Cosmetic Surgery Tips

Best Plastic Surgeon In Toronto For Breast Augmentation

Breast augmentation is one of the most popular plastic surgery procedures in Australia. The procedure is meant to increase the size of your breast tissue. The goal of this surgery is to achieve a more feminine shape without having implants that are too large or obvious.

There are several different options for breast augmentation, including saline and silicone implants, the use of fat transfer to augment breasts, breast lift surgeries, and other procedures such as liposuction to remove excess fat from other areas of your body. The cost of breast augmentation varies depending on your surgeon’s fees, but also on what type of implant you choose and whether or not you choose additional procedures like liposuction as part of your treatment plan.

Read on to learn more about Best Plastic Surgeon In Toronto For Breast Augmentation, Choosing Your Breast Implants AND Risks Of Breast Augmentation

Breast Augmentation has remained the #1 cosmetic procedure in North America for many years. Many women intimately associate their breasts with a sense of femininity; An enhancement in breast size, shape and can have a dramatic effect on a woman’s self-confidence. Women seek out a breast augmentation to increase fullness, achieve rounder cleavage, replace volume lost after pregnancy and weight loss, and to achieve overall body aesthetic balance and proportion. Our highly skilled SixSurgery team is equipped with elite technical skill and surgical finesse to ensure that your Breast Augmentation procedure is tailored to your unique vision and is sure to be a smooth process from start to finish.

Breast Augmentation, alternatively known as Augmentation Mammoplasty, is a surgical procedure where an implant is placed underneath the breast tissue. A breast augmentation is used to enhance or restore the volume and shape of your breasts. While each body is beautiful in its own right, some women feel deprived of their femininity when genetically predisposed to smaller breasts or when the breast shape and fullness they once had diminishes.

The SixSurgery
Approach to Breast Augmentation

Our approach takes half the time and leaves half the evidence

  • 2CM Incision
  • 30 Minutes
  • Shorter Recovery

Scarring and recovery time are two significant factors influencing a woman’s decision of whether or not to undergo a breast augmentation. SixSurgery surgeons combine state of the art technique and a unique surgical approach to offer the Tiny Scar Breast Augmentation, which minimizes scarring, reduces surgery length, and accelerates recovery time.

Typically, breast augmentation surgery will leave you with a 4-8 cm scar. This can be a discouraging fact for some women and ultimately deter them from wanting the procedure. The SixSurgery team understands your desire for discrete scarring, and through years of experience and innovation developed a unique surgical solution —The Tiny Scar Breast Augmentation. This technique is performed with a small 2 cm incision for saline implants and a 2.5-3 cm incision for silicone.

The miniature scar is not the only benefit from this elite surgical method. The fine-tuned technique can be performed in half an hour under local or general anesthesia as opposed to the typical one to two hours that a traditional breast augmentation will take. While recovery looks different for everyone, this approach has proven quicker recovery times where patients may return to regular activities in 5-7 days and resume more strenuous activities in approximately six weeks.

Am I A Good Candidate?

A woman may consider a Breast Augmentation for many reasons:


Some women are born with breasts that appear small or disproportionate to the rest of their body. While this is perfectly normal and acceptable, it may be negatively impacting your self-esteem. If this is the case, breast augmentation could be the perfect solution for you.

Breast Deflation

Breast deflation (loss of fullness) can occur under several circumstances. Some women notice reduced breast fullness following pregnancy and breastfeeding. Other women notice a significant decrease in breast volume after weight loss. Breast deflation and loss of firmness is also a natural process that may take effect with aging. If you notice that your breasts have lost the shape and firmness that they once possessed, breast augmentation can help bring them back to life by adding youthful fullness.

Disproportionate or Uneven Breasts

You may perceive your body as disproportionate or you find that your breasts appear unevenly positioned.

Weight Loss

Congratulations! You have made the choice to prioritize your health and get into shape. Unfortunately for many, this also results in fat loss in the breasts. If this has been the case for you, a breast augmentation will allow you to restore your breasts without having to compromise additional weight elsewhere.


Perhaps you are a breast cancer survivor and have had to undergo a mastectomy as part of your treatment. If this has taken a toll on your confidence, a breast augmentation can help to be a great resolution.

All of our patients must be in optimal health before going forward with the surgery
  • You must maintain a healthy weight with a BMI of less than 30
  • You must not be taking an immunosuppressant medication
  • If you are diabetic and require insulin regulation, we will be unable to perform your surgery in our private facility and will alternatively need to refer you to a hospital based colleague
  • You must not have malignant hyperthermia

Breast Implant Decisions

There are several considerations to be made during the breast augmentation process. While each step will be addressed during your initial consultation, the SixSurgery Team puts emphasis on empowering the patient with the information needed to enhance your understanding of the surgery. Consider your pre-operative consultation a time in which you and your plastic surgeon work together to construct the ultimate plan to achieve your desired result. By the end of your consultation, you will have agreed upon an implant with a specific filler, width, volume, and shape.

Catered to You

Your surgeon will use their extensive experience and cosmetic artistry to help you choose the perfect implant. Some factors which will be taken into consideration include:

  • Body shape and size
  • Existing (or natural) breast size and shape (breast anatomy)
  • Desired look – natural or fake
  • Amount of sagging or drooping (ptosis) of existing breasts
  • Amount and integrity of natural breast tissue
  • Lifestyle and physical activity

Measurements will be taken of your chest and breast size along with your height and weight in order to determine the optimal implant for you to fit your natural proportions, a method commonly referred to as Dimensional Breast Augmentation. You will be given the opportunity to look at, feel and try on samples of various implants available to you.

STEP – 1

Type of Implant


Silicone breast implants contain a highly durable, elastic silicone shell prefilled with a viscous medical grade silicone gel which has a consistency similar to that of natural breast tissue. Available in a wide range of sizes and profiles, silicone can be a great option for achieving your desired result. Previously, silicone implants had a bad reputation for causing safety concerns. The current generation of silicone implants are approved as safe as they contain a cohesive gel which mimics that of a gummy bear, giving them their colloquial name, “gummy bear implants.”


Saline implants are safe and natural, and are filled with salt-water which naturally exists in the human body. While the implant consists of saline, the shell is made with highly durable silicone. Available in a wide variety of shapes, sizes, profiles and textures, there’s a saline implant to meet the needs of a vast array of surgical goals. Saline implants have the unique benefit of being filled with fluid after the implant has already been inserted under the breast tissue, allowing them to be placed through the smallest scar possible. This means the size of the implant does not influence the incision and ultimately the scar.

Content of ImplantA silicone shell with a cohesive gel fill.A silicone shell with a saline (salt-water) fill.
IncisionsSlightly LargerSlightly Smaller
SizesSet fill volume and sizesFlexible fill volume that is adjustable during the procedure
Chance of RipplingLowerHigher
FirmnessSofter, More Natural FeelLess Soft, these implants have the consistency of water
PriceMore expensiveLess expensive
Detection of RuptureMore difficult and removal of silicon may be requiredImmediately detectable and saline will be safely absorbed by the body
SafetyFDA & Health Canada ApprovedFDA & Health Canada Approved

Implant Shape & Breast implants come in two shapes, round or teardrop shaped (also referred to as anatomical shaped). Round implants are symmetrical while teardrop shaped implants have more volume and projection on the lower half, mimicking the shape of a natural breast. While teardrop shaped implants provide a more natural look, most women prefer round implants for their balanced and full aesthetic.

Selecting your implant profile will determine the projection of your implant, in other words, how far your breast will protrude from your body. A low profile implant achieves a flatter and more natural look, while a higher profile implant will create a more prominent breast and a fuller, rounder look. Factors that may come into play when deciding on your profile size include the current width of your breasts as well as personal preference and surgical goals.Sixsurgery Implant Shape ProfileSixsurgery Profile

IMPLANT PROFILES Manufacturerallergan logo pngmentor logo png

The two main FDA-approved manufacturers of breast implants are Allergan and Mentor; implants from both manufacturers are available at our clinic. Allergan and Mentor have years of research experience and a high safety standard. A wide range of reliable and durable silicone and saline implants that vary by implant density, profile, shape and/or texture are available from each manufacturer.

STEP – 2

Size of Implant

Selecting your implant size can be one of the most difficult decisions in the entire process. Rather than measuring implants based on bra size, the sizing is categorized by the amount of liquid or gel that it contains. The standard unit of measurement used is cubic centimeters (cc). Our SixSurgery team will guide you through the sizing process to ensure you are choosing an implant that will best achieve your goals.

During your consultation, you will be shown volume sizing charts and will be given the opportunity to try on various sizers. This will help you have a real life visual of what each size will look like on your body. There are a few factors that will come into play when determining the best size for you. Aside from personal preference, the SixSurgery team will assess the amount of breast tissue you have to ensure you are choosing an implant that will be able to be sufficiently hidden behind your natural breast.

STEP – 3


All Breast Augmentation procedures initially involve the careful placement of a small incision through which a breast pocket is then created. At the Toronto Cosmetic Surgery Institute the incision can be made in one of three possible places on a woman’s body:

Breast fold (Infra-Mammary Breast Augmentation)

Through the areola (Periareolar Breast Augmentation)

Armpit (Trans-Axillary Breast Augmentation)

40% of procedures implement the incision in the breast fold, 20% make the incision around the areola, the armpit is used as the incision site in 40% of Breast Augmentations


Alternatively known as the breast fold incision, this incision is made where the breast meets the rib cage. The scar hides nicely within the breast fold under the breast tissue, and is very discrete.


The Trans-Axillary incision is made inside the armpit utilizing the natural fold that exists. The advantage to the Trans-Axillary incision is that it can only be seen when the arms are lifted and there are no scars on the breast.


This incision is administered along the edge of the areola. The skin is darker in this area allowing the scar to hide within the natural colour transition.

STEP – 4

PlacementBreast Augmentation involves the creation of a breast pocket that allows for the placement of the breast implant. The breast pocket is an empty space either above or below the chest muscle (pectoralis major) into which the breast implant is inserted.The position of the implant above or below the chest muscle will influence the final appearance of the breast enhancement.

The breast pocket can be made in one of two places: under the breast itself (subglandular or sub-mammary), or under the chest muscle (submuscular or subpectoral). There are advantages and disadvantages for both approaches; a below the muscle placement can also be performed using one of three different variations.breast augmentation breast implant over and under the muscle placement diagram

STEP – 5


Our exceptional SixSurgery team is experienced and skilled in a variety of breast augmentation surgical techniques. In your consultation, you and your surgeon will discuss the pros and cons of each technique and agree upon the method best suited to your breast anatomy and desired result.

Tiny Scar Breast Augmentation

Our Tiny Scar Breast Augmentation procedure uses the most advanced surgical techniques that leave you with a 2 cm scar (saline implant) or 2.5-3 cm scar (silicone implant). The incisions can be made in the breast fold (inframammary), the arm-pit (Trans-Axillary) or around the areola (periareolar). The entire procedure can be accomplished in 30 minutes leading to an expedited recovery time. Traditional methods leave behind a 4-8 cm scar and can take up to 2 hours. With these benefits it is no surprise that this is the most highly requested technique in our clinic.

Fat Transfer

Fat transfer breast augmentation is a procedure where fat is removed from other areas of your body using Liposuction and then reinjected into the breasts. This procedure is an ideal alternative for someone who does not want to introduce implants into their body and is looking for a subtle size increase. This surgical technique yields natural results and a soft natural feel. While this method of augmentation has its advantages, it is important to note that it will only bring you up approximately half a cup size to one cup size.

Breast Asymmetry

Asymmetrical breasts can significantly affect a woman’s self-esteem making it a common reason that women consider Breast Augmentation. Creating symmetry in the chest is a a more intensive procedure than a simple Breast Augmentation or Breast Lift making it obligatory that this specific procedure is carried out by a reputable reconstructive surgeon. The SixSurgery Team has a strong background in Breast Reconstruction After Breast Cancer and our surgeons possess the surgical expertise to strategically correct any degree of breast asymmetry. 

Augmentation Mastopexy

As you age, it is not uncommon to find that your breasts have lost their youthful shape, elasticity and fullness. This can hinder a woman’s confidence and leave you feeling discontent with the shape, size and position of your breasts. Augmentation Mastopexy or alternatively known as Augmentation Breast Lift, is a comprehensive procedure that will transform the appearance of deflated, sagging breasts and restore shape and volume. This surgical procedure can provide confidence boosting results for women with:

  • Drooping or sagging breasts
  • Nipples and areolas that point downward
  • Asymmetrical breasts
Bloodless Breast Augmentations

An innovative new surgical technique to eliminate the most common problem associated with breast implants: blood.

Cost of Breast Augmentation

Implant Type
Breast augmentation(anatomic silicone breast implants)
$11 300+


Round Implants(Saline)
Round Implants(Silicone)
$10 000+
Fat Transfer
$10 300+

(+ $3300 when added to a liposuction procedure)

Round Implants(Ideal Implant)
$11 000+
Breast augmentation and a Lift
$12 600 – 14 600+
Breast augmentation revision(initial surgery done by another surgeon)
$10 800 – $16 100+

depending on the type of repair required

Our job is to enhance not fabricate

Our patients commonly inquire about how their cleavage will change after a breast augmentation and whether it will become narrower. It is important to understand that the procedure will not significantly alter your cleavage. The reason for this is because we place the implant directly behind the nipple. This means, if you have naturally wide set breasts, your implants will be placed wider apart.

If implants are placed too close together in an attempt to tighten the cleavage, they will sit unnaturally under the medial portion of the breast while the rest of your breast tissue falls to the side due to the curvature of the implant. This will ultimately force your nipples to appear sideways, creating an unnatural and unaesthetically pleasing result. For this reason, we perform all breast augmentations in a way that aligns the implant with your existing tissue to ensure favorable outcomes.

sixsurgery toronto breast implants augmentation before and after
sixsurgery toronto breast implants augmentation before and after

Key Points to Remember

Key points to remember about breast augmentation:
  • plastic surgery small logo pngA breast implant is a sac (implant shell) made of highly durable silicone, and filled with either saline or a cohesive silicone gel to add volume.
  • plastic surgery small logo pngBreast implant augmentation is not guaranteed to last a lifetime and future surgery may be required to replace one or both implants.
  • plastic surgery small logo pngA Breast augmentation is a procedure to insert implants beneath the breasts to enlarge them. The implant shape and size depends on how much bigger you want your breasts to become and is also selected based on your breast anatomy, skin elasticity and body type.
  • plastic surgery small logo pngThe SixSurgery team will discuss with you the risks and benefits of breast implants and what results you can expect.


While the length of your recovery will be dependent on various factors, it is the SixSurgery team’s top priority to ensure that your experience from your initial consultation through to recovery is as positive and comfortable as it can be.

After surgery, to allow proper healing and to achieve optimal cosmetic results, it is essential that you follow our care guidelines during the initial recovery phase. Thereafter, in order to maintain the new, beautiful appearance of your breasts, long-term proper care of your implants is also important.

Regardless of whether you go home following your surgery or stay at the Fairmont Royal York Hotel, an imperative step to guarantee the most favourable recovery is ensuring you are not left alone during the first 24 hours following the surgery including overnight. You also should not be walking without assistance. During this time, you may be prone to fainting, falling, and hurting yourself. In the event that you wake up in the middle of the night to go to the bathroom, you must also wake up your companion. You are not allowed to go to the bathroom by yourself during the first night after your surgery.

The first couple months are critical for optimal results. Check out SixSurgery approved products and creams specific to your procedure on RecoveryMarket. We work with them to ensure you have everything you need for a speedy recovery: breast band, support bras, gel and absorbent pads.


A permanent scar remains after surgery where each incision was placed. Dr. Jugenburg is an expert at creating minimal scars that are beautifully concealed and virtually undetectable. The technique that is chosen for your surgery will therefore depend on:

  • Your existing breast anatomy
  • Personal goals
  • The content of your breast implants (saline or silicone)
  • The profile and size of your breast implants
  • The intended position of your breast implants (above or below the chest muscle)

Breast Augmentation Safety

As with any surgical procedure, no matter how routine, Breast Augmentation is associated with potential complications. At the Toronto Cosmetic Surgery Institute we take many safeguards during surgery to minimize your risk of developing problems and ensure the best possible recovery. Although extremely rare, thereafter, complications with breast implants can occur weeks, months or even years later and include:

  • plastic surgery small logo pngCapsular contracture
  • plastic surgery small logo pngBreast implant
  • plastic surgery small logo pngImplant rupture
    and deflation
sixsurgery toronto operating room
The Current State of Breast Augmentation

Most of our patients have no problems with their implants and continue to enjoy having the breasts they have always desired. Current generation implants are made from an extremely durable silicone shell to decrease the risk of implant leakage or rupture. In the case of silicone-filled implants, the amount of silicone released across the shell (silicone-gel bleed) is limited to:

  • 1 MillionMore than a million times less than established safety limits (based on the results of FDA reviewed studies).
  • 100More than a hundred times less than the amount of silicone absorbed from daily exposure to common consumer products containing silicone, such as antiperspirants, skin lotions and hair care products.

However, if any breast implant is found to be defective (leak or rupture), since all our implants come with a lifetime warranty, you will receive a brand new implant to replace the damaged one.

Choosing Your Breast Implants

The sheer number of breast implant variations available to patients and surgeons can lead to confusion; however, careful measurement, proper analysis of your anatomy, and experienced decision-making can help our plastic surgeons give you the best breast enlargement possible.

Unfortunately, some surgical recommendations are made on the basis of marketing, surgeon habit, or profit, rather than careful listening to the patient’s goals and concerns. As leading Minnesota aesthetic plastic surgery providers, our American Board of Plastic Surgery-certified plastic surgeons and experienced nursing staff help patients choose their breast implants with the benefit of extensive expertise and over 50 years of combined experience with thousands of patients.

Since breast augmentation is performed so frequently at Minneapolis Plastic Surgery, Ltd., we maintain an extensive on-site inventory of breast implants in virtually every size and profile, in both two types of cohesive silicone, as well as saline. Your implants don’t have to be ordered in advance, you don’t have to worry about us having the “right ones” in surgery, and on-time delivery is not an issue—they are already here!

Minneapolis Plastic Surgery’s AAAASF-accredited surgical facility is one of the first in the country to offer a complete on-site stock of Allergan Natrelle Inspira (Responsive) cohesive silicone gel implants in all sizes and profiles. Natrelle Inspira Responsive (cohesivity type 1) are higher-fill implants designed to reduce visible implant rippling compared to the previous  Allergan Natrelle silicone gel implants.

MPS now also offers a complete (all sizes and profiles) on-site consignment of Inspira Soft-Touch (cohesivity type 2) cohesive silicone gel implants with even more ripple resistance. In the unlikely event your anatomy requires the even-more crosslinked Inspira Cohesive implants (cohesivity type 3–identical to the style 410 cohesivity explained in more detail below), we can have multiple sizes and profiles of implants overnight express delivered to fulfill your requirements.

Breast Implant Information–What are the Options?

Types of Breast Implants

Breast implants come in numerous sizes (100cc – 800cc, or about 3 to 27 ounces each), shapes (round, oval, or teardrop “anatomic”), surface characteristics (smooth or textured), and fill material. Most breast implants are filled with saline or silicone gel, and occasionally other materials (though none of these “other materials” are FDA approved at the present time). Silicone gel implants presently come no larger than 800cc, but 800cc saline implants can be “overfilled” to volumes higher than this when requested in select patients.

Since the material inside breast implants is what gives them their “feel,” filler material choices have generated much controversy and media interest, not to mention scientific debate. We can provide both the science and years of expertise to help you determine whether saline or silicone is best for you.

Until March 9th, 2012, only two manufacturers produced breast implants FDA-approved for use in the United States (Mentor Corp., now part of Johnson and Johnson; and Inamed Corp., previously McGhan Medical, now owned by Allergan, Inc.). For the first time in 20 years in the United States, a third company (Sientra) has received FDA approval to sell their Silimed brand of silicone and saline implants, including textured anatomic silicone gel implants.

Prior to the FDA restrictions of 1991-1992, numerous companies produced breast implants with different designs, surfaces, and filler materials, including polyurethane-coated silicone gel implants, silicone-saline double-lumen implants (the Becker implant), and PVP hydrogel filled implants designed to pass mammography X-rays and have a feel more like silicone than saline (the Bioplasty Misti-Gold implant). After the FDA restrictions, these implant options and companies were lost to USA patients, though some of these companies and options remain available in other countries.

In the United States, besides the presently-available Mentor, Allergan, and now Silimed implants, several companies have produced investigational implants that are not yet FDA-approved and are implanted only by plastic surgeons associated with the FDA investigation/approval process.

Silicone or Saline? (How about fat?)

At Minneapolis Plastic Surgery we offer both saline and the latest cohesive silicone breast implants.

Saline identical to intravenous fluid was the most common type of breast implant filler material used in the United States from 1992 until November 2006, when the FDA re-approved the use of silicone gel-filled implants for primary elective breast augmentation. Prior to the 1992 FDA restrictions,and again after 2006, silicone gel implants are utilized in over 85 percent of all breast augmentation procedures in the United States, and remain the most commonly used breast implants worldwide.

Other types of filler material have been evaluated over the years prior to the introduction of silicone gel implants in 1963, and one or more problems are associated with these. Paraffin, sponges, and other unusual materials were used in early efforts to enlarge breasts; results were dismal until silicone came into use in the 1960s.

More recently, during the FDA restrictions from 1992-2006, soybean oil-filled implants were studied extensively, and were used in many patients in Europe, as well as a few U.S. patients in FDA studies. Breakdown of the oil, rancid smell, and other concerns ultimately led to withdrawal of this implant (Trilucent™) in the US and in Europe. Fat as implant fill material has the same concern, and is not used.

Fat graft injections of a patient’s own liposuction fat (directly into or beneath the breasts) have been performed by some physicians. Among other names, this has been termed “natural breast augmentation” since the surgeon uses the woman’s own fat tissue (and you have to pay for the liposuction used to obtain the fat)! The American College of Surgeons and the American Society of Plastic Surgeons have been cautious in endorsing breast augmentation via fat grafting because 30-50% of the transferred fat always dies, and can cause microcalcifications, scar tissue lumps, and/or oil cysts within the breast. These can be seen on mammography, and may confuse or obscure diagnosis of early or small breast malignancies.

Though many radiologists state that they can tell the difference between dead-fat microcalcifications (from fat grafting), and dead-fat microcalcifications (from possible breast cancer), many plastic surgeons (including those here at MPS) are not willing to risk your life for a procedure that remains unproven regarding long-term safety, especially since 1 in 8 or 9 women will develop breast cancer in her lifetime. And also since implants are still a superior choice lacking these mammographic concerns.

Unless your surgeon uses appropriate fat harvest technique, and transplants the still-living fat globules into carefully-spaced tunnels with tiny fat grafts surrounded by abundant healthy tissue for blood supply, fat damaged by poor liposuction techniques, or grafted haphazardly in big blobs, will not survive. Any breast enlargement initially achieved is gradually and ultimately lost as the dead fat cells are absorbed and carried away by the body—potentially leaving scars, lumps, and calcifications. Pretreatment with Brava suction devices may enhance fat “take,” but at best, most women realize no more than ½ to 1 bra cup size enlargement via grafting.

Breasts augmented with fat grafts that die, calcify, or become scarred nodules within the breast are far from “natural.” And as the dead cells are removed by the woman’s body, the once-larger breasts
gradually lose size, making lasting enlargement uncommon. We see many unhappy former fat graft breast patients who return for the implants they should have had in the first place.

The latest marketing “hype” around fat grafting for breast enlargement uses the term “stem cell breast augmentation.” This is the same procedure as fat grafting, but with the possible addition of centrifugation or addition of blood plasma to “concentrate” or “enrich” the “stem cells.” Until peer-reviewed scientific research validates breast augmentation via fat grafting (or stem-cell breast enlargement), this should be considered experimental only! Soft, natural, and lasting breast augmentation is (still) best achieved by skillful placement of breast implants.

Cohesive Gel or Saline Implants

Over the past decade, advancements in silicone gel implants have been developed and introduced, including a more firm, teardrop-shaped, textured-surface cohesive silicone gel (the “gummy-bear” implant). Like all cohesive implants, this “highly-cohesive” implant retains its form and innate integrity even when its outer shell is punctured. This implant is more firm (like a “gummy bear” or silicone bathtub seal) than the softer, latest-generation, cohesive silicone gel implant, and requires a larger 2.5 inch incision for placement. (It’s also more costly.) This implant–Allergan (formerly McGhan) style 410–has recently been FDA approved, but we feel this implant configuration is usually more appropriate for reconstructive or “rescue” operations than for primary cosmetic breast augmentation.

Numerous scientific studies were performed during these years of implant controversy, and to date, there has not been one credible peer-reviewed study that shows cause-and-effect relationship between silicone gel or saline implants and any sort of auto-immune disease or illness. Saline implants can leak and deflate, particularly if they are not filled properly, and they have also been shown to have a higher visibility of rippling or wrinkling on the implant surface. This rippling can cause unsightly and unnatural breast appearance, and tends to be worse when bending over or when wearing swimsuits or cleavage-revealing clothing. Implant placement below the pectoralis major muscles reduces saline-implant ripples, and usually eliminates or significantly reduces them when silicone gel implants are used.

Saline implants cost less, and can be inserted via a slightly shorter incision, though we continue to be surprised by the length and position of breast augmentation incisions (both saline and silicone) in patients we see from other practices. Incision length is much less a factor of saline vs. silicone than choice of surgeon. We have also found that the cost differential between saline and silicone gel implants is not always passed on to the patient, making saline implants more profitable than silicone in some doctors’ offices.

Surgeons who tend to promote the use of saline implants may do so out of training, their own experiences, habit, or profit motive, but those who scare patients with (disproved) autoimmune illness association, or tell them of the (outdated) FDA recommendation for MRI scans to check for “leaks” in silicone implant patients (unnecessary for all latest-generation cohesive silicone gel implants), only serve their own interests, not those of their patients. These are old, outdated, and inapplicable “concerns” that have been exhaustively studied and we believe no longer apply.

Leak and deflation of saline implants require surgical replacement (the implant manufacturers provide free lifetime implant replacement, and will cover a majority of the surgical costs for the first ten years after initial implantation). But another operation is needed, including time off from work or social activities, and restrictions during healing. When saline implant leak requires re-operation, most patients choose cohesive silicone gel implants to replace both of their saline ones, ensuring that leak and deflation can never again occur. Significant numbers of MPS patients who initially received saline breast implants have undergone a second procedure (whether they had a leak or not) to replace their saline implants with the latest generation of cohesive silicone gel implants. Rippling is eliminated or significantly reduced, softness and natural “feel” is enhanced, and leak or deflation is no longer a concern. Many also use this opportunity to choose a larger size. Whatever the reason, and despite the fact that many happy saline implant patients remain without concerns and with excellent results, a majority of our patients now choose silicone gel implants.

The newest generation of cohesive silicone breast implants provides incredibly natural-looking and feeling results, and also a high level of safety. The latest types of silicone gel breast implants have been used as part of the more general FDA study since 1992, and are soft, yet still a cohesive solid gel that cannot leak. These implants do not leak even if the shell is cut or punctured, and can be inserted via a 1.5 inch incision. Slicing open one of this latest generation of breast implants is like cutting Jell-O—you get two solid intact parts and leakage does not occur. (These implants are often erroneously called “gummy bear” implants since they are cohesive, though the true first “gummy bear” implants were the Allergan style 410s.)

Now that a third implant manufacturer (Sientra) is producing implants that are FDA-approved for use in this country, additional options exist for patient and surgeon choice. Sientra markets their version of high-strength cohesive silicone gel implants (smooth, round, textured, and teardrop-shaped) as “gummy bear” implants, further confusing this designation, which should probably be abandoned since it no longer describes a single type (or company’s) implants! Sientra has decided to sell their products only to American Board of Plastic Surgery-certified plastic surgeons (a laudable position), whereas Mentor and Allergan will sell their implants to any licensed physician, regardless of specialty. (This is how Dermatologists, Family Practitioners, and doctors with little or no plastic surgical training can legally obtain breast implants, and insert them into unwitting patients who think that these “cosmetic surgeons” have the same training and certification as ABPS-certified plastic surgeons.) Whether or not this will confer better statistics, outcome studies, or lower complication rates than the other companies’ practices remains to be seen.

With silicone gel or saline breast implants, microscopic silicone molecules can still enter a patient’s body, just as liquid silicone does in the patient who has an injection with a needle lubricated with liquid silicone. No scientific study to date has provided credible evidence that silicone has any cause-and-effect relationship with autoimmune diseases or conditions such as rheumatoid arthritis, lupus, scleroderma, or so-called “human adjuvant illnesses.” With these studies in mind, silicone gel breast implants were FDA-approved in November 2006 for elective first-time cosmetic breast enlargement in women over the age of 22. Use of silicone gel implants in women under age 22 is considered “off-label” use and is perfectly legal. We support the right of properly-informed women between the ages of 18 and 22 to consent to and request the implants of their choice, including silicone gel implants.

The present soft cohesive silicone implants made by Allergan are Natrelle implants, and newer Natrelle Inspira cohesive silicone implants are identical to the previous Natrelle implants, but with additional gel “fill” in the silicone shell, about 95% vs. 85%. Increased fill with the same soft (level 1 cohesivity) gel in the Inspira implant reduces visible rippling in thin patients with little tissue coverage. For even thinner patients that might still have ripple issues, Allergan now offers “Soft-Touch” level 2 cohesivity implants, with increased crosslinking to decrease rippling, and Natrelle Inspira “Cohesive” level 3 cohesivity implants, to decrease rippling further. Each increased cohesivity level is slightly less soft, more expensive, but offers progressively less potential for rippling in women with little tissue coverage.

Risks Of Breast Augmentation

breast augmentation risks

When carried out by an expert plastic surgeon, breast augmentation is a very safe procedure with minimal risk of complications. Any type of surgery carries certain risks, and breast augmentation is no different. Your surgeon will discuss the risks and potential complications of breast augmentation at your consultation. This will allow you to weigh up the pros and cons of the procedure before making your decision.

Some of the risks of breast augmentation include (but are not limited to):

  • Anaesthesia-related complications such as anaphylaxis
  • Excessive bleeding
  • Wound infection
  • Post-operative haematoma formation
  • Seromas
  • Implant malposition
  • Change in nipple sensitivity
  • Capsular contracture – formation of excessive scar tissue around the implant
  • Implant rupture
  • Breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL)
  • Excessive pain that does not improve over the first two weeks
  • Need for revision surgery

It is essential to bear in mind that many of these risks are very rare. In contrast, others, such as haematoma formation, can be easily managed by a washout procedure with the preservation of the breast implant.

Breast augmentation risks

Breast implants must be approved by the medicines and healthcare products regulatory agency (MHRA) before they are suitable for use in the UK. We also use FDA-approved implants. This means the implants have been shown to be safe and effective. The vast majority of breast augmentation patients do not develop serious complications during or after their procedure.

Several key risks should be borne in mind when considering breast augmentation. Breast implant-associated anaplastic large cell lymphoma is a severe complication of breast augmentation. However, it is extremely rare, with only a handful of cases reported worldwide out of millions of procedures performed. Breast implant illness is a condition some patients believe is due to breast implants. Patients may complain of the following symptoms:

  • Excessive fatigue
  • Generalised muscle and joint pains
  • Skin rashes
  • Cognitive impairment or ‘brain fog.’

If complications occur after breast augmentation, we would advise you to get in touch with our post-operative nursing team immediately. The next step would be to have an urgent clinical assessment by your surgeon. If you decide to have breast implant removal, we recommend discussing this with your surgeon.

Key points about breast augmentation:

  • Breast implants are not designed to last for your entire lifetime. It is recommended to have revision breast surgery to remove or replace one, or both breast implants 10 to 15 years after your first procedure.
  • The appearance of breast implants can change over time due to the influence of significant weight loss, pregnancy or menopause.
  • Excessively large breast implants could exacerbate breast sagging. A breast lift may be required in combination with breast augmentation to treat saggy breasts.
  • X-ray mammograms can be more challenging to interpret in the presence of breast implants. However, x-ray technology has significantly improved over the last ten years, making this less of a problem.
  • We would advise regular checks to monitor for breast implant rupture. Centre for Surgery is one of the few clinics to offer complimentary high-resolution ultrasound scans to monitor the condition of your silicone breast implants. If a potential rupture is detected, we advise having an MRI scan to confirm the diagnosis.
  • Breastfeeding can, in some cases, be affected by breast augmentation. Although many women can breastfeed normally after surgery, other women may find it more difficult.
  • Women who have breast augmentation will require regular post-operative reviews to monitor the condition of the breasts and ensure capsular contracture or implant rupture has not occurred.

If you think your breasts or implants appear different in some way after the surgery and/or you have symptoms of pain and discomfort, please get in touch with us to arrange a consultation with your surgeon for further evaluation.

Am I suitable for breast augmentation?

We would recommend women be familiar with the potential risks of breast augmentation before considering their suitability for the procedure:

  • Patients should be in good physical and mental health with no chronic medical conditions or active bacterial infection. If you have a significant medical condition, discussing this with your doctor at the consultation is essential to determine if any further investigations will be required to confirm your suitability for the procedure.
  • Patients with a flat chest or have saggy or tubular breasts are ideal candidates for breast enlargement surgery.
  • We recommend patients stop smoking and avoid excessive amounts of alcohol for at least six weeks before and after the procedure.
  • The procedure is designed to significantly improve the appearance of your chest for permanent results. Therefore, we recommend being in optimum mental health to embrace the changes after the procedure.
  • Breast augmentation is not designed to address body image problems such as body dysmorphic disorder or to make you look like a completely different person. It is vital to have realistic expectations about what the surgery can achieve.
  • It is essential to follow the post-operative instructions in full. Taking at least one week off work to allow breast augmentation recovery will help ensure your healing is as smooth as possible. You should avoid lifting heavy objects and have someone around you to help with everyday tasks.

What happens at the consultation?

The breast augmentation consultation is an ideal opportunity to enquire further about the risks of breast implants. Your surgeon will ask the following questions as part of the clinical assessment:

  • Your reasons for wanting the procedure and your treatment expectations
  • Any medical conditions you may have and potential allergies to medicines
  • What medicines you are currently taking, including any over-the-counter herbal supplements
  • Whether you have a personal or family history of breast cancer

What does the procedure involve?

Breast augmentation is most commonly carried out under a general anaesthetic to ensure your comfort during and after the procedure. There are three main types of breast augmentation incisions which can be used for breast implant placement, including:

  • Incisions under the breast crease (inframammary)
  • Incisions around the nipple (periareolar)
  • Incisions under the arm (transaxillary)

Once the incision has been made, the surgeon will gently separate the overlying breast tissue from the pectoralis muscle. This leads to creating a breast pocket positioned either on top of the chest muscle or beneath it. The surgeon will then place the implant in the pocket and ensure the implant is correctly centred behind the nipple to prevent implant malposition. The implants are inserted using a breast funnel as part of a ‘no-touch’ technique to minimise implant-related infection. Once the implants are correctly positioned, the incisions will be closed with dissolvable stitches, followed by applying sterile dressings. A post-operative support bra will be applied before the anaesthetist wakes you up. It is normal to have localised swelling and mild post-operative discomfort for up to 2 weeks after the procedure. Any breast augmentation scars will gradually become less noticeable over time, although they will not disappear completely.

If you develop pain, redness or localised warmth around your incisions or you generally feel unwell, we would advise seeking an urgent clinical assessment from your surgeon as these symptoms could be signs of infection.

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