Ask the Doctor

Double bubble typically would not be corrected with a lift alone. The issue is either a shadow crease from an implant that was intentionally placed below the existing inframammary crease or from an implant that has bottomed out. The correction for this is either to obliterate the original crease with scoring or fat grafting if the implant is sitting at the right level, or to raise the implant back up to where it is supposed to be if it has bottomed out.

All breast lifts involve incisions around the areola so it is unlikely that the tattoo won’t be affected somewhat.

The ideal implant is a saline based device so the surgeon has flexibility in how much it gets filled, which is great for addressing minor asymmetries. They do not behave exactly the same as traditional saline implants though, so I personally find they work best towards the top of their fill range if not slightly overfilled.

You do not need any extra calories for healing a breast lift scar. If you eat a well rounded diet with enough protein then you should not need to make any modifications to it for healing. Wait 4-6 weeks after surgery before starting any type of diet to ensure that your body has had enough time to heal the scars solidly. Hope that helps! 

Yes it absolutely can. Botox to the masseter muscle will weaken it enough to reduce grinding and clenching. Typically 30 units per side is needed as a starting dose but some patients require more. It is not a permanent solution so you will need to repeat the dosing every 3-6 months to maintain the results.

Out of all the lift techniques the periareolar lift is definitely the safest. The Benelli is one specific type of periareolar lift that is NOT skin only as it involves a lot of dissection around the breast gland. A straightforward periareolar lift using the Hammond wagon wheel technique will give the most reliable result with the least risk of complication.

Metal piercings need to be removed before surgery. Each office will have different policies on plastic jewellery but if you did have to remove the piercings you would not need to keep them out for a year. If your incision was not through the nipple then you'd technically be able to put them back in right after surgery.

I would generally recommend that patients take about a week to recover from a combination mastopexy-augmentation (lift + implants). If you aren't lifting anything heavy you may be ok to get back to work earlier, but it will be difficult to know until you've had your procedure and can see how you actually feel.

Both are there to guide you, but neither should be taken as a true representation of the final results. In general, I would not recommend using a rice test to choose an implant size independent of your surgeon, but it can be helpful when deciding between two sizes. If you are concerned that your implants may end up looking too small, then just go with the larger of the two options you’re choosing between. The difference between certain sizers can be marginal so you’ll probably never know the difference after the fact. This is why I feel its generally best to prevent the potential regret by knowing you chose the larger size if after surgery you feel like they are smaller than you were hoping for.

3-6 months should be more than sufficient, but there are differing opinions between surgeons as to how long patients should wait.

3-6 months should be more than sufficient, but there are differing opinions between surgeons as to how long patients should wait.

60-70% of fat is retained, and the results that are present at three months tend to be permanent unless you lost a significant amount of weight. If you were to regain that weight however, the volume would return to the breasts. 

We have lots and lots of data showing that breast implants don’t increase the risk of breast cancer. We also have data showing that fat transfer is also safe, but not nearly as much as for implants, so I would suggest going with implants even though both options are fine.

In theory it could, but it would vary patient to patient depending on the natural shape and position of their breasts. The increase in size from fat transfer is typically limited to half a cup and it adds volume but does not alter the shape of the breasts

There are many different ways to do the same procedure, so each plastic surgeon will have a slightly different technique. That means when it comes to recovery we will often have different opinions as well. On average it would be anywhere from 2 - 6 weeks, but again, we're all different so it's probably best if you discuss this with your surgeon to make sure you don't compromise your results. Best of luck!

In general most women will reach full breast maturity between 18-20 years of age however the breasts continue to change over a woman’s entire life. In addition to age and gravity, things like pregnancy, breastfeeding and menopause will cause changes in the breasts as well.

In general terms, deciding between a lift, augment or both is relatively straightforward. If someone wants their breasts larger, then they need an augment - either with an implant or fat. If someone wants the shape of their breasts or the position on their chest changed, then they will need a lift. The exact type of lift can only be determined during an in-person consultation with a plastic surgeon, but in most cases a donut or lollipop lift will achieve the desired results without needing the dreaded anchor scar.

No, breast implants and fat transfer will not give the same outcome. Breast implants have a very large range of sizes that can be used to augment the breast whereas fat transfer is limited to around a half a cupsize. Implants also are structured themselves and therefore can give a shape to the breast where as fat grafting will simply increase the size of what is already there.

Each surgeon will have a slightly different protocol for scar management, but in general it involves keeping the incisions clean and applying some pressure with a surgical tape in the first few weeks (steri-strips in my practice) followed by the use of a silicone based product (gel or sheeting) combined with scar massage and sun avoidance. It takes a full year for a scar to completely mature, so whatever protocol you use, make sure it’s something you can maintain for a while.

Although rare, it is definitely a possibility. Part of the informed consent process involves disclosing this fact to patients. It is more common with mastopexy (breast lift) procedures because there are more incisions, but even for that procedure it is rare to lose sensation altogether. It is common to have altered sensation at first because the nerves are being stretched when the implants are inserted. For some women it is a decrease in sensation, for others it is actually an increase in sensation that occurs but in either case it is usually transient.

Double bubble is a pocket problem, not an implant problem, so whether you get saline or silicone implants won’t really have much of an impact. Double bubble occurs when the implant slides down the chest, below the existing inframammary crease. This usually happens because the crease was divided during the creation of the incision, leaving a weak point for the implant to slide down over time. The key to avoiding a double bubble is for the surgeon to ensure to secure the inframammary crease before closing the incision to prevent this from happening.

For the breast augmentation they will have to be removed because they’ll interfere with my judgement of the appearance and if they’re metallic they can cause the electricity from the cautery to cause a burn to the nipple. It won’t cause a problem during the healing process but I wouldn’t recommend putting it back in for at least a few weeks after your surgery.

Typically silicone implants are felt to be softer, but as with everything else it is somewhat patient specific. In a very thin patient then saline will be much firmer. If someone has a lot of breast tissue to begin with then chances are they won’t really feel either saline or silicone.

All breast implants will ripple given the right conditions and in some patients it is unavoidable because they have very thin skin. If a patient does not have enough tissue to cover their implants then placing them under the muscle to camouflage the rippling of the implant would be the first step. Using a silicone gel implant, ideally with a high percentage of gel fill so there is less extra shell to ripple, or IDEAL implants would also help minimize the appearance of rippling. In extreme cases fat grafting or alloderm would need to be used to help thicken the tissues and cover the rippling. As with everything in plastic surgery, preventing rippling is very patient specific and would need to be customized for each one.

There are several reasons that I would decide to put implants under the muscle rather than over it. In general, I prefer to put implants above the muscle because it makes sense anatomically. There are situations where I will place the implant in a dual plane pocket (half under the muscle at the top, under the breast at the bottom). I almost never place it entirely sub muscular for cosmetic surgery.

The most common reason to put an implant in the dual plane pocket is that the patient doesn’t have enough tissue to cover it and will end up with “edge show” at the top. Other reasons would include the need to change pockets during revision surgery or in a patient with a high risk for breast cancer so that mammograms will be easier to obtain and read. The muscle can flatten the top of the implant a bit as well, so for some patients who are really worried about having roundness at the top and want that sloped look it can be helpful as well. The only reason I would put an implant totally sub muscular would be if we did a transaxillary procedure where there really is no other option for pocket choice because of the mechanics of that specific operation.

If you have breast implants and are getting a mammogram then make sure to let the technician know. They will take special views of the breast to make sure they capture all the breast tissue in a way that is not obscured. Usually the mammogram will compress the breast tissue on top of the implant, so it would be very rare for a mammogram to damage an implant.

It really depends on what type of implants you have. If you have saline then a rupture will be obvious because your breast will deflate. If your implant is silicone it will be more subtle and an ultrasound or MRI will be needed to assess the implant. If you are having other issues with your implant they will typically present with pain or a change in appearance in the breast that will prompt you to go see your surgeon and find out what is going on.

It’s impossible to predict exactly how many operations someone may need over their lifetime, but I tell all breast implant patients to expect at least one more over the course of their life. The best case scenario is someone gets their implants put in when they are younger, they stay in without problems for many years and then they get them removed later in life simply because they’re older and don’t want breast implants.

There is no placement that gives the most natural appearance across the board. It is all about choosing the right pocket for the right patient to achieve their own individual goals.

There are many factors to consider when choosing the right implant size to hit a target cup size such as skin elasticity, chest width, and your current breast size. While many patients are used to measuring their breasts by cup size, it’s actually kind of a moving target since different brands will tend to measure the same woman into different cup sizes. Because it is a moving target, we can’t really use it as a specific goal, but it is a good way to communicate what you are looking for. Ultimately implants need to be chosen at a sizing session that allows you to see approximately what the volume would look like when added to your breast. When you are trying them on, think of whether they look like what you are trying to achieve rather than focus on what the actual letter of the new bras you eventually buy is.

It is not recommended that you smoke cigarettes or marijuana while healing from your breast augmentation procedure. Nicotine products like cigarettes restrict blood flow and can have a negative effect on your healing process. Good blood supply is necessary for proper wound healing after your breast augmentation. It is best to avoid smoking cigarettes for several weeks after your procedure (and ideally use it as an opportunity to quit). Although marijuana does not contain nicotine, it can induce coughing, resulting in strain on the chest muscles and your incision sites. Marijuana can however be an effective pain medication so I don’t discourage its use in edible or vaporized form after surgery. This is something that should be discussed in person on a case by case basis before attempting to use marijuana as a postoperative pain medication.

All procedures need to be customized to each patient, so there is no general rule that applies to everyone. In the absence of any reasons to make me choose a different incision, I always favour an incision in the inframammary crease for multiple reasons including a decreased rate of capsular contracture, no damage to the breast tissue itself (which is better for breastfeeding and mammograms) and the fact that it is a very well hidden location. If you do scar poorly then it will at least be under the breast rather than right on the front of it. Hope that helps!

It’s very difficult to predict a specific cup size after breast augmentation. The answer depends partially on how large your breasts were before the operation and what size implants are being put in, but also what brand of bra. There is really no consistency anymore between what any specific cup size really is from one brand to another. One woman may be a double D in one brand and a C in another. The best way to determine the right size of implant is to try on sizers at your sizing session and see if they look right for your frame. Consider whether they look like what you picture a B cup should look like on you rather than focus on what the actual letter of the new bras you eventually buy is.

Usually it takes about 6 weeks for breast implants to “drop and fluff”. It can take a little longer with IDEAL implants, sometimes up to 8 weeks. The implants will continue to soften and settle beyond this, typically it takes a full year to see the truly final results.

In my practice, NEVER! I work painstakingly to create a pocket that fits your body and breast implant to give the look we’ve discussed at your consultation and keep the implants where we want them. Massage is something that older surgeons used to advocate because they thought it would decrease the rate of capsular contracture by creating a huge pocket. While the rate of clinically significant capsular contractures are possibly decreased, it is only because the contracted capsule is humungous, not because there isn’t a capsular contracture happening. The side effect of this is that you have a humongous pocket, which allows the implant to move all over the place in an unnatural fashion. Most commonly women complain that their implants slide down the side of their chest into their armpit, something we call a lateral malposition.

Everything mentioned here is certainly an option for natural appearing breast enhancement, sometimes a combination of these techniques is the best answer. There is often concern that someone will look “fake” with breast implants, but there are many different profiles and sizes of implants that when chosen correctly for the patient give a very ’natural’ look. After a consultation, once I’ve gotten specific details on what a patient is looking to achieve, examined them and taken a dozen measurements we come up with a customized plan that will get them from where they are now to where they want to be in a safe and reliable manner. No one procedure is the answer, the key is to match the right procedures with each patient's current body and their goals.

While it is important to avoid placing direct pressure on your buttocks during your Brazilian Butt Lift recovery, once you are fully healed, you can feel free to sit as much as you would like. However, be sure to discuss your options with a board certified plastic surgeon. Good Luck!

Yes, there are some steps that you can take to help maximize fat survival after a BBL. First, be sure to avoid direct pressure on the buttocks. Do not sit directly on the buttocks, and sleep on your belly during recovery. Also, be sure to eat a healthy diet with plenty of vitamins and nutrients. Third, keep in contact with your plastic surgeon and be sure to discuss any concerns that you may have during recovery.

Pig fat transfer is not a viable option. In theory if it worked you'd need to be on anti-rejection drugs (as if you'd had a kidney transplant) for the rest of your life which is something no legitimate surgeon would consider ethical. You'll need to gain some weight if you want a fat transfer procedure, and there are lots of easy ways to do that. Without examining you or seeing photos its difficult to give specific advice so I'd advise you book a consultation with a board certified plastic surgeon near you to see what your options are. Best of luck!

This is not new science, this is new marketing. ALL fat transfers involve the transfer of stem cells that naturally live within the fat. These cells have been shown to rejuvenate the skin of the breast and face when transplanted, but in the butt it's unlikely to make much difference to the overlying skin because of how thick it is. The secret to longevity is handling the fat properly to maximize how much of it gets a new blood supply in the area it's transferred to so it will live there permanently. Stem cells have nothing to do with it and further "enrichment" of the stem cells is just a technique used to take more of your money for the exact same procedure. I'd suggest you get a consultation with a board certified plastic surgeon near you who has a history of performing high-quality BBLs without having to resort to tricks and gimmicks to sucker unsuspecting patients in. Best of luck!

The fact that you are asking means you know the answer. Outside the US and Canada where we have board certification it is very difficult to do your homework properly. Like everywhere, there will be good doctors and bad in the DR, but if you aren’t from there and don’t speak the language it will be very difficult for you to tell who is who. Even if you did find an amazing surgeon there, it’s wise to be near your doctor while recovering in case you have any complications. If you go abroad then you probably won’t be staying more than about a week, so if you have any late complications your surgeon will not be available to you. In general, if you are going to have cosmetic surgery then do it safely near home or don’t do it at all.

In the first week of your recovery from tummy tuck, you will experience the worst of your swelling and other side effects. Over the next two to three months, you will see the majority of this swelling subside and you can begin to enjoy your new contour. However, it can take up to a year for your last bit of swelling or puffiness to completely resolve. If you wear your compression garment as directed it can help speed the improvement.

Although the tummy tuck is not a weight loss procedure, it can help patients lose several pounds in loose skin and tissue and take inches off their waistline. This can make future weight loss easier without having the hanging tissue in their way. However, you should not expect to lose a significant amount of weight from your tummy tuck alone. The best results will come to those who are already within their ideal weight range and suffer from mostly excess skin (not skin and fat) and are committed to maintaining a healthy lifestyle through proper diet and exercise after their procedure.

The cost of your tummy tuck procedure will vary depending on a number of factors including the area in which you live, the techniques involved in your procedure, the size of your abdomen and any other complicating factors. Your price will include your surgeon’s fees, surgical facility charges, medication, and may or may not include the required post-surgical garments (it does in my practice). Your total will be gone over in more detail during your consultation. When it comes to any plastic surgery procedure, the most important thing to remember is that cheaper is not necessarily better. More important than the cost is to ensure that your surgeon is board certified and experienced in the procedure so that you receive the safest, most effective care possible.

You can have a baby approximately 12 months after your tummy tuck procedure if absorbable sutures were used for the tightening of the muscles. If you are planning to have children in the short term I would recommend waiting to have your procedure until after you’re done having children. If you know you are having children someday but not for a while then you could consider having a tummy tuck as long as you know a future pregnancy could stretch out the abdominal tissue once again, reversing the effects of your tummy tuck. If this occurs, a second tummy tuck procedure may be needed.

Question Details: I currently have saline implants (350 on left, 250 on right) my left implant is moving upwards. I need to exchange implants and would like to stay with saline, maybe Ideal implant, & to stay about a D cup. I’m deathly scared of the scars so what is the minimal scarring lift I could get away with if a lift is needed.

Answer: Because the high riding implants change things a bit the nipples could appear deceivingly high at the moment. Without examining you it's difficult to be entirely sure, but based on the photos it looks like you would probably do just fine with a periareolar lift (donut lift). If you were my patient we'd have a discussion about potentially adding a vertical limb (to make it a lollipop lift) based on my discretion if in the OR the new implants were in and in the correct position and the nipples were not going be elevated enough with just the donut lift. Ultimately there are many different approaches and you have to trust that each surgeon will do what will get the best result "in their hands". Find a surgeon you trust and go with their opinion on how they can get you the best possible results. Hope that helps!

Yes, IDEAL implants do measure out differently than the others. Because the dimensions given by the manufacturer were measured on a convex surface (which more accurately reflects the shape of the chest) they tend to be about 5 mm wider and have 5mm less projection on average when put on a flat surface. The other manufacturers in North America did all of their measurements on a flat surface, and that is what the majority of surgeons are used to so it does take a bit of adjustment when getting used to sizing IDEAL implants.

While it is probably technically possible to fill the implants to that size, I would strongly caution against it. The larger an implant is, the more likely you will have complications both early and late. Also, stretching your breast skin that large will guarantee that you will need multiple procedures down the road to address the sagging of the implants as well as to deal with the excess skin when you eventually have them removed (you're not going to want these in your 70s!). Stretching your skin to that point may result in you needing something as extreme as a mastectomy to deal with the skin at that point. In addition to that, you'd also be hard-pressed to find a reputable surgeon who would be willing to perform such a procedure and therefore you'd be looking at sketchy facilities or third world countries, which come with significant risks of their own. I would really advise you not to proceed with this procedure.

It is not recommended that women undergo an abdominoplasty right after giving birth.You must first let your body heal from childbirth and return to your pre-pregnancy weight before a good assessment of whether a tummy tuck is right for you can be performed. If you had a caesarian section birth then there is also a significant increase in risk of infection were you to have a full abdominoplasty at the same time.

Wearing a sports bra following breast augmentation does not cause any problems and is typically encouraged for the first 6 weeks after surgery. At that point you can switch into any bra, but if you prefer sports bras then there is no issue wearing it indefinitely.

Surgical drains are required following some mommy makeover procedures to help collect any excess fluid that the body wants to release into the surgical site. This helps to reduce the risk of seromas. Most individuals can have their drains removed after about two weeks, though every patient is different. Not every procedure will require drains though.

A tummy tuck and breast augmentation are very frequently combined during surgery. This combination procedure is commonly performed as part of a “mommy makeover” (which is really just a combination of procedures addressing multiple areas affected by pregancy and breast feeding at once for a cost-effective and more dramatic plastic surgery transformation).

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Tummy tuck only addresses the skin on your stomach. There will often be a bit of contouring of the flanks when the skin is pulled centrally, but I would not anticipate any change to the back itself. If you want your back addressed it certainly can be done at the same time, it would just need to be done first so that you finish ‘face up’ in the position that is needed to recover a tummy tuck.

Mentor and Allergan implants are the ‘gold standard’ with more long-term safety data than any of the other brands. Motiva is popular outside North America, but would still be considered ‘off-brand’. At the moment, Motiva implants are not FDA or Health Canada approved which means we cannot be sure they meet the same standards as those that are approved.

It is definitely possible to convert a sub muscular implant placement to a subglandular one. If a pocket change is needed and a patient already has submuscular implants there are several options available to create a completely new pocket for the implant including going above the muscle or creating a new pocket underneath the muscle on top of the old one (known as a neosubpectoral pocket).

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.

A mini tummy tuck will only address the skin below the belly button and will slightly lower it as well. A full tummy tuck addresses all the skin of the abdominal wall and involves some improvements to the shape of the belly button. It also allows for muscle tightening when needed whereas the mini tummy tuck does not.

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.

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.

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.

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.

This is one of the unfortunate side effects of saline implants. All implants (saline or silicone) have a spontaneous rupture rate of about 1% per year. With saline implants, if that happens they tend to deflate overnight and require replacement ASAP before the pocket and capsule contract.

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.

It’s too early to tell the final results of your breast augmentation at this point. It takes a good 3 months for the breast implants to settle and any swelling to resolve enough to get a sense of what your final results will look like. If you are really concerned, you should always request a follow up with your surgeon for reassurance.

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.

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.

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.

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!

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.

The IDEAL IMPLANT® feels natural and boasts many advantages over other traditional implants. It is made up of a series of inner and outer silicone shells (same as for all implants) and is then filled with saline solution. This one-of-a-kind structure helps the IDEAL IMPLANT® provide a natural feel and control the movement of the saline.

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.

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.

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!

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.

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.

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.

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.

No breast implant revisions should be considered for at least 6 months. The results look very good at this point, so if down the road you want bigger implants it’s not too difficult to exchange up. If you are really concerned and need to address the issue now then book a follow up with your surgeon so they can come up with a plan for the next 6-12 months.

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.

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.

During a tummy tuck in Toronto, there is nothing that can be done to improve the appearance of stretch marks, unless they are removed as part of a tummy tuck to a certain extent. In general, the stretch marks below the belly button is can be removed from the plastic surgery, but above the belly button stretch marks usually, have to remain.

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.

The distance between a woman’s breasts is determined by the width of her sternum (breast bone) and the existing footprint of her breasts. While implants can sometimes be moved closer together surgically it runs the risk of them coming completely together and creating a synmastia which is a difficult problem to solve.

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.

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.

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.

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.

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.

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.

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.

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!

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).

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.

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.

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.

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.

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.

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.

While it is rare to develop a tolerance after just a few sessions, it is possible to build up a tolerance for Botox® Cosmetic making it ineffective. Usually this occurs after years of treatment if at all. You may want to try switching to Dysport or Xeomin to see if those work as the molecule for each is slightly different.

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

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.

There is a good chance it will work there, and will eventually be approved for that location, however at this point it is only approved for use under the chin. The best solution for medial thigh fat is still 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.

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.