Breast augmentation is one of the most popular procedures performed by Toronto plastic surgeons. Dr. Asif Pirani has extensive experience with breast augmentation surgery and as a board-certified plastic surgeon; he will listen to your concerns and develop a custom surgical approach to help you achieve your beauty goals.
The breast augmentation procedure is designed to enhance breast shape and volume. It can enhance body image, symmetry, and balance but also, may be useful in rejuvenating breasts that have lost volume and shape after having children or losing a significant amount of weight. Many patients find that their clothes fit even better following a breast augmentation procedure.
Breast augmentation can be performed using numerous methods. However, a new method uses a patient’s own fat taken from the abdomen or buttocks to augment the breast. This process is known as fat grafting or fat transfer.
More commonly, implants are used to enhance the size and shape of breasts. There are two types of implants: saline and silicone.
Saline is essentially intravenous fluid composed of a saltwater solution. These implants require smaller incisions and are typically less expensive. However, downsides to saline implants include: less authentic feel when compared to silicone, and a greater likelihood of rippling under the skin.
Silicone breast implants are filled with silicone gel. They feel the most natural and are less likely to create rippling under the skin. Gummy bear implants are a new type of silicone implant, which have a teardrop shape. These implants help shape an augmented breast.
There are a number of things to consider prior to undergoing a breast augmentation procedure. In addition to addressing a woman’s personal preferences and goals, Dr. Pirani must also decide upon implant type and size, incision placement, and plane of insertion. Dr. Pirani considers all of these factors as well as your own breast/chest size to determine the best treatment method and enhance your breast size and shape.
Generally in order to perform the procedure, an incision is made in the skin and then a pocket is developed either under or over the muscle. The implant is then inserted into this pocket before the pocket is adjusted to optimize the cosmetic result. The pocket is irrigated and closed in a layered fashion. A dressing is applied over the small incision and a postoperative bra is applied.
Dr. Pirani is able to place the implant either under or over the muscle. Placing the implant under the muscle is termed a subpectoral augmentation. Placing the implant on top of the muscle is known as a subglandular augmentation.
The majority of women benefit from a subpectoral augmentation; however, Dr. Pirani will make the decision with you after reviewing the advantages and risks associated with both subglandular and subpectoral augmentations.
The Dual Plane method combines the aesthetic advantages of both a subpectoral as well as a subglandular implant insertion. With this technique, the upper two-thirds of the breast implant is covered by muscle. The lower third of the breast implant is covered by only glandular breast tissue. This allows the upper portion of implant to have more tissue coverage and the lower third of the implant to have a more rounded appearance. This results in a much more natural appearing breast contour.
Dr. Pirani regularly performs dual plane subpectoral breast augmentations in addition to offering complete subglandular and subfascial placements. Dr. Pirani will alter the technique he uses depending on your unique anatomy and aesthetic goals.
A woman may be a good candidate for the procedure if she is interested in having any of the following:
• Larger breasts
• Breast asymmetries resolved
• The appearance of increased cleavage
• Restored breast volume and shape following childbirth/breast feeding
• Restored breast volume and shape following significant weight loss
Additionally, good surgical candidates should be relatively healthy. Smokers should quit smoking at least 3-4 weeks prior to surgery. Patients who have breast-fed recently should wait at least 8 weeks prior to undergoing the procedure.
Patients typically take 2-4 weeks to recover from the procedure. Many patients are able to return to work a week after receiving a breast augmentation. Depending on the type of augmentation performed, postoperative bras may be required for an extended amount of time. Patients should expect to continue to see changes in their breast shape and implant position for at least 6 months after surgery.
In Toronto, most implant based breast augmentations cost between $8000 and $9000. The price for breast augmentation will vary depending on incision placement, implant placement, pre-existing asymmetries, and the surgical complexity of the case.
There are three principal options for inserting a breast implant:
1. A breast implant can be inserted via an incision underneath the breast in the inframammary fold (IMF incision).
2. A breast implant can be inserted via an incision placed around the areola (peri-areolar incision).
3. A breast implant can be inserted via an incision placed in the armpit (axillary incision).
Each incision option has pros and cons. In general, the inframammary fold incision offers the surgeon the greatest ability to visualize and precisely developed a pocket for your specific implant. The inframammary incision also allows the surgeon to alter your inframammary fold position in cases where there is significant pre-existing breast asymmetry.
The peri-areolar incision is also an excellent option. The incision is placed at the border of the areola and surrounding breast skin. This is an excellent option for women of dark skin colour who are worried about poor scarring and pigment issues.
The third option for incision placement is through the armpit via a transaxillary incision. This incision option offers the least direct visualization and is not ideal for patients with significant breast asymmetry.
There is a fourth described incision option through the umbilicus (belly button), however, Dr. Pirani does not offer this as the risks and complications associated with it are not warranted in Dr. Pirani’s opinion.
It is possible to breastfeed after having breast augmentation with implants. However, there is a possibility of reduced ability to breast-feed following surgery.
Incisions placed around the areola (peri-areolar) and subglandular (over the muscle) implant placement are more likely to interfere with breastfeeding in the future. Using an IMF (inframammary) incision and placing the implant under the muscle are less likely to influence your ability to breastfeed in the future.
Dr. Pirani only offers procedures with general anaesthesia provided by a board certified anaesthesiologist. Our facility is fully accredited by the Canadian Association for the Accreditation of Ambulatory Surgical Facilities (CAAASF). Our surgical facility has also passed inspection by the College of Physicians and Surgeons of Ontario (CPSO). Our anaesthesiologists are staff anaesthesiologists at the Toronto East General Hospital.
On average, the procedure will take less than 2 hours to perform. Some more complex cases may take more time. If a mastopexy or breast lift is also performed at the same time, then the surgery can take up to 4 hours.
After your surgery, Dr. Pirani will provide you with specific post-operative instructions. You will also receive a handout detailing your post-operative instructions. Generally, the following can be expected following surgery:
• Bra worn 24-7 for 1 week
• Expect some discomfort for 2-5 days
• No underwire bras for 6-8 weeks
• No heavy lifting or strenuous upper body exercises for 4-6 weeks
• Your first follow-up appointment with Dr. Pirani will be 5-7 days after your surgery.
Dr. Pirani usually uses absorbable sutures that do not need to be removed. In the rare case where a patient is prone to poor scarring, he will use non-absorbable sutures that are usually removed 7 days after the surgery.
Immediately after your surgery, you will be taken to our recovery area where a registered nurse and anaesthesiologist care for you as you recover. In general, most patients will remain in the recovery area for a few hours before being allowed to go home. We have a specific set of health criteria that must be met before you are allowed to go home. Dr. Pirani will see you prior to you going home.
In general, patients will stay with us for a few hours before going home. Patients have the option of staying overnight in one of our private overnight stay rooms, which are luxuriously furnished. 2 nurses will care for you overnight if you do choose to stay in one of these rooms.
Dr. Pirani will usually see patients 5-7 days after surgery for the first post-operative visit. Based on how your healing progresses, he will then cater the frequency of further appointments to your needs.
All of Dr. Pirani’s surgical patients receive his cell phone number to call if they have any issues or concerns. In case of an emergency, patients should call 911.
Following your breast enhancement, you will need to purchase new bras. It is important that you keep in mind that your breasts will continue to change for several months after the surgery. It is advisable that you wait at least 6-12 weeks before purchasing a large number of new bras to account for this.
Initially after surgery, Dr. Pirani will provide you with a postoperative surgical bra. Dr. Pirani will reassess your bra requirements at your follow-up appointments and will direct you in terms of what type of bra you can wear. In most cases Dr. Pirani will have you continue to wear a supportive bra for the first 6 to 8 weeks after surgery; however, in some cases he may direct you to avoid wearing a bra to help your implants descend. In some cases, Dr. Pirani may request that you wear an underwire bra.
When it is time to purchase a new set of bras, it is very important to purchase bras that fit well. There are several specialized stores in Toronto that cater to women who have had a breast augmentation. Dr. Pirani and his team are more than happy to help you find the right bra following your procedure.
There is a large amount of information to review during a consult. Dr. Pirani will usually spend over an hour with you during this consultation to go over all of the surgical and implant options prior to creating a custom surgical plan for you. He will go over risks and complications and give you an idea of what you should expect in terms of results and recovery.
Dr. Pirani’s goal is to educate you so that you fully understand your customized surgical plan.
To schedule a consultation with Dr. Pirani, call 416-360-8772.Back
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