Introduction to Breast Augmentation
The history of breast augmentation started many years ago. The first recorded attempt goes back to 1895!
Royal College-certified plastic surgeon Dr. Marc DuPéré began specializing in breast augmentation surgery back in 2001 and has now become one of the most sought after plastic surgeons.
At the VISAGE Clinic, we understand that, for our ladies, it is very important that they feel and look their best. The image they have of themselves is central for their quality of life, their social interactions and their self-esteem.
Once you have decided to proceed with breast augmentation, it is important to find the right plastic surgeon to perform your procedure. Dr. DuPéré has more than 11 years of experience in this specialized field of plastic surgery. We can comfortably help you to choose the implant that is right for you, the location of the incision, the position of the implants and the right technique, hence, reach your expectations.
At VISAGE we are aiming for a breast augmentation procedure to look very natural, with a final natural tear-drop shape and nice upper pole fullness. In order to achieve your desired size, we have the newest sizers on the market that will guide you to decide on the “appropriate-for-you” size of implants.
The margins of a breast should be soft and a smooth transition should be present. Too large implants will give a woman an augmented look. Too small may also not be good. A breast implant should be chosen according to the width of the existing breast for a natural result. Finally, a small drop in the breasts is a normal and natural look. The breasts should always come down the sides when a women lies on her back.
It is very natural to be concerned about safety when considering elective surgery. All our surgeries are performed under general anesthesia in a fully accredited surgical facility, approved by the College of Physician of Ontario, and with operating room registered nurses and board-certified anesthesiologists.
We know that breast augmentation can greatly increase a women’s self confidence and her appearance. At the time of your consultations – you normally meet with Dr. DuPéré at least twice prior to surgery for your own benefit and comfort – all the various options will be visited and explained to you: type and shape of implants, silicone gel versus saline implants, incisions, implant size, position of the implants, risks and complications, etc. We are devoted to helping you better understand the procedure, its risks and to make informed decisions about your breast augmentation procedures.
Please make sure you visit our main website for comprehensive videos and before and after pictures of breast surgery.
Aesthetics of the Female Breasts
Breasts come in several shapes and sizes and each woman may have different expectations as to what kind of results she would like to obtain with breast augmentation surgery. Those expectations may be different across generations and across societies.
Position of the nipple-areolar complex is important, the cleavage, upper pole fullness, volume and symmetry are all important. Other parameters to consider include the patient’s height and weight, breast’s width, height and projection, tissue’s thickness, overlying skin quality, chest wall bony frame and patient’s athletic activities.
Breasts change drastically with pregnancies, breast-feeding and post weight loss.
Excessive fat outside the breasts may also hide an aesthetically-pleasing breast; it is common for women to acquire fatty tissue in the bra roll area and above the breast, under the shoulder areas (the part that overhangs over a strapless top for example). Therefore, gentle liposuction might be considered at the same time.
Finally, whenever liposuction is required, the fat harvested can be used as an adjunct procedure such as fat transfer to other areas such as the face.
Dr. DuPéré and his team understand that choosing to give yourself curves and/or restoring the youthful shape you once had, is much more than vanity; it is a way to gain back some confidence in your femininity, self-esteem and quality of life. VISAGE Clinic Breast Augmentation offers ways to create and/or restore a beautiful breast appearance.
Breast Implant Material
Breast implants come in various shapes, projections, textures, ‘fills’, and sizes. Dr. DuPéré exclusively uses FDA and Health Canada approved implants. He uses the entire family of implants from Mentor, a division of Johnson & Johnson and also Natrelle® distributed by Allergan. Together with Dr. DuPéré, you will pick the appropriate implant size and shape, guided by your chest and breast anatomy, your body proportions and your preferences.
Low (soft touch) and high-cohesive (firmer- form-stable) silicone implants are very popular now in Canada. Worldwide, 90% of the implants used are silicone gel-based. They come in various shapes – round and anatomic (tear-drop shape), smooth and textured, various projections and heights and various percentage of ‘fills’ depending on the desired ‘softness’ of the resulting augmented breasts. The silicone used in the Health-Canada and FDA-approved implants is of the utmost highest medical-grade quality, known to be biocompatible and safe for implantation.
Round implants tend to be more popular. Anatomical-shaped ones are often considered in cases of tuberous breast deformity and for breasts with mild sagginess (ptosis). Anatomical-shaped implants have a slight risk of malrotation (2-5%) which can result in re-operation.
The saline-filled implants are still being performed today at VISAGE. Because of the chances of rippling which is inherent to the saline implants, the saline implants are now a less popular choice for the women. They are however, very safe, less costly, and for a lady with good and thick soft tissue coverage, they can still be an acceptable choice.
The procedure is performed under general anesthesia or intravenous sedations with local anesthesia in a fully-accredited surgi-center. Our center is a level 3 accreditation, the maximal level of safety granted by the College of Physicians and Surgeons of Ontario. We work with surgical operating room registered nurses and board-certified anesthesiologists. We have worked with the same group of hospital-based anesthesiologists since Dr. DuPéré received his Canadian fellowship in 2001. Therefore, this group is very experienced with aesthetic surgery and with the high standards we offer to our VISAGE Clinic patients.
The procedure takes approximately 1.25 to 1.5 hours of surgical time. There should be no race in breast implant surgery, so, Dr. DuPéré does not claim to be the fastest. Bleeding around the implant is the enemy of breast augmentation surgery, so careful dissection and hemostasis is vital to an excellent result. Minimal pocket bleeding produces a rapid recovery. The procedure would take slightly more surgical time should liposuction and/or fat grafting be required.
The implant is inserted via a 3.5 to 4.5-cm incision. Most women in North America choose the infra-mammary incision. This is the approach with the least chance of interfering with nipple sensation and breast-feeding. A small number prefer around the areolar disk, between 4 and 7 o’clock at the margin between the skin and darker areola. This would be selected in cases where a small periareolar lift – or nipple lift – is indicated. In very selected cases and after appropriate and informed discussion, the axillary approach can be chosen. This latter approach has a higher re-operation rate for shape and position problems, and for difficulty controlling bleeding. This is reserved for a very small group. Transumbilical approach is not safe and should not be done. Ultimately, the natural shape of the breasts and safety of the procedures are the most important outcomes.
The implant is placed either under the gland itself, under the pectoralis fascia, under the pectoralis major muscle itself or the new dual-pocket technique. Pros and cons of the various positions for the implants will be discussed at the time of your consultations. Some patients may have options, while others will have fewer options, unless they are accepting of a mastopexy – or lift – procedure. An implant put under the pectoralis muscle may help to blunt the edges of the implant and avoid a round look. It also helps to prevent the implant from dropping over time. It seems to also give an advantage at lowering capsular contracture rate. Mammography and ultrasound of the breasts are also easier to perform when the implants are under the muscle itself.
Most women want a very well defined cleavage. Dr. DuPéré does all his inner chest dissection as close to the midline as safely possible to provide a nice and well-defined cleavage. That being said, there is a 1.5-2 cm midline ‘no-man’s land’ which cannot be violated for fear to lift the midline skin, lose the cleavage and acquire a one-breast result (symmastia, a difficult problem to correct). Moreover, the implant should be centered under the nipple-areolar complex.
Drains are sometimes used for 1-3 days post-operatively.
Most patients go home the same day if this is the only procedure they are having. Dr. DuPéré’s cell phone number is provided to all surgical patients. A prescription for pain and antibiotics will also be given. If required, overnight stay can be arranged at the surgi-center with registered nurse’s supervision.
Pregnancy and Breast-Feeding
Pregnancy and breast-feeding will affect your breast shape, size and skin laxity, with and without breast implants. It is hard to predict how an augmented breast will behave throughout those physiological phenomena. If you are considering having children soon, you may want to delay your breast augmentation procedure. Also note that un-operated women have a 33-35% chance of not being able to breast feed. Therefore, any surgery to the breasts can increase this percentage. This would be more likely with an incision around the areola.
Risks and Complications
Dr. DuPéré’s duty as a surgeon is to discuss the common complications and the rare, but serious ones with you. This constitutes part of the informed consent. Education is always important and knowing the possible risks will make you more attentive to our recommendations in order to avoid complications. Your compliance is crucial. As with any surgeries, risks and complications with breast augmentation are always possible, but have been very rare.
Appropriate planning, technique and patient’s compliance should assure a positive outcome for you.
Examples of complications
- Scar (normal fine scar usually the norm, but stretched scar, thick keloid, indented and hyperpigmented can occur)
- Dehiscence or opening of the wound
- Exposure of implant if wound opens completely and requirement for immediate medical attention
- Pain for 1-4 weeks post-op
- Bruising around the surgical sites
- Loss of sensation over the surgical site and around the scar, including loss of sensation to the nipple(s), temporary or permanent
- Inability to breast-feed post-surgery
- Palpable and/or visible edges and/or folds/rippling of implants
- Loss of cleavage (symmastia)
- Rupture of implants
- Bottoming out of implant over time
- Double-bubble deformity (usually when a lift was not performed, but was indicated, or with serious pre-op breast anomaly such as a tuberous deformity).
- Temporary superficial vein clotting (superficial thrombophlebitis) over the chest or upper arm; this is not dangerous and would improve over 3-4 weeks with anti-inflammatories.
- Asymmetry: asymmetry is a normal occurrence in the human body. but everything will be done to minimize it.
- Seroma: accumulation of fluid around the implant that would necessitate regular aspiration of the fluid and compression. Rarely, if the seroma formation does not stop, drains may have to be reinserted or the implant may need to be removed.
- Infection: very rare, but that would require immediate surgical treatment as antibiotics might not be sufficient in those cases. If surgical lavage is not successful, the implant might have to be removed; we would wait 3-6 months and redo the procedure again.
- Serious bleeding within the breast envelop that requires another surgery to explore and attend to the bleeding and resulting clot
- Nerve and vessel injury: with any surgery, injuries to nerve and blood vessels are a possibility, which can result in loss of sensation over an area of the body. This could include loosing some feeling in the nipple complex. Rarely, a motor dysfunction could result.
- Skin necrosis: part of the skin dies due to undo pressure or vascular compromise. Wound care might heal the defect or a secondary procedure might be needed.
- Risk related to liposuction, if performed: dimpling, irregularity, fat embolism, too much or not enough fat removal, cardio-vascular issues, etc.
- Sub-optimal fat ‘take’ if fat transfer is performed. Fat transfer is a delicate procedure and there is a limit to the amount the soft tissue can ‘accommodate’ new fat in one procedure. So it is possible that a second procedure may be required and additional fees would be incurred by the patient.
- Deep venous thrombosis: clots within the calf that could ultimately travel to your lungs (pulmonary embolism): gentle movement of the toes and legs post-op help to prevent this issue. This is something more common with ladies, those who smoke and those on the birth control pill or estrogen replacement.
- Migration of implant over time which may require re-operating for aesthetic reasons
- Capsular contracture: the body always forms a layer of thin collagen around a foreign material called a capsule. In less than 1-3% of implanted patients, the capsule may contract and either move the implant superiorly or make it more visible. This could occur anytime after surgery… 6 months, 2 years, 10 years, etc. It is not dangerous. If this is unsightly, we may need to go back in surgery and remove the capsule and re-implant. This is usually unrelated to the surgical technique and would be associated with additional fees to the patient. A new implant is normally recommended.
- General anesthesia-related issues: heart, lungs, brain, etc.
Recovery after Breast Augmentation
Pain will be present anywhere from 3-7 days on average, slightly more so if the implants were placed under the muscle.
Stretching exercises should be initiated on the DAY OF SURGERY: gentle stretching of both arms OUT and UP, several times every hour when you are awake. This will speed up the recovery.
Short distance ambulation inside your house helps to prevent clots in the deep venous system of the legs.
No sports/gym for 8 weeks. No upper chest exercises for 12 weeks.
Most people can go back to non-physical work (i.e. desk work) in about 10-14 days post-operatively.
Drains are sometimes used and would typically be removed 5-7 days post-operatively. All stitches are usually internal and dissolving. Tight compression over your chest would also be applied with tensors for 2 days, and then a comfortable sport-bra is recommended. No push-up bra and no wires under the bra for 6-8 weeks.
Thirty (30%) of our patients are not from Toronto. Because of Dr. DuPéré’s strong and long-standing interests in body and breast implants, people come from all corners of Canada for those procedures.
We do offer a Fly-In Package. The VISAGE Clinic staff is quite accustomed to helping patients with airport and surgical clinic transfers. We also have preferential pricing at various hotels near the clinic for all budgets.
It is required to stay around Toronto for a minimum of 7-10 days post breast augmentation in case of emergencies.
We can also arrange any nursing help for hotel or home, post-operatively, if needed.
Other Breast Procedures
Dr. DuPéré also performs breast lift (mastopexy) with or without implant:
- Benelli’s technique: periarealar only, for small lift and/or areolar resizing
- Lejour Vertical technique (lollipop scar – no horizontal scar)
- Inverted T for larger breast and lift.
Dr. DuPéré performs nipple lift and correction of inverted nipples
Dr. DuPéré performs breast reduction surgery, usually using the Lejour Vertical Mammoplasty technique (no horizontal scar).
Dr. DuPéré also performs complex procedures on patients with tuberous breast deformity, pectus excavatum, pectus carinatum and asymmetries.
All cosmetic surgery consultations are with Dr. Marc DuPéré personally.