Ask the Doctor

Featured Question of the Week

Is sclerotherapy of the breast a risk factor for necrosis with subsequent breast lift/augmentation surgery?

“Your past treatment with sclerotherapy to reduce the appearance of veins could have an impact on a future breast lift and augmentation procedure if a significant number of your veins were treated. In theory it could affect the blood flow out of the tissues and cause congestion. A board certified plastic surgeon can examine the quality of your skin and review the notes from the sclerotherapy procedure to determine whether there is a risk or not and advise you accordingly. You may need to consider staging the procedures 3 to 6 months apart if there is a concern because combining a lift and augmentation stresses the tissues more than either procedure on its own.”

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Past Ask the Doctor Questions

How much arnica gel do I need after a BBL?

Areola reduction and implants: is that enough to give me lifted breasts?

“Breast implants can effectively improve sagging that is due to volume loss with pregnancy, weight loss, age, and other factors. The implant can restore volume in the top of your breasts to give them a perkier appearance, while an areola reduction can restore the size and balance of your nipples. For more severe sagging that is due to stretched out skin and excess tissue, a formal breast lift might also be combined with your procedure. A breast lift can reposition your breasts to a more youthful position and address the position of your nipples at the same time. ”

Looking to get breast implants, should I wait until I’m done having kids?

“Pregnancy and breastfeeding can affect the appearance of your breasts, causing some volume loss and sagging. This is one reason why many women opt for the procedure after having children. So, if you plan to have children and breastfeed in the near future, you may want to wait on your procedure to ensure lasting results. However, if you don’t plan to have children for a few years, there’s no reason why you can’t have your procedure now. Many young women opt for the procedure to enhance the appearance of naturally small breasts and still enjoy their results after childbirth. Your surgeon may recommend having your implant placed behind the muscle if you plan to breastfeed.”

Will a breast lift alone improve the stretched out skin on top of my breast? Not interested in implants.

“The breast skin can become stretched from pregnancy and breastfeeding, weight loss, age, or other factors. A breast lift can improve the appearance of your breasts by removing excess skin and reshaping the breasts to a more youthful appearance. It also addresses the position of the nipples bring them higher up on the chest and in some cases getting them to point forward instead of downward. Unfortunately a breast lift will not remove a significant amount of stretch marks if they are on the top half of the breast. Can pressure of a high support sports bra harm the breast implants? I have ”knife cutting the tissue” feeling and pulsing. A support bra is recommended after breast augmentation to assist with the healing process and help the implants settle into place. If you are experiencing sharp pain or pulsing, the compression garment may be too tight and you should see your plastic surgeon to address the fit and your healing process. While it’s not likely to cause harm to your implants, the issue should still be addressed for a more comfortable and more successful healing process..”

Teardrop vs Round breast implants to get a natural look for a petite build?

“Both teardrop and round implants can give natural-looking breasts for women of all frames. The right implant has to be chosen for each woman depending on her specific body and what she is looking to achieve. “Natural look” means different things to different women so it’s important to discuss the specifics of exactly what you are looking for with your surgeon. While in theory the teardrop shaped implants should give a more natural appearance with the gentle slope at the upper half of the breast and a natural curve at the bottom, in practice it is very difficult to tell the difference between them in most cases once they’ve been put behind a woman’s natural breast tissue and she is standing upright. The choice of implant must be individualized for each patient depending on the measurements of her body and the quality of her tissues, which means there is no cookie-cutter answer as to whether one of these is better in all cases.”

How long does it take a seroma to heal?

The time for a seroma to resolve will vary with each particular case. It depends on many factors including the size of the seroma, the location, how fast your body is producing more fluid and what you are doing to treat it. Sometimes they will resolve within a few weeks with nothing but a few in-office drainage procedures and compression, sometimes it takes months and the insertion of an indwelling drain.”

I have had breast implants for about 10 years. How long until they need to be replaced?

Your breast implants only need to be replaced if you have developed a complication like capsular contracture, rippling or rupture of the implant. An examination by your plastic surgeon or an MRI scan (if you have silicone implants) can determine the integrity of your implants to see if there has been an silent rupture and a replacement is necessary. While having a replacement procedure for fresh implants would renew your warranty, every procedure comes with risks of developing complications so as the old saying goes: “if it ain’t broke, don’t fix it!”

If a saline implant ruptures, how long until I need to have it replaced or removed?

Because saline can be safely absorbed by the body in the event of a rupture, there is no immediate urgency for a replacement. However, the sooner you can go in for a replacement procedure the better. Once the implant deflates, you risk the breast pocket contracting, which results in a more involved replacement procedure. For a smooth replacement procedure with successful results, you shouldn’t wait longer than a month after the rupture occurs.

Which breast implant placement gives a more natural appearance?

Your two options when it comes to breast implant placement are sub-muscular (behind the muscle) and sub-glandular (above the muscle and behind the glandular breast tissue). Both can give you natural-looking results, but they each come with different benefits. Having the implant placed behind the muscle can result in a more natural breast slope and is ideal for patients with less breast tissue or thin skin. Patients with adequate breast tissue and good quality breast skin can have great results with sub-glandular placement which is a little bit more comfortable during recovery. As with everything else in breast augmentation, there is no one right answer that applies across the board, the choice for pocket location has to be made to suit each patient.

Are cone shaped breasts normal after a breast lift with augmentation?

With a vertical (a.k.a lollipop) lift the breasts can definitely look a bit cone-shaped at first. This is because of the way that they are sutured together once they’ve been lifted. This technique gives great projection and fullness at the top of the breasts long term but in the immediate post-op period the breasts do look a bit cone-shaped. I find it typically takes between 6 weeks and 3 months for the breasts to settle and then patients have a much better idea about their final shape.

Do you need two surgeries for breast lift and augmentation?

Breast lift with augmentation is a very powerful and safe operation to overcome the “deflated” look many women experience following pregnancy or with significant weight loss. In my practice, I most commonly perform this procedure in a single operation. That said, there are several variables among patients that might create the need to stage this procedure into two separate operations. These include the severity of ptosis (drooping), thinness of skin and breast tissue, smoking history, and size/reshaping aesthetic goals. This decision can only be made after a thorough consultation with a board certified plastic surgeon(or two). It sounds as though your surgeon falls to the conservative end of the spectrum here, but I believe you are getting solid advice.

What are some common signs that breast implants are encapsulated?

Capsular contracture is assessed based on several criteria and then classified according to Baker grading system. There are four grades of severity, grades 3 and 4 usually require some fort of surgical management.

Capsular contracture is classified as follows:
Grade 1: the breast feels soft
Grade 2: the capsule around the implant is palpable
Grade 3: the capsule around the implant is palpable and visible
Grade 4: the capsule around the implant is palpable, visible and painful.

Patients typically notice a capsular contracture when it starts to move from grade 2 to 3 typically the breast begins to feel harder and the implant actually starts to ride up on the chest. The edges of the implant may start to become visible as the capsule forces the implant into a more spherical shape. If allowed to progress then the breast will typically start to hurt as well.

What causes implants to “sag” to the side when your laying on your back?

Implants can “sag” to the side when the pocket that the implant is placed in becomes larger to accommodate the weight of the implant or from your muscle gradually extending. This can also occur if your pocket was created too far across. Luckily, there are solutions to this problem. A board-certified plastic surgeon could shorten the pocket laterally so that the implant does not move too far to your sides. Another option would be to replace your implant with a form stable textured implant (gummy bear implant) to decrease movement in conjunction with the shorter pocket length.

Will Simply a Breast Augmentation Correct my Tubular Breasts?

An augmentation alone will likely not give you the look you are going for. The constriction of the lower half of the breast, if not properly addressed, will deform the implants over time. The puffiness of the areolas will also not be corrected with an implant alone. In order to fully correct the tuberous appearance to give a ‘natural’ appearing breast you would need a combination breast lift with augmentation that includes a formal release of the constricted areas appropriately.

Is it normal for pressure and numbness to occur after breast augmentation?

It’s completely normal to feel discomfort and pressure on the chest early on. Keep in mind, you just added a fair bit of weight to your chest with these implants. It will decrease with time as the tissues relax and the implants “drop and fluff”. You will get used to the added weight overtime and eventually it will feel normal, but for now, it may help to sleep in a semi-reclined position. Sensation can certainly be altered following a breast augmentation, the nipples in particular will commonly be a little bit more or less sensitive (and return to normal within a few weeks to months), but being completely numb is not typical.

Can I get a tummy tuck and a breast augmentation at once?

After breast augmentation, what will my final size be?

It’s very difficult to predict the specific cup size after breast augmentation. The answer can depend on how large your chest and breasts were before the operation, what size implants are being used, but also what brand of bra. There is no consistency anymore between cup sizes from one brand to another so its essentially impossible to give a specific prediction. The best way to choose implants is to try them at your sizing session and see if they look right for your frame and disregard the letter that may be on your eventual cup size. It’s also a good idea to wait at least three months after your breast augmentation to get properly sized for a new bra because things can change over the initial healing period.

Tummy Tuck Drainage: How much is too much?

It’s always important to understand that everyone heals at a different rate so there is always some variability with how much someone drains and for different lengths of time. For the average tummy tuck, drainage should last about two weeks but it certainly can last longer. Make sure you wear your compression garment as tight as you can comfortably tolerate, and the drainage should begin to slow down soon. If you are really concerned, then booking an appointment with your board-certified plastic surgeon is important.

Can pregnancy and weight gain affect the implant pocket?

Pregnancy and weight fluctuations don’t typically affect the pocket itself, but affect the breast tissue overlying it, creating a disharmony between the implant and the breast. This typically leaves patients with an implant that is exactly where their surgeon put it (which at the time of their augmentation was perfectly behind the breast) but a breast that is no longer in the same position. This is why a waterfall deformity (where breast skin and tissue appear to be hanging off the front of the implant, like a waterfall) is the most common issue breast implant patients have following pregnancy, breastfeeding and weight fluctuations. Correcting this will involve modifying the pocket, lifting the breast, or a combination of both.

How long is breast augmentation recovery?

Everyone heals at a different rate, so there is always some variability with recovery time. Some patients are back to the majority of their activities in about 24hr and some take longer. In general, patients feel pretty good within 24-48h but I still suggest about one week of taking it easy for a straightforward breast augmentation procedure. Please keep in mind, each procedure is unique for every patient so your experience may vary.

Will my tummy tuck scar improve overtime?

It is perfectly normal for patients to be concerned about scarring after a surgical procedure, such as a tummy tuck. It’s also normal for the closed incision to be bunched and raised following your procedure. This is done so that they wound can heal with the least tension and the eventual scar will be a nice, thin line. If you’re just post-op, it’s always too early to tell what your final scar will look like. I would suggest not worrying about the appearance of your incisions for at least 3 months although it takes a full year for the scars to mature and fade.

What is so 'Ideal' about the IDEAL® Implant

The “IDEAL” aspect of the IDEAL Implant is that it is a saline filled implant (which many patients prefer for safety and peace of mind) that feels like a silicone implant (which most patients and surgeons feel is much softer and natural than a traditional saline implant).In essence, it offers the benefits of both types of implants without the downsides, however like everything in plastic surgery, there is no one thing that works best for all patients. That’s why an in-person consultation and discussion about all of the implant options for a breast augmentation with a board-certified plastic surgeon Toronto is essential to success.

Why are surgeons comfortable combining a breast lift and tummy tuck surgery?

It’s a very common combination of procedures and we are very used to doing them together because they are commonly needed in the same patient and the positioning in the OR is nearly the same for both. They can be done at separate times as well, and that is also commonly done for patients who don’t want a long anaesthetic or want to stage the procedures for financial or recovery reasons. It will cost a bit more and have a second recovery phase, but ultimately whatever works best for the patient in this case is the way to go.

How long after breastfeeding should I leave a capsular contracture before revision?

The answer to that really depends on how bad the capsular contracture is. Capsular contracture is assessed based on several criteria and then classified according to the Baker grading system. There are four grades of severity, grades 3 and 4 usually require some sort of surgical management. Capsular contracture is classified as follows:
Grade 1: the breast feels soft.
Grade 2: the capsule around the implant is palpable (can be felt from the outside)
Grade 3: the capsule around the implant is palpable and visible.
Grade 4: the capsule around the implant is palpable, visible and painful.
I would suggest waiting at least 6 months after weaning your child if you have a Baker type 4 (or painful) capsule that is causing significant discomfort. If you are not suffering with pain, then a year would be ideal to ensure all the tissues have completely settled.

Can I get a Tummy Tuck & Brazilian Butt Lift at once?

Technically speaking the combination would be safe, but for optimal results you should do the two surgeries at least 3 months apart. The BBL requires you to recover without lying on your back or sitting for 2 weeks and the TT requires you to recover in a seated position or lying on your back with your waist slightly bent. These are opposites, so you can imagine that doing both at the same would result in a recovery that compromises one of the results if not both. The best way to do it would be to have your BBL with all the associated liposuction in one stage, then 3-6 months later have the tummy tuck to remove all the excess skin from the abdomen.

I have the new IDEAL® Implant, 2 years post-op, and one of them has ruptured without any trauma. Advice?

Implants do have a spontaneous rupture rate of about 1% per year. It’s possible you had a valve failure in one of the chambers. With the IDEAL implant, it would not fully deflate because there are two chambers of saline and the likelihood that both would rupture without trauma is incredibly low. So while one of the chambers has emptied, the other is still intact and maintaining good volume. If the breast only went down a bit in size then it’s probably the anterior chamber that ruptured. If it’s lost most, but not all of its volume, then it was probably the posterior chamber that ruptured. I’d suggest booking an appointment with your surgeon to be examined and get the ruptured implant replaced. The only way to know what caused it is to remove it and have it examined by the company.

How does a tummy tuck affect the skin on your back?

Why does every doctor recommend Mentor and Allergan implants but not Motiva Plus?

Once breast implants are placed under the muscle, is it possible to replace them over the muscle?

Unhappy with my breast augmentation; how long should I wait to have implants removed?

Breast implants can be removed at any point; however I would suggest waiting at least 6 months before making that final decision. It’s common for a patient to feel depressed and have some form of ‘buyer’s remorse’ in the first month or so but almost everyone feels great again by 40 days. It takes a good 3 months for things to settle and the swelling to resolve enough to get a real sense of what your ultimate results will look like. If at that point you are still unhappy then you could reasonably consider having them removed.

Difference between a mini-tummy tuck and tummy tuck?

Who is the best surgeon for breast augmentation revision (symmastia)?

Symmastia is a challenging problem to correct and there is no guarantee the greatest plastic surgeon on Earth could completely correct it 100% of the time (assuming you could ever get other plastic surgeons to agree who is “the best plastic surgeon“). Depending on the current location of your implants, you’ll either need a pocket change to submuscular (if you are above)
or acellular dermal matrix to close off the pocket if you are already below the muscle.

Do breast implants need to be replaced once it can be seen?

Unfortunately, once an implant is exposed it needs to be replaced. Exposure to the outside world contaminates the implant with bacteria, and while it may appear as though it could just be pushed back in and sutured, there would be a near 100% chance of having an infection within a few days of the procedure. Even if the implant was able to be saved and used without a massive infection early on there is a very high chance of developing a severe capsular contracture later.

Can Breast Implants Be Exchanged Through the Armpit?

Unfortunately, there is no reliable and controlled way to do a proper exchange through the armpit. It is a long distance between the incision and the implant making it difficult to grasp the implant without risking rupturing it. There is no way to look inside and correct the pocket to ensure the new implants sit nicely. Even patients who had their implants inserted through the armpit need a breast incision to remove or exchange them and (hopefully) are warned about this by their surgeons in advance.

What are the largest breast implants available in Canada?

In Canada the largest implants we can get are 800cc saline implants. They can be overfilled somewhat, but how much is a discussion that needs to be had on a case-by-case basis between each patient and their surgeon. There may be additional early and late complications due to the heaviness of the implants so it is always important to do your homework about the risks when thinking of going with extremely large implants.

My saline implant suddenly deflated after 10 years, what happened?

Will I lose nipple sensation after I have a breast augmentation?

It’s highly unlikely that you’ll lose your feeling in your nipples, but it is a documented complication and risk of breast augmentation. The risk would highly depend on your incision placement and whether a breast lift is necessary to be done at the same time. In general if the incision is away from the nipple/areola then the risk of losing feeling is relatively low. Learn more about breast lift incision options.

I'm a week out from my breast augmentation and nipples are low. Should I be concerned?

What kind of scars would I have from a breast lift with implants?

The exact type of scar you end up with would depend on the type of lift that went with your procedure. There are three main types of lift – periareolar, which gives a circular scar around the areola. Sometimes this is accompanied by an incision in the inframammary crease to place the implant because we don’t typically like to put them through the nipple anymore. There is a vertical lift, which would give you a lollipop scar and there is also an anchor lift, which would add a scar in your inframammary crease to the lollipop. Only after being examined can we really know exactly what type of lift is needed and give a specific answer as to what someone’s scars will look like.

Can facial fat transfer be done gradually?

It certainly can be done this way, however it typically is done all at once for reasons of cost. If money is not an object, then you can have as many small areas as you’d like done over as many sessions as you want. Each session would involve harvesting a bit of fat from your abdomen or inner thighs, purifying and injecting it. There will be some swelling for a week or so and your final results will be apparent in about 3 months.

Can I get a breast augmentation under IV sedation vs. general anesthesia?

You can ask for anything, but I personally would never consider that. There is really no way to keep a patient comfortable through a breast augmentation without having them very deeply sedated to the point that they might not breathe on their own. This is why we use general anaesthesia to protect their airway and ensure proper breathing and oxygenation of the tissues during the procedure. IV sedation is better for the “surgeon” in cases where they are trying to do this in an office instead of a proper operating room (because you can’t give general anaesthesia in an office). This type of situation should be a red flag as major surgery such as breast augmentation should never happen outside a fully accredited operating room. When having your consultations, make sure you only see board-certified plastic surgeons who operate out of fully accredited facilities with board-certified anaesthesiologists providing your anaesthetic. Anything short of that is unnecessarily risking your life for a procedure that is quite safe under proper conditions.

What would feel and look more natural - saline or silicone implants?

Generally, its felt that the silicone gel offers the softest and most natural feeling breast, but it depends on how much breast tissue you have of your own. The more of your own tissue covering the implant, the less likely you’ll really feel either of them to the point that you may now know the difference. A personalized consultation with a board-certified plastic surgeon will help determine what breast implants are right for you!

If I have an IDEAL Implant, will I know if it ruptures?

Because the IDEAL IMPLANT® is filled with a saline solution patients do not have to worry about a silent rupture occurring. With silicone implants, you cannot tell if your implants are intact or ruptured by just looking in the mirror, which is why it is called “silent”. The internal structure of the IDEAL implant lets it feel more like a silicone implant, but still behaves like a saline if it is ruptured.

What is the IDEAL Implant and what is it made of?

Does a combination of breast and body procedures make for a terrible recovery?

A combination of breast and body procedures, also commonly known as a Mommy Makeover, is very common. Recovery will be more extensive than just having one procedure, but in the grand scheme of things, it is less recovery time overall and so most women who want both their breasts and bodies treated are choosing to do the combination procedures both for convenience and cost-effectiveness. Mommy Makeover is a very customized suite of operations, so while it is safe and generally a good idea to combine for most, this won’t apply to everyone. Only in-person consultation with a board-certified plastic surgeon can truly give someone an idea of what procedures they’d need and whether it is a good idea to combine them.

What is your opinion about smoking tobacco and plastic surgery?

Smoking tobacco and having a plastic surgery procedure may lead to complications in the future. For instance, patients that smoke are more likely to get an infection or have bleeding complications since all tobacco products constrict the small blood vessels and limit the amount of blood that can get to the healing area. The blood carries the oxygen and nutrients to heal as well as the white blood cells that help prevent and fight infection. For this reason, it’s recommended to quit all tobacco products AT LEAST 2 weeks before your surgery.

Downsizing from large implants to small implants, should I be concerned?

Depending on how large your implants are and the laxity of your skin, your skin may have been stretched out by the implants to the point where you may require a breast lift to correct sagging and deflation that can occur. It also depends on how far you want to downsize because that will directly relate to how much excess skin needs to be removed and how much the breasts need to be reshaped around the new smaller implants. This is one area where an in-person consultation with a board-certified plastic surgeon is highly recommended to make sure you are making an informed decision!

Breast Augmentation Revision: how long should I wait to go bigger?

Six months would be the minimum time before another surgery, if you don’t want to risk problematic scarring. It will also let your tissues adjust to these breast implants which will better accommodate the larger ones for your next procedure. There are complications that come with very large implants, so make sure to discuss these at length with your surgeon before proceeding so you know exactly what you’re getting into.

Why is breast revision surgery so much more expensive than the first procedure?

With the exception of very simple implant exchanges, revision breast surgery tends to be a lot more technically challenging and takes longer to do, which translate into higher costs. On top of that, sometimes expensive products like alloderm are needed to correct certain problems and those cost thousands of dollars for the product alone, and add time to the procedure as well. Finally, primary breast augmentations can be relatively inexpensive because of various sales or promotions offering discounts. Nearly every plastic surgeon does breast augmentations and all are in competition and trying to get patients through the doors any way they can (more in the US than Canada due to advertising laws and the fact that, in many states, one does not even need to be an actual surgeon to perform breast augmentations), Revision breast surgery is much more difficult, very few surgeons are willing to do it, and it is highly specific to each patient so it is priced individually and generally reflects the true cost of surgery.

Is it common to feel too big after a breast augmentation?

Don’t worry, you are definitely not alone in how you feel. It’s too early right after a breast augmentation to know what your final outcome will be. There is still a lot of swelling this early. It’s quite common for women to feel too large after surgery and in my opinion those women are the ones who are usually happiest once the swelling goes down and the implants settle into place. Give it a few months and you will probably be very happy.

Does OHIP cover breast implant revision surgery due to severe infection?

OHIP has fairly strict guidelines where they will cover emergent surgery for complications related to an aesthetic procedure but generally will not cover secondary aesthetic procedures down the road. One thing OHIP does is allow surgeons to request coverage ahead of time, so if there is a significant deformity and severe psychological distress then your surgeon could possibly request coverage for a breast reconstruction with an implant but it is a shaky argument at best. I would suggest talking to your surgeon about this to see what can be done. Also, instead of getting revision surgery, it is always in your best interest to choose a board-certified plastic surgeon in Toronto that can help you avoid infections or complications in the long-run.

When should I consider a breast implant revision if I don’t like the results?

How does sex feel after a fully healed labiaplasty?

When you get the go-ahead from you board-certified plastic surgeon, typically 6 weeks in my Toronto plastic surgery practice, it may feel a bit uncomfortable the first time, but afterwards, it should feel essentially the way it did before. Patients who received a labiaplasty near Toronto who had pain before due to the size of their labia minora will find that relieved. In rare cases, patients can suffer from ongoing pain during sex – this is an unfortunate complication that luckily does not happen often.

What is a a typical recovery like for a breast lift?

Generally, most patients will experience some discomfort for about 2 weeks after a breast lift in Toronto. Patients generally come back to our office saying that the pain was less than they expected and pre-operative drains are not necessary. In most cases, you’ll be able to return to light activities after 2 weeks. However, each plastic surgeon in Toronto does things differently, so make sure to interview a few and go with the one that you feel most comfortable with.

Does a tummy tuck help improve the appearance of stretch marks?

How often do breast implants need to be replaced?

While breast implants don’t have a set expiry date, it’s common to change them around 10 years because that’s how long the warranty is. If you aren’t having problems with your implants then there is no need to ‘rotate’ them on a specific schedule. In some cases, you may have issues so it’s probably time to book a consultation with a board certified plastic surgeon near you to see what your surgical options are. Breast revision surgery in Toronto is helpful to restore and replace implants if malpositioned or more.

Can breasts that are too far apart be moved together?

Should I avoid taking fish oil or other supplements before surgery?

Fish oil and some other supplements should be stopped before surgery because they act as a blood thinner, which can lead to excessive bleeding during surgery. Other supplements that can act like blood thinners include Glucosamine/Chondroitin, Ephedra, Echinacea, Gingko, Ginseng, Kava, Garlic, St. John’s Wort and Ginger. I generally suggest stopping these for at 2 weeks before surgery and waiting at least 2-3 days after to restart.

How are breast implants placed during breast augmentation?

There are a few things that need to be considered when talking about breast implant placement for breast augmentation: Pocket location (where are the implants going to go) and incision (how are they going to get there).
Pocket location is generally described in terms of subglandular and submuscular. With subglandular placement the breast implant is placed below the breast tissue itself, but above the pectoralis major muscle. In a submuscular pocket the implant is placed below the pectoralis muscle which is raised off the chest along with the breast.

In terms of incision choice, the goal is to create the best final scar. Because it’s not yet possible to make an incision and heal it completely scarlessly, the goal when deciding on incision placement is to have a final scar that is either well hidden, healed so that it is nearly invisible or both. There are two locations that are used most often – an inframammary crease incision is placed in the fold under the breast and a periareolar incision goes along the border of the areola and the breast skin underneath the nipple. There are also transaxillary (done through an incision that is placed in the armpit) and transumbilical (through the belly button) breast augmentations as well, but these are less common.
There are many pros and cons for each pocket or incision choice which is why there is no single implant placement that works best for everyone. Ultimately, the choice for implant placement comes down to figuring out which combination of incision and pocket location is going to be the right fit for each patient.

Should I massage my breasts after getting breast implants?

The thought behind breast implant massage is to keep the capsule around smooth implants large and loose to allow for some natural movement of the implants and theoretically decrease the likelihood of capsular contracture. Breast implant massage is falling out of favour as we are finding over time that it didn’t really make much of a difference but can potentially cause issues with implant position if done wrong. There are still some specific instances where it can be useful, but is generally not recommended across the board the way it once was. Textured implants are designed to have the capsular tissue grow into the microscopic nooks and crannies to hold them in place (kind of like Velcro), so massaging them is definitely a bad idea.

Who is a candidate for a mini tummy tuck compared to a full tummy tuck

A mini tummy tuck is an ideal procedure for someone who has some loose skin below the belly button and doesn’t need their muscles repaired, but this is a very limited group of people. This is a procedure that removes the excess skin and pulls the remaining skin below the belly button tight. The belly button is usually left untouched with a mini tummy tuck, so people looking to have the shape of their belly button corrected wouldn’t be candidates for a mini. A full tummy tuck goes all the way up to the rib cage and shifts a lot more skin down for removal. The belly button is separated from the overlying skin and placed through a new opening once the excess is removed and the skin pulled tight again. If someone has a frowny belly button, or a piercing they want to be removed then this would be the procedure for them. A full tummy tuck is also needed for anyone with separation of their abdominal muscles needing repair (common for women after pregnancy), with a lot of excess skin and/or excess skin above the belly button and those with extensive stretch marks they want removed.

How soon can I get a tummy tuck and a breast lift after having a baby?

This is a great and very common question. The answer is a bit different for the two procedures as the tummy and breasts return to their pre-pregnancy state at different times. In terms of the tummy tuck, I would suggest waiting at least 6 months after a standard vaginal delivery to allow for the uterus to shrink back to its pre-pregnant size and to allow for the muscles and skin to recoil as much as possible. Re-draping the skin over an abdomen that is still enlarged will lead to residual loose skin once the abdomen flattens again. In the case of a caesarian section I would strongly urge anyone to wait a full year to allow for the scarring of the abdominal wall to fully mature, allowing for better visualization and dissection of the skin from the muscles below.As for the breast lift, I would suggest waiting at least 6 months, ideally one full year, after completing breastfeeding (if you are planning to breastfeed) to allow the breasts to settle into their final shape. The hormones associated with pregnancy and breastfeeding cause significant changes in the shape, size and texture of the breasts so in order to get the best, and most long-lasting, result with your breast lift it is important for your hormone levels to have stabilized so that the breasts don’t change significantly after the procedure.

When getting liposuction, do most doctors require compression garments?

While I can’t speak for every surgeon, I personally have my liposuction patients wear the garment 24/7 except to shower for 3 weeks post op followed by another 3 weeks during the day only for 3 main reasons:
1. Controlling swelling: the compression on your tissues helps your body to reabsorb the edema fluid that accumulates in the tissues after any procedure. This can take quite some time to happen without help from the compression garments
2. Improving contour: the compression helps to keep the tissues adherent to the underlying structures while healing, this can help prevent the wrinkled skin appearance that can happen when the tissues heal in ways we don’t want them to.
3. Improving scarring: pressure has been shown to improve the appearance of scars. Although liposuction scars are fairly small, no one has ever complained about having a scar that is too invisible.
For those reasons many of us would argue that the compression is every bit as important as the liposuction itself in determining the final outcome.

What is the recovery like for Belkyra?

Excellent question. Belkyra (Kybella in the USA) is not like Botox in that you should expect to go back to life right afterward. The recovery is definitely not anywhere near the recovery for surgery though. The common side effects include swelling (87% of patients), bruising (72% of patients), pain (70% of patients), transient numbness (66% of patients), redness (27% of patients), and areas of hardness in the treatment area (23% of patients). Less common side effects include tingling, nodule formation, itching, skin tightness, and headache. These side effects typically resolve without treatment and do not commonly result in patients discontinuing treatment. I try to do all of my Belkyra injections on a Thursday or Friday so that my patient can recover over the weekend and get back to life by Monday. I also have my patients take Arnica for 2 days before and for several days after to minimize and resolve the bruising.

Can an abdominoplasty be performed without permanent stitches?

ABSOLUTELY! In my opinion, permanent sutures should never be used for an abdominoplasty. If your muscles are being tightened or a separation is being repaired, you will need sutures that last a while in the muscle layer, so the body can heal in the way we want it to, but the permanent sutures that were used historically aren’t necessary any more. We have long-lasting, absorbable sutures that will hold things where they need to be long enough for your body to heal, and then dissolve so nothing is left behind. Between 6 weeks and 3 months you should be able to return to full activities depending on how active you are, and by 1 year, everything has completely dissolved!

How do I know if I need a breast lift or a breast lift with augmentation?

This is a very common question I get and it’s actually pretty easy to know which breast procedure you’ll need. If you like the size of your breasts, but want to improve the shape then a lift alone is what you need. If you want to have larger breasts as well as breasts with a better shape, then a combination breast lift with augmentation is what is necessary. Where it gets confusing for some patients is when they want things to be fuller in the upper pole of the breast, but don’t really want to increase their overall breast size. In most cases, I can use some of the breast tissue from the lower half of the breast to “auto-augment” the breast, giving the same upper pole fullness that comes with a breast implant, but without having to increase the overall size of the breasts or add a foreign object (the breast implant).

Will the loose skin after liposuction improve in appearance?

This is a constant concern for liposuction patients and unfortunately, there is no real catch-all answer to this. There is always some contraction of the skin after liposuction and the research seems to show that it takes about a year for this contraction to complete. The amount of contraction varies wildly amongst patients depending on the elasticity of their skin. Skin also loses elasticity as we age, so someone who might have been a good candidate for liposuction when they were younger may not still be. When I evaluate someone for liposuction I always pull a bit on the skin in the area to see how much resistance there is as well as how quickly the skin recoils to get a sense of whether they will be a good candidate for liposuction, or will likely need some sort of skin excision surgery to remove the excess skin. Another thing to look at is stretchmarks. Skin that has stretch marks has by definition lost a significant amount of its elasticity, so it would not contract well after liposuction.

Can someone with mild asthma get a breast augmentation

Yes, absolutely. Asthma alone is not an absolute contraindication to breast augmentation surgery (or any other elective surgery for that matter) and mild asthma in particular shouldn’t be a problem. I would have a patient with asthma meet with my anaesthesiologist ahead of time to make sure that everything is optimized for surgery and that my anaesthesiologist is comfortable with the severity of the asthma, but it would be rare that an otherwise healthy person be denied surgery for mild asthma.

Is waiting 6 months after breastfeeding sufficient before getting my Breast Augmentation?

A full year would be preferable but if everything has returned to normal you could be ok. If there is still any milk coming out however then the glands are still active and you may see further changes after your breast augmentation procedure. Similarly, if you are planning to have more children, your breasts shape, size, and volume will change during and after pregnancy. The only way to know for sure is to book a consultation with a board certified plastic surgeon near you to see what your options are.

Natrelle Inspira Silicone Soft Touch vs. Responsive Touch Implants Are these considered gummy implants?

Although there is a slight difference in the texture between these implants, all silicone gel implants available in North American today belong to the 4th or 5th generation of silicone breast implants, and all would be considered “gummy bear” implants. In reality, there is little difference in the feel of these two implants once they are actually inside a patient’s breasts. However, a consultation with a board-certified plastic surgeon can help aide you in the process of choosing the ideal implant for you, based on your physical anatomy, desired results, and many other factors.

Is 50 too old for a mommy makeover?

Age and plastic surgery is a common question. Your age doesn’t matter so much compared to your overall health. A lot of people in their 50s and 60s are having cosmetic surgery, in particular mommy makeovers, so there is no reason that you should be overly concerned about your age. The only way to know for sure is to book a consultation with a board-certified plastic surgeon to see what your best options are, and whether your health will impact the results of your surgery.

Tightening abdominal muscles from a tummy tuck - is it permanent?

Great question. Once the abdominal muscle tightening has healed, generally after 6 weeks it is considered permanent unless you have an injury or become pregnant, in which case the muscles will stretch as is natural with pregnancy. Whether the sutures stay for life depends on what your surgeon uses. Some people will use a permanent suture, which will be there forever. I use a dissolving suture that takes a long time to dissolve, leaving a stable scar holding your muscles together but no foreign material that can cause problems. In general, a normal amount of heavy lifting should not be an issue once you have healed, in order to tear the muscles apart you would need to do something significant that would likely result in an injury whether you have had a tummy tuck or not.

Does Botox® Cosmetic stop working after multiple treatments?

I recently found out I'm pregnant. Can I still breastfeed with a breast augmentation, or will it cause distortion?

It’s really impossible to predict how your breasts will look once you are done breastfeeding but if you want to breast feed your child then you should just go ahead and do it. If things change afterward it’s not that hard to revise your breasts but you certainly don’t want to miss out on something as special as breastfeeding because of aesthetic concerns. In terms of safety, there is at least one study I’m aware of that shows breast milk has negligible levels of silicone in patients with implants, less than what is found in a commercial formula so it’s certainly safe.
Learn more about Breast Augmentation in Toronto

What does a Mommy Makeover include?

A “Mommy Makeover” isn’t a set combination of procedures but rather a customized suite of surgeries to reverse the changes to a woman’s body after pregnancy, childbirth and breastfeeding. It commonly includes a tummy tuck and a breast procedure, but that could be an augment, a lift or a combination of the two. Liposuction, labiaplasty, vaginal tightening are also common additions. The only way to know what’s right for you is to book a consultation with a board certified plastic surgeon near you to see what your options are.

Can I use Kybella for the inner thigh gap?

How Does a Compression Garment Help After Liposuction?

I personally have my liposuction patients wear the garment 24/7 except to shower for 4 weeks post op for 3 main reasons:1.) Controlling swelling: the compression on your tissues helps your body to reabsorb the edema fluid that accumulates in the tissues after any procedure. This can take quite some time to happen without help from the compression garments2.) Improving contour: the compression helps to keep the tissues adherent to the underlying structures while healing, this can help prevent the wrinkled skin appearance that can happen when the tissues heal in ways we don’t want them to.3.) Improving scarring: pressure has been shown to improve the appearance of scars. A tummy tuck scar is quite long and right on the front of your body so anything that can help make it flatter, softer and less visible is to your advantage.For those reasons many of us would argue that the compression is as important as, if not more important than, the method of liposuction used in determining the final outcome. While a commercial product like spanx will be ok later in the healing process, the surgical compression garments your get from your surgeon have a higher level of compression and should be worn for the first 3-4 weeks at least.

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