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How long will it take to recover from my breast augmentation? How much pain will I be in afterwards?

Recovery really depends on a few factors. Adequate pain control is likely the most important. Individual pain tolerances differ greatly. I find that women who have had children generally have less post-op pain, as they have a much higher pain tolerance. From a surgical point of view, there are several things the surgeon/anaesthesiologist can do to decrease your post-op pain.

I generally perform breast blocks prior to making any incisions with a mix of short- and long-acting local anaesthetics. I have found this greatly reduces post-op pain. I also encourage patients to take the prescribed pain killers regularly every 4 hours especially for the first 24-48 hours. If you don't stay on top of the pain in the immediate post-operative period, it is extremely difficult to "catch-up". Most of my patients experience very little post-op pain after their breast augmentation surgery.

Of course, the type of breast augmentation you have will also determine your post-operative discomfort. Larger implants, and subpectoral implant placement will also increase post-op discomfort. This doesn't mean you shouldn't get large implants, or place them under the muscle - you simply need to know what to expect. Many women also experience difficulty with sleeping in the first few weeks after augmentation due to the weight of the implants on their chest. This is more significant in back-sleepers.

What implant size should I choose?

This is always a difficult decision for some. In my opinion, the best thing to do is have a thorough sizing session. I provide my patients with a range of about 3-4 implants that are appropriate for their specific measurements. I then have them try these implants on in a special sizing bra. With this process, my patients have been able to choose their own implants. I have found this to be the best method for implant sizing. Your surgeon should be willing to spend the time with you doing this.

How much time off of work will I need after my breast augmentation? When can I pick up my kids?

My experience has been that there is a huge variation in the amount of time needed off from work. I have patients that go back to work the next day (against my advice), and I have had patients take as much as 2 weeks off from work. It really depends on what you do for work, and how you feel. As for taking care of your kids, if your implant is placed under the muscle, it will be a few weeks before you feel comfortable enough to pick them up.

Will my nipple sensation be altered by having a breast augmentation?

The literature would indicate that there is a 15% chance of losing sensation to your nipple-areolar complex. Having said that, I think the numbers in the literature are very high. I certainly haven't had this problem with my augmentation surgery.

Although the rates of sensation loss may be as high as 15%, a significant proportion of these cases will be temporary. It all depends on the degree of injury to the nerves that provide sensation to your nipple. If the nerves are just bruised (neuropraxia), your sensation should return within 6-12 weeks. Increased sensation or hypersensitivity is also a possibility.

When I perform a breast augmentation, I'm very careful when dissecting the lateral pocket. This is where the main nerve(s) supplying your nipple are located.

When do scars begin to fade?

As for scars, I tell patients it will take a year to see the absolute final result. Practically, however, by 3-6 months the scar will be very close to the final result. I suggest 3M paper taping combined with a silicone ointment that I provide. I use a specific scar massage protocol to help speed scar resolution in my patients.

What is the difference between a subpectoral, submuscular, and dual plane augmentation?
  • Submuscular = the implant is COMPLETELY under the muscle with no release of the muscle (rarely done).
  • Subpectoral = the implant is placed under the pectoralis major muscle, with the inferior edge of the muscle released so that the lower portion of the implant is covered by gland. This is what most people refer to as "submuscular"; however, they are technically incorrect. A classical subpectoral placement is the same as a Dual Plane I.
  • Dual Plane = a form of subpectoral implantation with varying degrees of muscle release/separation from the gland in order to vary the amount of muscle/gland coverage ratio.  Dual Plane is a form of under the muscle or subpectoral placement.
Should I wear a surgical bra after my breast augmentation?

In general, my post-operative surgical bra guidelines are based on the following:

If I want the implant to drop (usually after a subpectoral or under the muscle augmentation), I have my patients go without a bra. I may also use a bandeau which pushes the implants down. This is because implants tend to ride high in the first few weeks after a subpectoral augmentation, and I want to get my patients to the final cosmetic result as soon as possible.

If I have inserted an implant in either the subfascial or subglandular space, I usually have patients wear a surgical bra, as I don't want the implants to drop or distort the position of the IMF. The IMF is the fold under the breast (inframammary fold).

In cases where I have altered the IMF position for symmetry purposes, I will have patients wear an underwire bra to help define the new IMF.

How do I sleep after my breast augmentation?

Sleeping on your back is your best option in the early post-operative period. Sleeping on your side is your next best option. I tell my patients that sleep will be an issue in the first few weeks after breast augmentation surgery, as you now have two weights on your chest which can make it more difficult to fall asleep.

Which incision site is best?

There are several things to consider when deciding on which incision you use to perform your surgery. Cosmesis and the resulting scar are certainly an important consideration. Another consideration is the risk for capsular contracture. When a foreign body is placed in the body, the body reacts by forming a capsule of tissue around the foreign body. In the case of breast implants, this capsule can be soft or it can become hard and even painful. They can even distort the implant and result in poor cosmesis. This is termed a capsular contracture, and the rates of these can be quite high, depending on implant choices and incision type.

Recent evidence seems to indicate that there are higher rates of capsular contracture with peri-areolar (nipple) incisions. Using an incision in the fold under your breasts (IMF incision or inframammary fold incision) seems to be associated with the lowest rates of capsular contracture. The cosmesis of this incision is also ideal as it is hidden under your breasts. Armpit incisions have the potential of being seen every time you lift your arms.

The IMF incision also provides the surgeon with the best approach to perfect your implant pocket, alter the IMF if needed, and obtain hemostasis. Much of the armpit approach involves blind and blunt dissection.

How much does a breast augmentation cost in Toronto?

Silicone/cohesive gel implants will run somewhere between $7000-$9000 in most cases. Saline implants are usually a few hundred dollars less. The size of your implants rarely impacts the price.

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