo breast augmentation using implants .

Gummy Bear Breast Implants

Within the silicone implant category, there are two types of implants: moderately cohesive and highly cohesive silicone gel implants. The highly cohesive gel implants are the newest variety. The silicone inside this type of implant behaves like a solid. The silicone does not flow or leak, even when the implant shell is compromised (whereas a moderately cohesive silicone implant does not have these properties). The (highly cohesive) implant has been termed the ‘gummy bear’ implant in the media.

Due to their firmer consistency and ability to hold shape, gummy bear implants were initially manufactured in a ‘teardrop’ shape (which was not possible with non-gummy bear silicone implants). The teardrop shape was seen as a potential aesthetic benefit as it could theoretically mimic the shape of natural breasts more accurately. One downside of the implant is that the breasts feel firmer and were less mobile. Currently, teardrop shaped implants are not being used for breast augmentation due to the association of the textured surface (which all teardrop shaped implants posses) and BIA-ALCL.

In December 2011, Allergan introduced a new type of gummy bear implant: the Natrelle INSPIRA®. These highly cohesive gel implants have a smooth shell surface, which provides a much more naturally mobile augmented breast when compared to traditional (teardrop shaped) gummy bear implants. These smooth shell highly cohesive silicone implants have not been associated with the development of BIA-ALCL.

Both moderately cohesive and highly cohesive smooth shell implants are available for breast augmentation. They are very similar to each other except that the highly cohesive implants are much less likely to leak if the implant wall is compromised. It is very slightly firmer than the moderate cohesive implant, but most patients currently opt for the gummy bear due to the decreased likelihood of leakage.

Determining which type is better for you depends on a number of factors, which Dr. Tong will evaluate and discuss with you so that you can make an educated choice about silicone breast implants.

How to Choose a Breast Implant Size

During your consultation, Dr. Tong will find out about your goals, take anatomical measurements of your chest, and establish a range of implants from which you can choose. Choosing a breast implant size is a very personal decision. The process starts with you. Think about what you hope to achieve with Breast Augmentation. Collect photos that you would like to emulate and bring them to your consultation. This will give Dr. Tong a good idea of what you want to attain from Breast Augmentation.

Additionally, by viewing our Breast Augmentation before and after photos, and trialing implant sizers in the office, Dr. Tong will help you select your ‘perfect’ breast implant size. Finally, our clinic has the 3D Vectra Breast implant Simulator to further help you visualize the potential result. The Vectra simulation should not be used as the sole means of choosing your implant, but as another tool to aid in the selection process. This tried and true method has worked tremendously well during Dr. Tong’s years of cosmetic surgery practice in the United States and Canada.

How is the Breast Augmentation Procedure Performed?

Breast implant surgery is performed under deep IV sedation or general anesthesia. Patients are asleep and totally unaware of their surroundings during the procedure. The surgery is performed at St. Thomas Surgery Centre, located within Dr. Tong’s plastic surgery office in downtown Yorkville, Toronto.

First, an incision is made at the predetermined incision site, either in the breast fold, armpit, or at the edge of the nipple/areola complex. Dr. Tong surgically creates a space called the implant pocket, usually under the chest muscle (submuscular), or sometimes over the chest muscle (subglandular). He then inserts the implant into the pocket through the incision. After insertion, the operating table is positioned so that the patient is sitting upright (while still asleep). This allows Dr. Tong to judge the implant position and size in the most precise manner. Dr. Tong will make adjustments as needed to obtain the optimal appearance. He places a few stitches to close the incision and the anesthetist will gently wake the patient from anesthesia.

Risks and Complications of Breast Augmentation

As with any surgery, there are risks involved with having Breast Augmentation. Although the procedure has a low risk profile, Dr. Tong will make sure to go over the pertinent potential problems associated with Breast Augmentation at the time of your consultation.³

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

Implant Rippling

The risk of implant rippling, which means the surface contours the implant can be seen through the skin, is often minimized by placing the implant under the chest muscle. Using a silicone implant helps to decrease the risk of rippling as its physical characteristics lower the likelihood of visible implant edges when compared to a saline implant. Additionally, choosing an appropriate-sized implant for the existing skin envelope (i.e. one that is not too large) will decrease stretching of the soft tissues that can contribute to rippling.

Surgery may be an option if rippling occurs, as long as it’s possible for the implant to be placed under the muscle. Additionally, a saline implant can be exchanged for a silicone implant when a saline implant is present Fat transfer is another option to improve rippling. Using fat that is harvested from another part of the body, the rippling can be made less visible by injecting fat along the areas as a means of camouflage.

Malposition

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

Capsular Contracture

Capsular contracture occurs when scar tissue forms around the breast implant. When the scar tissue becomes thickened, the breast can look and feel different. Symptoms include the breast feeling firmer or tight, the breast changing shape, the implant migrating upwards or pain. The formation of scar tissue around an implant is less likely with under-the-muscle placement when compared to insertion over the muscle. Using an incision in the breast fold also decreases the risk of capsular contracture when compared to a periareolar (“nipple”) incision. If capsular contracture is significant, the correction requires surgery to remove scar tissue. The implant is also usually replaced.

Asymmetry

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

Implant Rupture

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

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)

Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) is a rare type of lymphoma that can occur around a breast implant. This type of cancer has been found to be associated with textured surface breast implants. The cancer is not a true breast cancer but is a cancer related to the immune system. When detected early, the cancer is very treatable. To date, there have been no confirmed cases of BIA-ALCL that involve only a smooth implant, and therefore breast augmentation with Dr. Tong is only performed using smooth surfaced implants.

If a patient has a textured implant from prior surgery, there are currently no recommendations to have them removed in the absence of any other symptoms. However, a patient should monitor their breasts. The most common symptom of BIA-ALCL is painless swelling of the breast due to a fluid collection. The swelling most commonly occurs 7-10 years after a textured implant has been placed, but may occur at a sooner or later stage as well. Other symptoms include the presence of a lump, skin rash, enlarged lymph nodes, weight loss or fever. If you have any of these symptoms in association with breast implants, schedule an appointment for further assessment with Dr. Tong or your original surgeon.

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

How to Choose the Best Plastic Surgeon For You

Breast Augmentation and Pregnancy

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

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

How Long Do Breast Implants Last?

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

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

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

Fat Transfer Breast Augmentation

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

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

Get Educated About Breast Augmentation

There is a lot of information to digest during your Breast Augmentation consultation and Dr. Tong will make sure that you are informed at every step. The initial consultation may take over one hour to complete. You will never be rushed. We feel that the better-educated patient will make better choices about her surgery and her surgeon.

To learn more about how Toronto Breast Augmentation surgeon Dr. Lawrence Tong, can help you with your Breast Augmentation goals, set up a consultation with Dr. Tong by giving us a call at (416) 972-0999. Alternatively, let us give you a call; just fill out our contact form and we will contact you on the same or the next business day. No physician referral is needed.

See Dr. Tong’s work in our Breast Augmentation photo gallery.