About the Treatment
- What are the different options for breast augmentation?
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 with improved structure cohesiveness.
- How is a breast augmentation performed?
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.
Generally, 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 post-operative bra is applied.
- How do I choose a breast implant size?
Deciding the right implant size is a completely personal decision and varies between patients. There are many factors that you will need to take into consideration when choosing the right breast implant size for you.
- Body Type: The first consideration is to think about what your body type is. This means looking at how wide your shoulders are as well as your chest width. The goal is to find the most natural-looking set of implants that work with your body.
- Type of Implant: There are two types of breast implants to choose from: silicone or saline. Saline, or salt water, has a less natural look than silicone and hangs differently. Silicone, also known as gummy bear implants, has a more natural shape. Because of how the different materials look, the size will vary between the two.
- Personal Goals: Once you know the kind you want and what to expect from your own body type, you need to match it up with your personal goals. Look at pictures in magazines or movies to get some inspiration for how you would like your augmentation to turn out, and Dr. Pirani can find the perfect size for you.
- Should the implant be placed over or under the muscle?
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.
Generally, subpectoral augmentation is associated with:
- A lower incidence of capsular contracture (thick scar formation around the implant)
- Decreased rippling
- Maximal preservation of nipple sensation
- Less implant visibility and palpability
- Less tissue stretch over time
- Better mammogram visualization
- What is a dual plane breast augmentation?
The dual plane method combines the aesthetic advantages of both a subpectoral and a subglandular implant insertion. With this technique, the upper two-thirds of the breast implant are covered by muscle. The lower third of the breast implant is covered by only glandular breast tissue. This allows the upper portion of the 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, altering the technique he uses depending on your unique anatomy and aesthetic goals.
- Who is a good candidate for breast augmentation?
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/breastfeeding
- Restored breast volume and shape following significant weight loss
Additionally, good surgical candidates should be relatively healthy. Smokers should quit smoking at least four to six weeks prior to surgery. Patients who have breastfed recently should wait at least eight weeks prior to undergoing the procedure.
- How much does it cost to have a breast augmentation with implants?
In Toronto, most implant-based breast augmentations cost between $9,000 and $10,500. The price for breast augmentation will vary depending on incision placement, implant placement, pre-existing asymmetries, and the surgical complexity of the case.
- How long do breast implants last?
On average, breast implants last many years. The longevity of the implant depends on the individual. Implant manufacturers state that you should not expect your implants to last forever and they will eventually need to be replaced at some point.
The reason for replacement has to do with the natural wear and tear of the implants by your body and various activities. Sometimes you might have experienced a weight change that affects the appearance of the implants or you could have a rupture in the implant itself, making a replacement necessary.
With saline implants, it’s easier to determine when a rupture has occurred because the implant will physically decrease in size. Silicone implants, however, usually do not visibly shrink when they have ruptured.
- What are my breast augmentation incision options?
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 develop 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.
- Can pregnancy affect my breast augmentation?
If you have already gone through a breast augmentation or are wondering how a future augmentation could be affected by pregnancy, we can help. Pregnancy, while a magical time, can have some effects on the appearance of your breast implants.
During pregnancy, the mammary glands typically swell as they prepare for breastfeeding. As a result, the skin could possibly stretch out. Following pregnancy, the glands will shrink back down, leaving the excess skin behind. There is also a risk of dimpling, which is where the breast tissue sags around the implant, altering how the implant appears.
Remember that most women never experience any change in their appearance following pregnancy. If you are concerned about these risks, speak with Dr. Pirani to ease your mind.
- Can I breastfeed following the procedure?
It is possible to breastfeed after having breast augmentation with implants. However, there is a possibility of reduced ability to breastfeed 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.
- Can breast implants interfere with mammograms?
A common concern with breast implants is whether they have any effect on mammograms. Since women are recommended to have routine mammograms as they age, this is a legitimate concern.
While in the past this was a bigger problem, with the advancements in technology available for screening, the ability to read accurate results has become much simpler. For patients who have their implants placed above the pectoral muscle, you can have an MRI in order to get a better view of the breast tissue and screen for any concerns.
For patients who have their implants placed below the muscle, the tech performing the mammogram can manoeuvre the breast tissue using an implant displacement technique, allowing for a comprehensive and effective reading.
You should never avoid getting a mammogram done because you have breast implants, but instead just let the office know ahead of time and they will work with you to help get the best scan possible.
- Are breast augmentation scars noticeable?
The location of your implants, the size of the implants, and your own skin all factor how noticeable your implant scars are. There are three common incision locations:
- Inframammary: This is the most common incision site used. It is an incision made in the crease that appears naturally under the breast.
- Periareolar: The incision in this type is made along the lower border of your areola.
- Transaxillary: The least common type of incision, this one is made in the armpit.
The ideal incision location for you will typically depend on how large your implants are that you are having placed as well as your body shape. You and Dr. Pirani will discuss the pros and cons of incision placement before the procedure. Keep in mind that some skin types are more likely to show scars than others, so this could be a factor in your decision.
- What kind of anaesthesia is required for surgery?
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) and has passed inspection by the College of Physicians and Surgeons of Ontario (CPSO). Our anaesthesiologists are staff anaesthesiologists at the Toronto East General Hospital.
- How long does the operation take?
On average, the procedure will take less than two 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 four hours.
- What is required for post-operative care?
After your surgery, Dr. Pirani will provide you with specific post-operative instructions. Generally, the following can be expected following surgery:
- Bra worn 24/7 for one week
- Expect some discomfort for two to five days
- No underwire bras for six to eight weeks
- No heavy lifting or strenuous upper body exercises for six weeks
- Your first follow-up appointment with Dr. Pirani will be five to seven days after your surgery
- Do any stitches need to be removed?
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 seven days after the surgery.
- Can I exercise after my procedure?
If you are a physically active person, you will want to return to your exercise regime as quickly as you can. You can exercise after surgery, but you need to go easy. Here is how it breaks down:
- Right after surgery: You actually should start walking around right after your surgery. You should not do anything extreme or strenuous, but taking frequent, brief walks will keep your circulation up and promote healing.
- Six weeks later: You should be well enough to return to all of your normal exercise routines.
The key to a healthy recovery is to listen to your body and not overdo it when it comes to exercise. You need to make sure you heal properly in order to get the best results possible.
- When will my follow-up appointment be?
Dr. Pirani will usually see patients five to seven days after surgery for the first post-operative visit. Based on how your healing progresses, he will then tailor the frequency of further appointments to your needs.
- What if I have a problem after surgery?
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.
- How do I choose the right bra?
Following your breast enhancement, you will need to purchase new bras. As your breasts will continue to change for several months after the surgery, we advise you to wait at least six to 12 weeks before purchasing a large number of new bras.
After surgery, Dr. Pirani will provide you with a post-operative surgical bra. During your follow-up appointments, he will reassess your bra requirements and direct you about what type of bra you can wear. In most cases, Dr. Pirani will have you continue to wear a supportive bra for the first six to eight 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.
Immediately after your surgery, you will be taken to our recovery area where a registered nurse and anaesthesiologist will 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 your return home.
Patients also have the option of staying overnight in one of our private, luxuriously furnished overnight stay rooms, where two nurses will care for you.
Patients typically take two to four weeks to recover from the breast augmentation procedure. Many patients are able to return to work a week after receiving a breast augmentation. Depending on the type of augmentation performed, post-operative 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 six months after surgery.
For a breast augmentation consultation, Dr. Pirani will spend approximately 45 minutes going over all of your surgical and implant options, after which he will create a custom surgical plan that addresses all of your concerns and goals. He will go over risks and possible complications and give you an idea of what you should expect in terms of results and recovery. You can usually try implants at this initial consultation to see how different implant sizes look on your body. Dr. Pirani’s goal is to educate you so that you fully understand your customized surgical plan and feel confident and informed.
- Procedure Cost
$9,500+ (Taxes not included)
Enhance Your Beauty
Contact us today to schedule your consultation with Dr. Pirani.