Surgical Procedures

Breast Augmentation

"My breasts were shrunken and drooping after
pregnancy. Breast augmentation gave me back
my self-esteem."

"I'm completely healthy but my breast size makes me unhappy"

Millions of women are unhappy with their breasts.

They are self-conscious because they are too small.
Or they may be disappointed because the shape, size and position of their breasts are not what they once were.

Breasts shrink, sag and atrophy. Whatever the problem is, it can have a serious impact on a woman's emotional well being. Breast Augmentation can solve the problem.

Underdeveloped, small breasts can be enlarged.

Drooping, sagging breasts can be lifted and repositioned. Many breast problems can be addressed and the benefits are obvious. No more hiding in baggy clothes or undressing in the closet. The return of self-esteem and confidence.

New Attitude and a New You.

No exercises, devices or medications have any long term effect on breast size. There is only one way to increase the size of your breasts: breast augmentation. Over two million women have increased their breast size through breast augmentation, 383,886 in the USA in 2006 alone, up 19 percent from 1997.

Breast Augmentation is a procedure that satisfies a woman's desire for a fuller bust line. Many women were happy with their breasts in the past but realize that time, pregnancy and weight gain or loss has altered their breasts in ways they find unattractive. Breast augmentation can enhance your breast shape and size and give you the more proportional figure that you have always wanted.

You are not alone: The Aesthetic Society, which has been collecting multi-specialty procedural statistics since 1997 says that as of 2007 the overall number of cosmetic procedures has increased 446 percent since the collection of the statistics first began.

Breast Augmentation is an unnecessarily complicated subject when in reality it is really quite simple.

There are really only four decisions to be made. Some you make, some are made by your surgeon and the rest are made by you and your surgeon.

What are the "Four Decisions"?

1. Am I emotionally ready for the procedure?

Breast augmentation is an intensely personal emotional decision, not a logical decision.

This is why friends (husbands!) and relatives often react so strongly and negatively when the issue of breast augmentation comes up. They don't share the emotional need for the procedure and only see the possible drawbacks and not the potential benefits. After doing many hundreds of breast augmentations we have figured out that you don't need counseling- you need "boobs'. Many women feel guilty and torn about their desire for breast augmentation. This is quite normal but not surprisingly no one feels this way after the procedure!

Most of our patients have been circling around the procedure for many years but have deferred it for financial, emotional, familial or marital reasons. Are those issues now resolved for you? Could you handle a complication? You will know when you are ready. This is your decision to make.

2. What is the best implant choice for me?

This is a logical question best made by you and your surgeon. Everyone has preferences. Here are mine. Without doubt the best implant for the majority of breast augment patients are cohesive silicone gel filled implants -either textured or smooth.

These implants provide the softest most natural looking breasts. Because of their soft "Gummi Bear" like consistency they allow complete control over the height, width and projection of the implant so that it suits your needs and anatomy. Cohesive gel implants impose their shape onto the breast so you really get projection and fullness where you need it. Cohesive gel implants do not run, deflate or sag. They are extremely durable and are expected to have a lifespan much longer than saline filled implants. Because gel filled implants are usually textured and prefilled they require a larger incision for placement than do saline filled implants. This incision is usually made in the inframammary (under wire) fold and is about 5 cm ( 2 inches) long. It usually heals inconspicuously.

Cohesive gel implants have a excellent safety record and have been available in Europe for almost 20 years. They have been widely available in Canada since 2006. We have used many hundreds of them since 2002. There is no association whatsoever with this, or similar, implants and any known disease including cancer. In fact, women with breast implants actually have a lower incidence of breast cancer than women without implants. Neither saline nor gel filled implants interfere with the detection of breast disease in any meaningful way. These implants were approved for use in the United States as of October 2006 as well.

Note how cohesive gel implant ( right) retains its shape

Although saline filled implants have been around since the 1960's, they have a number of design problems that make them less than ideal for breast augmentation.

The first problem is that real breasts are not filled with saline.

Saline is a liquid that will run to fill the bottom of the implant when you are in the upright position. This leaves the upper pole of the implant (and breast) relatively empty. This results in folding and rippling of the implant. This can be visible externally. The implant can also be felt in thin women with little breast tissue.

"Over-filling" (adding more saline than recommended by the manufacturer) the implant does not eliminate this problem but creates a weird, round, "beach ball" appearance and creates a new problem of visible implant "scalloping". Many of the strange breast augmentation pictures that you see on the internet are overfilled saline implants.

If your surgeon recommends this get another opinion.

Saline implants feel unnatural as well.

Because they flex continuously these implants will develop a small pin hole leak and the implant will deflate usually at 10+ years. This will require re operation to replace the implant.

Saline filled implants are filled using a filling tube once they are in place. This means that they can be placed via a number of "novelty" incisions: via the belly button, underarm, around the nipple or using the under wire crease approach. While this may seem like an advantage it is in reality not because what matters is how the implant feels and looks and not how the implant got there.

If you are young, have excellent skin, no sagging and a full breast then a saline filled implant will work for you. Everyone else should use a cohesive gel filled implant.

If your surgeon has little experience (ask us) with cohesive gel filled implants get another opinion so that you have all the facts before deciding what kind of implant to use.

3. What is the best implant location for me?

This is a simple surgical decision based on how much soft tissue padding you have in the upper chest and what the position of the breast is on the chest wall. There is no single best implant location for everyone.

If you are thin with little or no breast tissue then the implant will be placed under the pectoralis major muscle (sub muscular). This provides maximum coverage of the upper portion of the implant so that the implant cannot be seen or felt.

If you have more than 2.5 cm (1 inch) of padding in the upper chest and no significant breast sagging then the implant can be placed either under the muscle or directly under the breast tissue (sub glandular).

If you have a sagging breast you need to consider a breast lift with or without an implant. See Breast lift link here to breast lift section

Although there are some surgical variations within these locations those are the basic options.

4. What is the best size for me?

Selecting the appropriate sized implant and ultimately breast size is a unnecessarily anxiety prone issue. Most women have a "picture" in their mind of what they would like to achieve. They often express this as a preferred cup size. While this is useful as a general guide to the ultimate size it is not reliable because there is no agreed upon standard as to what a cup size actually is. Cup sizes vary from bra manufacturer to manufacturer. Implants do not come in cup sizes either. They are sized by volume (cc's if saline) or weight (grams if cohesive gel). Furthermore a cohesive gel implant can be full height with low projection or moderate height with high projection and be of equal weight.

We have learned that breast augmentation is a visual procedure. You need to know, as closely as possible, what it will "look" like. We will spend a lot of time with you trying on trial implants to get an idea how various weights and profiles fit your "picture". The point is for you to be happy with the outcome not with a specific cup size.

We believe that proportionality is the goal when choosing an implant. Bigger is not necessarily better. Complication rates also go up with overly large and disproportionate implants.

Summary:

1. Breast augmentation is an emotional procedure- make sure you are ready for it and positively motivated

2.. Implant choice is very important. While the perfect breast implant does not yet exist, textured cohesive gel filled implants are currently the best implants available. Saline filled implants are a poor second choice for most women even though there are more insertion choices.

3. Implant placement location depends on your anatomy- there is no "Best" location for everyone, there is only a best location for you.

4. The final augmented appearance is more important than an arbitrary cup size letter

5 . 89% of women surveyed replied that cosmetic breast augmentation met their goals 'completely' or 'mostly'. In addition, 94% of the women surveyed said they would recommend the surgery to others.

6. Breast implants are safe

Breast Augmentation: How It's Done

Dr. Weiglein has found that breast augmentation is best done under general anaesthesia. It takes less than an hour to perform. All of our procedures are done in our private accredited and inspected operating facilities. The Centre only uses fully trained and experienced certified anesthetists. After you are asleep the incision locations are carefully measured and marked. Local anesthetic is injected into this area and under the breast to reduce post operative discomfort. The incisions are then made and the appropriate space (subglandular or subpectoral) carefully made. After ensuring that there is no bleeding the implants are carefully placed and oriented. The incisions are then carefully closed with several layers of dissolving sutures. Sterile dressings and a Bandeau are then applied. After the procedure you will recover for approximately an hour in our recovery room. A responsible adult must take you home. You may shower the day after your operation. Medications are prescribed for post operative discomfort that many women describe as being similar to being engorged when breast-feeding. You will need to take about five to seven days off work and limit physical activity for about two weeks. Recovery is slightly longer with placement of the implant under the pectoral muscle.

It is a "Happy, but Sore" procedure.

Follow up appointments are scheduled to allow monitoring of your progress and answer any concerns you may have. The final visit is usually at 5-6 weeks post surgery or as long as necessary to ensure that all is well.

The Centre is involved in the BIFS (Breast Implant Follow up Study) and will follow selected patients over a 10 year period.

We are one of the leading cosmetic surgery practices in Canada so you can rely on our expertise.

Questions about:

General anesthesia is required for the 50 minute procedure. If you are not healthy enough for an anesthetic we will not proceed.

Bleeding can occur after any operation. In breast augmentation this can produce a collection of blood around the implant in the implant pocket- a "hematoma". This is very uncommon and usually not a significant medical event as the amount of blood is generally small. It may require the insertion of a drain or other methods to remove the accumulated blood. If it happens it will occur in the first 24 hrs. It is important to stop taking any medication (aspirin!) or supplements (green tea!) at least 10 days prior to any surgical procedure as many of these products act as blood thinners.

Infection can occur after any operation. A surgically clean environment, careful surgical technique, healthy patients and suitable antibiotic coverage will minimize the risk of infection. If an infection occurs, the only treatment , is to remove the implant for a three month period and then electively re insert a new one. Infection usually becomes apparent at about 3-4 weeks after the operation.

Capsular Contracture is the gradual and progressive distortion of an implant by the shrinkage of the tissue layer (capsule) around it .This takes place over a period of years. It may occur on one side only. It can result in visual asymmetry and a hard, round, projecting and high breast. It can be uncomfortable but this is generally not an issue. It is not an allergy, rejection, immune response or disease. It is not known why this occurs and there is no guaranteed way of preventing it or resolving it once it has occurred. Once you develop a capsular contracture the only certain way to prevent further problems is to remove the implant and leave it out. Massaging the implant is of no use. Operating on the capsule and replacing the implant is usually not effective.

Capsular contractures cannot be totally prevented but the incidence can be dramatically reduced by choosing the correct type of implant. Smooth walled saline filled implants have a capsular contracture rate of as high as 18%. Textured cohesive gel filled implants have a capsular contracture rate of less than 2% and possibly lower when in the sub muscular plane.

Fact: most women with capsular contractures prefer to keep their implants despite the obvious distortion as this is preferable to being without implants. Breast augmentation is an emotional procedure.

Malposition and Rotation may result in visible breast asymmetry. This can usually be prevented by careful planning and appropriate implant size selection. Despite this, some individuals form "double capsules" and may require re operation and use of a smooth walled round gel filled implant. Overly large or disproportionate implants have more problems with rotation and malposition. Individuals with very loose breast skin or those replacing deflated saline implants are more prone to rotation. These individuals may not be suitable for "anatomical' cohesive gel filled implants.

Breast feeding is expected to be unaffected following breast augmentation.

Pregnancy is unaffected by implants and the implants pose no risk to the baby. The appearance of the breast following pregnancy is not predictable.

Nipple sensation is expected to be unimpaired following breast augmentation. They may be hypersensitive initially. Areas of the breast surface skin other than the nipples may have altered sensation for a prolonged period of time. Breast reduction and often breast lift will cause reduction or loss of nipple sensation.

Mammography does not damage current generation implants. The technicians know how to carry out an appropriate mammographic breast exam in the presence of implants. This may require additional views to be taken.

Scars following breast augmentation are generally insignificant and not an issue for most patients. Cohesive gel filled implants almost always require an inframammary incision for placement. Remember that an incision is a tool that the surgeon uses to accomplish a given task. I believe that an incision should be large enough to allow the surgeon to see what he is operating on. Surgery shouldn't be done "blindly".

From Initial Phone call to Post Op Visits: How it Works

Your initial contact with the office will be with Trish, our Patient Coordinator. She will guide you through the process. You will then meet with Dr. Weiglein to determine the best solution to your particular problem. This initial meeting is designed to be an information and educational meeting. It is actually a time when you "audition" us and we "audition" you. With your input a recommendation will be made and all questions answered. We have numerous pre and post operative photos for you to see. There are always former patients available to speak with you about their experience. We welcome friends / husbands/ others to this meeting.

You will then meet with Josie again to discuss costs, scheduling and logistics. If you require more time to consider your options, or wish another appointment, we will arrange it. If you wish to finance the procedure we will assist you.

We encourage you to see us as a second opinion.

If you elect to proceed you will then meet with one of our nurses for your pre operative visit. She will review the procedure and expectations. Any necessary lab reports will be reviewed. Anesthesia standards require a pre operative physical from a family doctor.

Well before the operative date you will again spend time with our patient coordinator to establish the appropriate implant for you. We use an innovative visual sizing program to allow you reduce the stress and anxiety that often surrounds this decision.

We will provide you with full written post operative care instructions, your prescriptions, follow-up appointment dates, contact telephone numbers and instructions for care-givers at your pre operative appointment. No question will be left unanswered.

Need more information?

Please contact us if you have questions. Dr. Weiglein is one of the leading cosmetic breast surgeons in Canada. We always help you to decide what is best for you.