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Breast Augmentation FAQ

It's natural to have many questions as you consider breast augmentation at Ottawa Plastic Surgery. On this page, our Ontario plastic surgeons have answered a few of the most common questions they are asked during consultations.

If you have a questions you don't see answered below, please contact us online or call our office at (613) 792-4137. We look forward to helping you achieve your cosmetic goals.

What Incisions Do You Offer?

One of the reasons that breast augmentation is so popular among Gatineau, Kingston, Cornwall, and other Canadian patients is that women can achieve a very substantial change in their breasts through a very small incision, leaving few visible scars on the breast. The most common choices of incision location are in the crease under the breast (inframammary), around the lower edge of the nipple (areolar), or under the arm (axillary). The inframammary approach is most commonly used in my practice, as scars are quite subtle in this location, and it allows easy access to the breast so that the implant can be placed with the greatest accuracy. Each of these incisions is well-concealed by most types of clothing or bathing suits.

The inframammary incision is well suited for the patient who has a well-defined crease already present. This approach generally affords excellent results and predictability, with minimal disruption of the existing breast tissue, and is the most commonly selected incision in my practice.

The areolar approach can also give excellent results, and is usually selected when the crease is poorly defined, or needs to be adjusted in certain unique breast shapes. The areolar approach is very useful when additional breast surgery, such as lifting or skin tightening, is indicated. While this approach can create beautiful results, it may be associated with a higher rate of complications in certain patients. As such, we use it less commonly than the inframammary approach.

The axillary approach is used less frequently in my practice, as the scar can potentially be visible in certain types of clothing, and implant placement and positioning can be more difficult to control compared to the inframammary or areolar approaches. However, some prefer this scar location, and in certain situations, it may be preferable.

Generally speaking, nipple sensation and the ability to breastfeed are well preserved with all approaches. It seems that placement of implants above the muscle and placement of overly large implants have the greatest influence on nipple sensation and nursing, rather than choice of incision. Finally, silicone/cohesive gel implants will require a slightly larger incision than saline implants, as these implants are placed into the breast fully expanded, whereas saline implants are filled after they are placed into the breast, resulting in smaller scars.

Should I Have My Implant Placed Above or Below the Chest Muscle?

One of the most important factors in the outcome and long-term success of Ottawa breast augmentation is the creation of the implant pocket, which is the soft tissue envelope created within the breast to contain the implant. It must be created to fit the selected implant precisely, and can be developed either above or below the chest muscle (pectoralis major muscle).

In general, it is preferable to place the implant either under the muscle, or partially under the muscle, depending on individual patient factors, such as their build, breast shape, or amount of pre-existing breast tissue. Placing the implant under the muscle will provide extra soft-tissue coverage to the implant, which is especially important in the upper portion of the breast when there is a small amount of pre-existing breast tissue. The implant is better supported over time, and the edges of the implant will be less easy to see and feel after surgery in the sub-muscular location. As well, some women can develop excess scar tissue around the implant after surgery, known as a capsular contracture, which can make the breast hard or distort its shape. This adverse occurrence seems to be less likely, or at least less visible, when the implant is placed under the muscle.

However, placing the implant above the muscle (sub-glandular) is also possible, and some surgeons feel that this approach is preferable. Sub-glandular placement is best indicated for those patients who already have a moderate or large amount of pre-existing breast tissue present, or who have a breast that is located low on their chest wall, where there is little to no muscular coverage.

What Size Implants Should I Choose?

This is the most difficult question for many women considering breast implants in Ottawa. Most women state that they do not want to be too large, and do not wish to look "fake", and that their greatest fear is that they will look unnatural after surgery. Fortunately, my patients tend to feel very comfortable with their results, and incorporation of breast implants into one's own body image is usually excellent after surgery.

There are many different strategies that can be employed when helping you to select an implant size during consultation. Your preference of final cup size will be discussed, and the dimensions of your breasts and chest wall will be determined, as well as your overall body shape and physique. From all of these factors, sizes will be suggested. Trial implants will then be worn inside a bra, in order to give an approximation of how you might look after your surgery. Additionally, we routinely employ computer imaging technology to assist in evaluation, planning, and communication with our patients. This can be very helpful in visualizing what your ultimate results might look like. To learn more about how to choose your perfect implants, visit our Breast Implant Options page.

What Shape Implants Should I Get?

Implants can be either round or tear-drop shaped (anatomical). In theory, anatomically shaped implants sound like they should provide the most natural results. However, in practice, it seems that approximately 80% of our patients are best suited for round implants. Sometimes, implants can rotate inside the breast, and if they have a specific shape, this can affect the projection of the breast, whereas a round implant is unaffected by rotation. In many patients, it is often quite difficult to notice a significant difference between the round and anatomic shaped implants after surgery. As such, round implants are typically recommended for most patients. Occasionally, however, some patients have a distinctly unique shaped breast or chest wall that will particularly benefit from an anatomic, rather than a round, implant. These patients will enjoy significant aesthetic benefit with the use of these implants, in order to justify the small risk of implant rotation. Otherwise, round implants are typically recommended. These decisions can be best discussed during your personalized consultation with Dr. Silverman or Dr. Boyd.

What's the Difference Between Saline and Silicone Gel Implants?

Saline and silicone gel implants are both available at my practice, as I feel that it is important to have many options for each patient. Both implants can give excellent results, and the choice between saline and silicone must be individualized. Silicone implants are fully approved for use for breast augmentation in Ontario, Canada by the Health Protection Branch (HPB), and in the United States by the Food and Drug Administration (FDA). Both saline or silicone implants are safe, and as such, I am comfortable to offer either one to my patients. However, there are some important differences. Silicone implants typically last longer that saline implants (25 years compared to 10-15 with saline), and have a softer, more natural consistency and feel. They will also show less rippling in the implant shell in patients with small amounts of pre-existing breast tissue and can provide a more durable and long-lasting result. However, silicone implants require a slightly larger incision for placement. As such, this choice needs to be individualized to each patient's needs and wishes, and will be discussed thoroughly during consultation.

How much does breast augmentation cost?

Breast augmentation is a highly customized procedure, so no two surgeries are priced identically. We consider several factors when estimating the cost of breast augmentation, including the type of implants used, complexity of the procedure, and fees associated with the operating room and surgical staff. During your consultation, we offer you a written quote that reflects the details of your particular surgery.