Breast Surgery

Breast Augmentation

Many women desire a full figure with larger breasts. They may have small breasts to begin with or they may have lost volume over time after changes in  weight and pregnancy.

During your consultation, we perform a thorough examination of your breasts. We take note of their size and shape, the position of your nipples, the quality of your skin and the amount of breast tissue you have. We measure all breast dimensions. We have implants available to help give you an idea of the possible result. They are a guide only.

After analyzing your breasts and from what you have told us during the consultation, we determine the best possible operation. A breast augmentation is ideal for breasts with centrally positioned nipples. Sometimes a breast lift is required if the nipples are low and need repositioning.

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Once we have agreed on the best procedure, we will discuss the possible surgical incisions, where the implants may be placed, and the type of implants available along with the advantages and disadvantages of each option.

Breast Implants may be inserted through incisions under the breast, through the areola, and in the underarm region.

Under the breast (Inframammary fold): This incision is located under the breast within the breast fold. It allows for excellent access and precise positioning of the implants. No scars are visible on the breasts themselves.

Peri areolar: This incision is located on the lower curve of the areola. The scar usually heals well and is generally not visible. For this incision to be used, the areola must have a large diameter, especially if you choose silicone gel implants. There is always a risk of reduced nipple sensation and areolar distortion with this technique.

Underarm (axilla): This incision is located in the armpit (axilla). Although there are no scars on the breasts, the scars may be visible in the axillae. Precise positioning of the implants is more difficult through this incision because the access is limited.

Breast implants may be placed behind the pectoralis major muscle or behind the breast, in front of the muscle. The best placement depends on your anatomy skin thickness, level of physical activity and the type of implant you select. We will discuss the pros and cons of each with you.

At Incognito MD and the Gatineau Cosmetic Surgery Clinique, we offer all types of breast implants which are currently available in Canada. The two main types are saline-filled implants and silicone gel implants. All are made with a silicone rubber shell. The new generation of silicone gel implants are fully approved by Health Canada and the FDA. We will explain the advantages and disadvantages of each type of implant including the risk of capsule formation, rupture, fold formation, etc. You will have an opportunity to see and touch the various implants to help choose what is right for you.

The risks of breast augmentation include capsular contracture, scars, infection, bleeding, breast asymmetry, loss of nipple feeling, implant rupture or deflation, implant displacement and malposition implant fold formation/rippling, implant palpability, breast lumps, the possibility of other operations in the future, etc. There is no guarantee for brassiere size and more complications occur when oversized implants are used (stretching/thinning of the breast skin over time, greater chance of breast sagging/bottoming out, higher chance of requiring a breast lift/mastopexy, more likely to see and feel the implant, etc.) There may be some impact on the ability to breast feed depending on the incisions used.  There is no increased risk for breast cancer andou will be able to continue self breast examinations following the operation. Mammograms are permitted and the implants do not delay the diagnosis of breast cancer. In recent years, an uncommon type of lymphoma ((BIA-ALCL=Breast Implant-Associated Anaplastic Large Cell Lymphoma) has been diagnosed in women having textured breast implants.  The lifetime risk ranges from 1:1000 to 1:30,000.  Your surgeon will discuss BIA-ALCL with you. For more information please visit   www.plasticsurgery.org/alcl.

Information about Breast Implant Surgery:

In preparation for your consultation about a breast surgery that may involve breast implants, please read the following information. 

In general, breast implants are considered safe.  They are commonly used and are approved by both by Health Canada and the FDA in the United States, as well as by other agencies around the world.

Breast implants are however foreign bodies.  Despite taking all precautions necessary to maximize the success of your operation, we cannot predict all the interactions your body will have with these implants.

1.Saline filled breast implants:

  1. Silicone plastic envelope, filled with saline water
  2. A firmer feel if over-inflated that may diminish over time. If the implants are not filled maximally, implant folding (rippling, wrinkling) or a wave effect may be more marked. 
  3. Rippling more evident over time
  4. The water can oscillate giving a wave effect.
  5. Deflation if ruptured

2.Silicone gel implants:

  1. Silicone plastic envelope, filled with cohesive silicone gel
  2. A more uniform or natural feel
  3. Available choices include softer or firmer silicone
  4. Associated with less rippling than saline implants
  5. No deflation if ruptured but exposure to silicone possible which can be silent or reactive

3.Implant duration:

  1. Even if there is a lifetime guarantee by the manufacturers, this does not mean that breast implants will last forever
  2. We recommend that you change your implants after a certain amount of time to reduce the chances of a leak or rupture
  3. There is no specific time frame to exchange breast implants however many surgeons recommend changing the implants after 10-15 years as a preventative measure. The longer an implant is in place, there is a higher chance that it will rupture.  

4.Capsular contracture:

  1. A breast implant is a foreign body
  2. We cannot perfectly control how your body will react to an implant, nor can we perfectly control the factors with may cause a capsular contracture.
  3. A capsular contracture is a foreign body reaction to the breast implant where your body wraps the implant in more scar than usual
  4. It is not dangerous but it may become uncomfortable and painful if the scar hardening is severe
  5. The exact cause of capsular contracture is not completely known but theories exist
  6. There are many grades of contracture, ranging from mild (no corrective intervention necessary) to severe. A severe capsule causes a tightening of the implant, producing a hardening of the breast and may requiring surgical correction.
  7. We cannot predict which patients will develop significant and symptomatic capsules but certain surgical techniques seem to aid in reducing their development
  8. The scientific studies are sometimes contradictory with regards to capsule formation—certain studies suggest rates of 5% to 7% while others cite 1% to 2%
  9. The studies where an implant insertion funnel was used during the surgery show a reduction of 54% in the capsular contracture rate (1.4%)

5.Smooth vs Textured Implants:

  1. At Incognito Medispa, smooth implants are generally used
  2. In certain cases, a textured implant may be recommended, for example when anatomic shaped implants are required

6.BIA-ALCL :

  1. Recently a rare condition called BIA-ALCL, a type of lymphoma, has been diagnosed in a small number of patients receiving textured breast implants
  2. According to the American Society of Plastic Surgeons (ASPS), the risk is very low (0.001%- 0.00003%) or 1/30,000 and all of the confirmed cases have been associated with textured implants and not smooth implants
  3. At present, neither Health Canada nor the FDA recommend removal of textured implants.
  4. These patients however, need to monitor their breasts for any symptoms such as unexpected swelling, etc.

7.Size or volume of implants:

  1. Multiple sizes and projections (profiles) of implants exist. We will assist you in your implant selection in an effort to give you the breasts you are looking for, with either a more modest or visible change
  2. The same implant will not necessarily give the same result from one patient to another
  3. The best way to select your implants is with your surgeon. We will follow your chest dimensions as well as your wishes
  4. At Incognito Medispa, you will be seen a second time before surgery to ensure that you have made the best choice of implant for you

8.Other considerations :

  1. To date, Health Canada reports no association between breast implants and other diseases (auto-immune, inflammatory, cancerous, etc.)
  2. Studies over the years have not noted a link between breast implants and systemic disease (Institute of Medicine, FDA and others)
  3. A recent study (fall 2018) suggests that there is a possibility of a higher risk of developing certain rare diseases in patients receiving silicone implants, but not saline implants. The named conditions include rheumatoid arthritis, scleroderma, Sjögren, and melanoma.  The author however noted no direct cause and effect relationship between silicone implants and these conditions.  He also admitted a weakness in the study in that the patient complaints were documented by survey only.  The medical conditions mentioned were not necessarily diagnosed by a physician nor were they confirmed.  

9.What is Breast Implant Illness?

  1. ‘B.I.I.’ is not a recognized medical condition but instead a name circulating on social media during recent years
  2. Certain patients with breast implants suffer from varied and unexplained symptoms that they relate to their implants
  3. The symptoms may be completely different from one patient to another and can range from a generalized feeling of itchiness to the symptoms of fibromyalgia, chronic fatigue, anxiety and others
  4. The problem is that it is very difficult to establish a causal link between these symptoms and breast implants, because these symptoms may occur in women without breast implants
  5. This is not to say that the implants are not the cause because implants remain a foreign body in the human system…however, to this day there is no study confirming this condition nor do Health Canada, the FDA, and the Canadian and American Societies of Plastic Surgeons
  6. In reality, no one can pretend to know the cause of these symptoms, be it breast implants or something else. Please be assured that the surgeons at Incognito Medispa remain open minded.  We endeavour to be up to date with the current scientific studies.  We listen to our patients.  We are available to you even over time.  Certainly, if necessary or if there is any doubt, the implants may always be removed.  

10.Reoperation:

  1. We recommend to almost all our patients to eventually have their implants exchanged at some point in time over their lifetime
  2. Some patients may have earlier reoperations for specific reasons : capsular contracture, rupture or deflation, displaced implants, the desire to have bigger or smaller implants, etc.

11.Mammography:

  1. It is well established that breast implants do not cause breast cancer nor do they limit the detection of breast cancer
  2. If a portion of the breast is not well visualized during the mammogram, other specific views or an ultrasound may be recommended

Summary:

There exists a wealth of information, and sometimes too much, about breast implants.  Even for your surgeon it is difficult to break down and communicate all this information to you, especially when there are poor scientific studies with contradictory data.  We base our practice on the recommendations of the national authorities (Health Canada, the FDA), our professional associations (CSPS, ASPS, ASCPEQ) and implant manufacturers as well as the unbiased scientific studies, to provide you with the best and safest products and services

Nobody desires a complication…. certainly not you and definitely not your surgeon either!

Breast implants have existed for many years and have been gradually modified over time. They are subject to long-term studies which are on-going and whose conclusions remain to be determined

Know that your surgeon is available to help you be it soon after your operation or over the years to come.

 

Please visit the following website for examples of this operation: http://www.surgery.org/public/photos/breast_augmentation