Everything you need to know about breast augmentation

Breast augmentation is one of the most common cosmetic surgery operations that gets performed. When I see a patient for a consultation about breast augmentation, I talk about four specific topics. The first is the type of implant being saline or silicone gel. The second topic is about the incision placement, whether the incision goes under the nipple, under the breast, or under the arm. The third topic is whether the implant is put in front or behind the chest or pec muscle. The fourth topic is about the size and shape of implant. The first topic to discuss is what type of implant, and this is saline or silicone gel. While silicone gel is by far the most common, particularly in Canada, saline is sometimes still offered. The saline and silicone gel implants, from the safety point of view, are completely equal. There is no benefit between them. A lot of people have a mistaken impression that saline implants are somehow superior. And this comes from an issue that arose with older styles of implants that were put in the 1970s and 80s that had frequent rates of rupture and a period of time where we weren't allowed to use silicone gel implants. And at that time, saline was all that was available. At this point, science has well proven that in fact, the silicone gel implants were not causing any kinds of diseases. And those types of implants were re approved both by Health Canada and the FDA between 1999 and 2006. In Canada, at this point, silicone gel implants are approved. And there are two specific companies that are approved to provide those implants. There are other companies around the world that have applied for this, but have not been given access to Canada. And so the two companies that we use both offer very high quality implants which provide excellent patient safety. My recommendation between saline and silicone gel then, is usually dependent on patient factors. Most often, I recommend silicone gel implants. And the reason is that silicone gel implants have much less folding, rippling and irregularities that could be visible as compared to saline implants. Saline implants are sacks or bags filled with water, and as such, they are subject to movement and deformation, which sometimes can be visible, such as seeing bumps or irregularities on the surface of the skin. Or sometimes you can just feel the edges of those kinds of saline implants in patients who are bigger to begin with. In fact, saline implants are perfectly acceptable, and I will happily offer it to those patients. But more often than not, I recommend the silicone gel because it does have a smoother, more natural feel. The second topic to discuss with patients is the incision and how the implants get put in. So there are generally three most common types of incision. That includes under the breast, under the nipple, and under the arm. The most common one that I do is from under the breast. I do also offer under the arm on occasion for patient preference. About two to three years ago, some evidence was released that showed that incisions under the nipple, in fact cause a lot of future complications. In particular, capsular contracture, which is scar tissue or hardening around an implant that gets put in. Implants that get put in from under the nipple have a higher rate of this happening. And so, in fact, at that point, when I read that evidence, I stopped offering that type of incision to patients. Generally speaking, the incision placed under the breast is hidden in the fold under the breast and is relatively short, being somewhere between 4 and 6 centimeters in length, depending on the type of size of implant that gets chosen. The third decision to make is with regards to placement of the implant, Whether it goes above or below the muscle on the chest. The muscle on the chest is the pec muscle and the muscle that we often work out when we're doing things like bench press or pec fly types of exercises. The benefit of putting the implant on under the muscle is that the muscle provides some additional padding and soft tissue protection over top of the implant. And so from a cosmetic point of view, this can result in a softer and more natural appearing implant, Particularly in the upper part of the chest, where the muscle helps to smooth the transition from the chest onto the breast implant. In addition, there are some medical benefits to putting the implants under the muscle because there is some evidence to show that there is a lower rate of infection and capsular contracture or scar tissue forming around the implant if the implant is put in under the musc instead of over top of it. We generally believe that this is because implants placed over top of the muscle are closer to the breast gland, which does have some bacteria in it. That bacteria can cause a contamination and result in capsular contracture over time. Generally speaking, I recommend and prefer to put implants under the muscle because it's both a cosmetic and a medical benefit to patients. The only disadvantage to putting it under the muscle is that there can be activation or movement of the implant. Movement or activation of the implant only occurs with exercise that involves the pec or chest muscle. So if a patient has implants put under the muscle, it would be possible that when they go to the gym and do those kinds of chest exercises that there could be movement or Displacement of the implant while those exercises are being performed. When the exercise stops, the implants are back in their regular position. They're undamaged and unchanged. So, in fact, it doesn't change anything in the long term and it doesn't affect the implants. It's purely while those exercises are being done. For most people, in fact, this does happen. And so it's a relatively minor issue. And as such, I think that the minor disadvantage of having implants under the muscle, which is that activation or movement, is far outweighed by the benefits of putting it under the muscle, which are both cosmetic and medical in nature. The fourth topic to discuss with patients is the sizing of the implant, which includes the profile, the dimensions, the width, as well as the volume. Generally speaking, the volume is the main variable to be chosen, and that volume will then dictate the size of breasts that is achieved. Patients will often ask me, what cup size am I going to be? Or ask me to aim for a specific cup size. I'm very specific with patients on this topic because I can't promise or aim to achieve any specific bra size. Of course, the main reason for this is the fact that bra sizes are not consistent. There is no industry standardization of them at all. And as a result, since most patients don't know exactly what breast or bra size they are before surgery, I can be quite sure that after surgery it's impossible to predict. And if someone goes to one store or another after surgery, they will likely be measured differently. As such, I can't promise a particular cup size, but I can at least set an objective and that we can achieve through choosing different volumes of implants. I also then, once the volume is selected, help the patient to decide on what profile to choose. The main point in choosing a profile is in fact the importance of the dimensions and width of the implant. A higher profile implant will of course stick out more, but also be narrower. The most important thing is to choose an implant that's the appropriate width. And so part of a consultation includes measurement of the width of the breast and considering an implant that will fit within that. If an implant is chosen that is too wide, it will stick out to the side and cause what's normally known as side boob, which can cause some discomfort and is cosmetically not acceptable to many patients. As such, we need to pick implants that fit the proper chest width, and as such, the profile is really the next thing that gets chosen in order to have an implant that is the appropriate width with the volume that we've already chosen. I have a system known as Vectra, which is a 3D imaging system. It allows me to take pictures of patients and then do enhancements and show patients different sizes of implants so they can actually see what it looks like.

Here we have Gloria, and Gloria is coming in today to discuss her breast augmentations done by Dr. Volcrick. So I'd like to start off by asking you, how did you hear about Dr. Volck?

So I actually work very close by to the building where he works, and I also heard by my boss, so she said very nice things about him, so that made me come here.

And how was your experience in our office at your initial consultation?

He's super friendly. We got along super well. He's very droll. So I was very nervous coming in and just asking a bunch of questions and he explained everything to me. So he's very nice, very professional, actually.

And why did you choose Dr. Goldberg to be your surgeon?

Like I said, I felt super comfortable with him and that made me feel better about the whole process. So it was very easy with him, so that's why I chose him.

And what procedure did you have with Dr. Goldberg?

I had my breast on my patient.

And how was your surgery?

It was super smooth. I actually went on vacation the week after, so it was pretty painless. I was super surprised.

And what were your concerns, your reasons to having wanting breast augmentation?

I think it was more personal. I wanted to wear certain tops and certain dresses and I just. I was always finding myself wearing push up bras. So it was very uncomfortable for me, so that's why I did.

And how was your recovery?

My recovery was very well, like I said. I went on a trip a week after and I didn't have any issues in terms of recovery. I didn't take any painkillers or any sort. I took a week off work, but I can still manage. I can still move. The scars are very seamless. You can say you don't even notice it anymore. Like it just pulls with your boob so you can't even tell they're even there.

Would you do it all over again?

Yes, 100%. It was the best decision I've ever made, let me tell you that. I think the hardest thing was for me was sleeping, because I sleep in my stomach. So that was the hardest part for me. Just sleeping on my back. That was the hardest part, pretty much. But other than that, it was painless, like I said.