Augmentation Mammoplasty

For patients who were born with underdeveloped breasts or who developed sagging atrophic breasts after breastfeeding, breast augmentation can produce very gratifying results. Breast augmentation is achieved with the use of breast implants. The commonly used implants are saline implants and silicone implants. Saline implants are less expensive and can be placed through smaller incisions. However, there is a possibility that it may need to be replaced in 10-15 years. The new silicone cohesive gel implant is available in Canada. It gives a better, more natural result and it is permanent. It is however more expensive. The size and shape of implants are chosen through careful measurements of the patient's chest anatomy before surgery.

Theoretically, the implant can be placed under the breast gland (sub-mammary), under the chest muscles (sub-pectoral), or in between the Pectoralis Major and Pectoralis Minor chest muscles (sub-muscular). We routinely place the implants in a sub-muscular pocket. This gives the best projection, softness (less capsule contraction), and appearance.

The approach to create the implant pocket can theoretically be done through incisions under the breasts (infra-mammary), around the areola (peri-areolar), at the armpit (trans-axillary), or around the bellybutton (trans-umbilical). We use the peri-areolar and trans-axillary approach. We believe these approaches provide the best results with the least conspicuous scars.

>Surgery is done under either sedation anaesthesia or general anaesthesia, depending on patient's request. Full chest dressing is used for one to two days. After removal of dressing, a supportive bra is necessary for 3 months. Two weeks after surgery, massage of the breasts by the patient is mandatory to avoid formation of a hard capsule and to have a successful outcome.

Mastopexy is sometimes necessary to lift up sagged breasts during augmentation mammoplasty. The simplest approach with the least scarring is through the peri-areolar incision. A small implant is usually placed simultaneously during the lifting procedure. This combined approach of lifting and augmentation is ideal for patients whose breasts have become small and saggy after breast-feeding.

The common complications of this procedure such as capsule contracture, asymmetry, hematoma and infection can be easily minimized if patients follow Dr. Wong's instructions thoroughly.

Reduction Mammoplasty

Reduction mammoplasty is usually covered by OHIP for functional reasons. Dr. Wong routinely refers this operation to a colleague of his who specializes in this procedure.