Your Path to Breast Augmentation

Breast Augmentation Consultation

The decision to have Breast Augmentation is a major step and extremely personal. At the Toronto Cosmetic Surgery Institute, Dr. Jugenburg, Nurse Kim, and our staff always guides and supports our prospective patients in an initial consultation. During this consultation, you will discuss your reasons for wanting Breast Augmentation and will undergo a thorough medical check-up.

If found to be a suitable candidate for surgery, Dr. Jugenburg or our Nurse Kim will explain all the available options to you and make recommendations as to which approach is best suited to your body and desired goals. You will also have the opportunity to view our state-of-the-art facilities and meet with our team of friendly and experienced staff.

Learn About Breast Augmentation

Please understand a consultation is an opportunity for you to meet with us, and for us to assess you and come up with a surgical plan.  A consultation IS NOT an information session.  Your consultation is allotted a limited amount of time.  To make the most of your consultation, please make sure to prepare yourself accordingly.  Read about breast augmentation on our website and the sites listed below, make sure to WRITE DOWN your list of questions, and also find 10 photos of breasts you like, and 10 photos of breasts that you do not like (these should be naked, head on or side view as you find on plastic surgery before/after photos  – ideally find before/after where the before looks like you)

Breast Augmentation, although very common, is still a surgical procedure. The commitment to undergo a breast enlargement should, therefore, be made only after you have considered all the advantages and disadvantages, and then made an informed decision.

To be able to make this decision, you need to understand what the surgery involves, and what to expect after the surgery. There are many very informative sites online that help patients towards making this decision. Unfortunately, there are also many sites that scare patients with sensational headlines and content.

The following websites are reliable sources of information on Breast Augmentation surgery and outcomes:

RealSelf
A website where real patients ask questions, post their stories, and board certified Plastic Surgeons answer questions
American Society of Plastic Surgeons
The official site of the American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgery
The official site of the American Society of Aesthetic Plastic Surgeons

Understand Your Options in Breast Augmentation

There are a number of choices that you will need to remake in order to choose a suitable Breast Augmentation procedure for your requirements. Dr. Jugenburg will guide you through this process and help you make the decision based on what will most enhance your body.

Dr. Jugenburg is experienced in all types of breast enlargement and is therefore comfortable performing any technique that he believes will give you the best possible result. The decision on what is best for your breasts has to do with your existing anatomy and body proportions.

Your options include:

  • Silicone (Cohesive Gel or Gummy Bear) implants vs. Saline (salt water) implants
  • Round implants vs. Shaped (Anatomic or Teardrop) breast implants
  • Smooth breast implants vs. Textured breast implants
  • Implant under vs. Implant over the muscle (implant sits under the breast)
  • Incision in the Breast Fold (Infra-Mammary) vs. Around the Areola (Peri-Aerolar) vs. Through the Armpit (Trans-Axillary)

Look at Your Own Breasts

Look at yourself in the mirror. You need to understand that every woman is different and that your existing breast size, shape and position will significantly influence the appearance of your body after Breast Augmentation.

Some women have breasts that sit far apart, for example. In these women, a proper breast enlargement will require that the breast implants are still placed behind the breasts, even if the breasts are notably apart.

If Dr. Jugenburg were otherwise to attempt to place the breast implants close together in an effort to achieve the desired cleavage, the natural breasts would sit more off to the side, and the result would be a very unnatural look.

When looking at yourself, also note that your right and left breasts are not identical. Nobody is perfectly symmetrical, and you are not an exception to this rule. Typically, right and left breasts differ in size, position, orientation, and the size and shape of the nipples.

Some women have very slight asymmetry, while in others this asymmetry is more pronounced. During your consultation, Dr. Jugenburg will discuss this with you and explain what can be done to improve your asymmetry.

Look at Before and After Breast Augmentation Pictures

Search the Internet or our before and after gallery for images of women with breast implants in order to get a better understanding of what looks you like and what you do not like. (Search for terms such as boob job photos and breast implant before and after pictures.)

There are many bad results out there, so do not worry if you see something that you think is unattractive. Breast Augmentation is perceived as an easy surgery and many doctors who are not Plastic Surgeons (such as family doctors, emergency doctors and gynecologists) are performing these procedures.

The results are not always ideal. While no surgeon can ever guarantee you perfect results, a properly trained Plastic Surgeon is more likely to be able to give you great results, and if needed, correct any potential problems.

It would be ideal if you could bring with you to the consultation examples of both what you like and what you do not. If appropriate and to save having to print them out, you can email these to us at info@torontosurgery.com prior to your consultation.

When looking at pictures of other women’s breasts, you should consider these features:

Breast Size
How big do you like them to be? Should they be proportional to the chest? Should the breast implants be so big that they protrude significantly forward or not?
Breast Shape
Do you prefer a round push-up bra appearance or a more subtle breast shape?

Who is a Typical Breast Augmentation Patient?

At the Toronto Cosmetic Surgery Institute, we typically see women with the following profile:

  • Average age: 27 years-old (with a range of 18 – 67 years-old)
  • Relationship status: Single
  • Body mass index (BMI): 25 (with a range of 18 – 35; normal is 20 – 25)
  • Education: College or University
  • Average original breast size: 400 cc’s (range 225 – 980 cc’s)
  • Breast implant surface: 95% smooth
  • Breast incision: 40% Trans-Axillary, 30% Infra-Mammary, 30% Peri-Areolar.
  • Implant placement: 85% below the muscle (sub-muscular)
  • Are You a Good Candidate For Breast Augmentation?

    Many women would desire to have Breast Augmentation, but not all are good candidates for this procedure. The best candidates are women who have all the information, fully understand what the surgery involves and what are the limitations of the surgery, and who have a realistic expectation. They meet the qualifications for a consultation.

    Breast Augmentation can improve the appearance of your breasts, but should not be used as a means to improve your overall life or to make a bad relationship better. Women should only consider undergoing Breast Augmentation for themselves and not at someone else’s urging.

    Besides fundamentally improving confidence, self-esteem and body image, common reasons for Breast Augmentation are:

  • Small breasts
  • Asymmetrical breasts
  • Drooping or sagging breasts after pregnancy and breastfeeding
  • Changes in breast size or shape due to weight loss
  • Reconstruction after surgery to treat breast cancer
  • Cosmetic improvements after breast reconstruction
  • Patients who are not good candidates for Breast Augmentation:

    During a consultation with Dr. Jugenburg, he will assess the current appearance of your breasts, your reasons for wanting surgery, and your expectations in order to determine the best way forward for you.

  • You have had previous radiation therapy
  • You are under 18 years-old
  • You do not fully understand Breast Augmentation surgery and/or breast implant procedures
  • You do not have realistic expectations about Breast Augmentation surgery
  • You are pregnant, breastfeeding, or have an infection
  • Breast Implants go UNDER your Breasts, NOT INTO your Breasts

    It is really important for you to understand that a breast implant does not go into your breast, but it goes UNDER your breast.  A breast augmentation will take you existing breast tissue and enlarge it.

    The reason this is relevant is because you need to look at your breasts critically, evaluate your shape and position and understand the limitations of what a breast augmentation can do for you.

    Notice the shape of this patient's breast before, and then after her breast augmentation.

    In the above image, if you look closely, you seen a small breast in the ‘before' image.  In this particular case, her small breast was mostly glandular breast tissue (hard, non-malleable tissue) and very little fat.

    Once an implant was placed under her breast tissue, in the after image you can see a hint of the ‘before' shape sitting on top of her new implants.

    This demonstrates how in some patients, hard non-malleable glandular tissue does not mold itself over the implant but simply gets pushed forward by the implant.

    You can see the shape of the breast before, and a hint of the same shape on top of the implant in the after picture.
    Here you can see an outline of her breast tissue sitting on her chest, and then on top of the implant.

    Breast Augmentation: The Surgery

    During the whole process of Breast Augmentation, there are many different choices that must be made in order to leave you with an optimal result that transforms the appearance of your breasts. Selecting the right implant, the right approach, and the right placement all affect what the final breast enhancement will look like.

    Preparation is 90% of the process. The surgery itself is just an execution of a well thought-out plan.

    Setting Up for Your Surgery

    You will arrive at our facility in Toronto 2 hours prior to your surgery to allow our nurses to check you in, give you any medication that may be required prior to the surgery, and to allow you to relax in our pre-surgical room.

    Once the Operating Room is ready, Dr. Jugenburg will come into the pre-surgical room to speak with you. You will have a chance to ask any last minute questions that you may have.

    Dr. Jugenburg will then take pre-surgery photos and mark your breasts. Next, you will meet with our Anesthetist, who will perform one last check to ensure you are safe to have the surgery. Finally, you will be taken into the Operating Room, which has by now been set up for your Breast Augmentation surgery.

    Breast Augmentation Anesthesia

    All our Breast Augmentation surgeries are performed under general anesthesia. You will be fully asleep and completely unaware of anything; you will not feel any pain. The anesthesia begins with the insertion of an intravenous (IV) line by the Anesthetist.

    Through this line you will be given induction medication to relax you and to put you to sleep. During the procedure, you will also receive liquid and any medications necessary through this line. The General Anesthesia is maintained throughout your procedure by gases that you will inhale through a mask.

    Our Anesthetist uses laryngeal masks, meaning that we do not need to insert a tube into your throat (trachea), unless necessary. The benefit of this is that you will not wake up with an uncomfortable throat, which is common with endotracheal tubes (tubes in your throat).

    Once the surgery is finished, the Anesthetist will turn off the gas and you will start to wake up over the next 60 seconds or so. During your sleep, we use various sophisticated monitors to ensure that you are fully comfortable and completely unaware of any surgery.

    Insertion of Your Breast Implants

    Once you are asleep, your chest is cleaned with an antiseptic solution, and sterile drapes are placed all around to maintain a bacteria-free environment. We inject local anesthetic (freezing) into the breast area, so that when you wake up from the general anesthesia your breasts feel frozen and you have minimal discomfort.

    Next, a small incision is made (at the breast fold, around the areola, or through the armpit) to create a tunnel from the skin to the space under the breast. A breast pocket is created, which is an empty space either above or below the chest muscle (pectoralis major) into which the breast implant is inserted. This space is washed out with an antibiotic solution.

    Then the breast implants are removed from their sterile packaging and inserted into the breast pocket. Please note a breast implant is NOT inserted into your existing breast, but UNDER your existing breast. Both ‘under the muscle’ and ‘over the muscle’ implant placements are under the breast tissue itself.

    Breast anatomy

    Keller Funnel No-Touch Technique

    We use a special instrument called a Keller Funnel to perform the No-Touch Technique, which means that the implant is transferred from its sterile packaging directly into the sterile breast pocket. This limits the chance of a contamination and potential infectious complications after the surgery.

    It is just one of the countless measures we take to ensure you walk away with beautiful, worry-free breast enlargement. Once the implants have been inserted, we meticulously check for symmetry and make any adjustments necessary to give you the best symmetry possible.

    Finally, we use absorbable sutures to close the incisions. Bandages are placed around your chest and wounds, a surgical bras put on you to hold the implants in place, and we inform the Anesthetist that it is time for you to wake up.

    Recovery After Breast Augmentation Surgery

    Once you are awake, you will be transferred to the Recovery Room where a highly skilled nurse will monitor you as you wake up. Most women spend 30 – 45 minutes in the recovery room until they are fully awake and ready to leave our facility. For further information on your recovery, please refer here.

    Implants settling after breast augmentation

    Following your breast augmentation surgery, the results you see immediately after surgery are not your final result.

    During the initial stages, you may have a lot of fullness on the upper part of your chest and it may seem like you have what Dr. Jugenburg refers to as ‘Frankenboobs'.  You may feel like you look like Frankenstein!   That is ok, as that initial look will settle.  The swelling will go away and the implants settle into their position.

    It usually takes 3 months for the implants to fully ‘settle'.  In some cases, it can take longer.

    Once the implants have settled, realize that your body will go on to change over time.  Weight gain, weight loss, hormonal changes, gravity, and pregnancy are among some of the factors that will affect your long term appearance.

    Assuming you maintain your body without any significant changes, understand that GRAVITY is an ever constant force that is present and now you have larger and heavier breasts.  It is inevitable, that over time gravity will affect your overall body, including your breasts

    Before and after breast augmentation, seen at 3 months after surgery
    Breast augmentation
    Over time gravity always affects the a breast augmentation looks. Here you see a 3 months and 12 months after surgery. Take a closer look at the change in the way the breast looks at the breast fold. At 12 months the implant / breast has come down and now hangs over the fold, while at 3 months it was more 'perky'. Realize there is not cure for gravity.

    Follow-Up Visits

    After your surgery, you will have scheduled follow-up visits at the Toronto Cosmetic Surgery Institute to allow us to monitor your progress and healing. Your initial follow-up visits are with one of our expert nurses; once your wounds have healed, Dr. Jugenburg will see you again to monitor the progress of your implants as they settle in.

    Follow-up visits are very important and we ask that you do not miss them. They allow us to ensure that your scars heal beautifully, that your breast implants settle in as expected, and that ultimately, you are left with the perfect breast enlargement.

    Additional Procedures

    In certain instances, additional procedures may be recommended at the time of a breast augmentation in order to enhance the cosmetic outcome. These can include a breast lift, breast reshaping, correction of shape or volume asymmetry, correction of tuberosity and others.

    Breast lift is the most common additional procedure I recommend to my patients (only when I deem it beneficial). This does NOT apply to all patients, only to those who have droopy breasts. Some women do not realize they have droopy breasts, or they assume implants will lift their breast.

    Others simply do not want to consider a breast lift in order to avoid the scars of a breast lift. However, when a breast lift is recommended, it is so that it helps to reshape the breasts and make the breast tissue and the breast implants align.