Montreal breast augmentation & breast implants – Objectives

Breasts can lose volume and shape after weight loss, childbirth or as a result of aging. Do you really need breast implants? Dr. Nicolaidis feels that Plastic Surgeons pose breast implants far too often, when a simple lift is all that is needed. Breasts don’t have  to be big to be beautiful!!!

Breast augmentation canbreast augmentation & breast implants enhance the size of the breast as well as give a better proportioned figure. During consultation for breast augmentation, Dr. Nicolaidis will examine the patient taking into consideration factors such as the size and shape of the breasts, skin quality and the placement of the nipples. If the breasts are sagging, a breast lift may also be recommended together with or instead of breast augmentation. But it is important to note that the combination of breast lift and augmentation at the same time is known to have one of the highest complication rates among Plastic Surgery procedures.

Breast implants can make it more difficult to read standard mammograms, but modified mammography techniques have been developed given the huge number of women with breast implants. Women at risk of breast cancer will need to consider this prior to making a decision about whether to have breast implants. Implants can be placed under the chest muscle so that they may interfere less with mammograms, but other factors also need to be considered. Dr. Nicolaidis will discuss this with the patient fully.

An association has been found between TEXTURED breast implants and a slow-growing lymphoma in 1 out of every 36,000 patients, much higher with Allergan textured implants (1:2800, leading to their voluntary recall in July 2019). For this reason, Dr. Nicolaidis no longer uses textured implants for breast augmentation in Montreal. He can discuss this matter further with you at the time of consultation.

Fat transfer to the breasts has become increasingly popular over the last number of years. Dr. Nicolaidis will perform small amounts of fat grafting to the breast. But he prefers implants over large-volume fat transfer to the breast for 2 reasons, provided that the patient does not have risk factors for Breast Implant Illness. Firstly, large-volume fat transfer has a higher incidence of cyst formation and microcalcifications. The latter can be confused on mammogram for possible breast cancers, leading to stress, investigations, possible skin incisions, etc. Secondly, the longterm risks of fat transfer are uncertain since they have not been registered and followed closely until recently.

Montreal breast augmentation – Anesthesia

Dr. Nicolaidis always performs breast augmentations under general anesthesia. However, should you desire a breast augmentation surgery without implants and general anesthesia, we invite you to consult our section about breast augmentation by fat injections.

Montreal breast augmentation & breast implants – Surgical Techniques

A number of decisions regarding a breast augmentation must be considered with your plastic surgeon. First of all, there are 4 possible incision locations through which to place the implant : the breast fold, under the nipple, the armpit and the belly button. Dr. Nicolaidis will discuss incision location with you in preparation for your breast augmentation.

Vreast augmentation & breast implants 1 breast augmentation & breast implantsSecondly, implant placement can be either under the chest muscle or over the muscle (between the chest muscle and the breast tissue). Since Dr. Nicolaidis no longer uses textured implants, he tends to place implants under the muscle in order to minimize the risk of capsular contracture.

Thirdly, individual factors and personal preferences will help determine the appropriate implant size for your breast augmentation. Keep in mind that, in general, the larger the implant, the greater the risk of complications.

The final decision to consider is the implant type : saline-filled or gel. The cohesive gel does not seep, run or shift. Silicone gel implants tend to give a more natural appearance than saline implants, feel more like real breast tissue and do not normally ripple or fold as saline implants sometimes do.

Montreal Breast augmentation – Recovery after breast implants surgery

Following breast augmentation, dressings are left in place for one to two weeks. Breast augmentation is usually performed on an outpatient basis so it is important to arrange for someone to drive the patient home after surgery and to stay with her the first night following surgery preferably in the Greater Montreal area. After breast augmentation, some bruising and swelling may occur initially, but this will disappear quickly. Most residual swelling will resolve within a month of the breast surgery. Wounds are well-healed after two to three weeks. However after a breast augmentation, patients are asked to sleep only on their backs for a period of approximately one month.

Montreal Breast augmentation : Return to work after breast implants surgery

After breast augmentation surgery, it is often possible to return to work within just a few days or a week.

Montreal Breast augmentation : Possible complications after breast implant surgery

BIA-ALCL: Textured implants (with a certain roughness on the outside in order to decrease the contracture rate) have now been shown to be associated with a rare type of Iymphoma called BIA–ALCL. For this reason, Dr. Nicolaidis stopped using textured implants as soon as this association became clear.

Breast Implant Illness: Smooth implants have never been shown to increase the risk of this lymphoma. However, it has become increasingly clear that silicone (which is in the envelope of both gel and saline implants) is not inert as we once thought. Between 1 and 10% of implanted patients seem to develop a reaction to the silicone (or some other chemical in the implant), which over time may lead to chronic  inflammatory conditions and perhaps even immune disorders. The term Breast Implant Illness (BII) has been coined to describe the symptoms that may be caused by breast implants. Although BII has not been proven, Dr. Nicolaidis believes strongly in this illness, given that almost all of his patients return after EXPLANTATION claiming that their symptoms are much improved. Patients at higher risk of developing BII are THOUGHT to be those with allergy history, skin disorders, thyroid disease, asthma, food intolerance, history of autoimmune disease.

Black Box Warning: Given that the safety of breast implants has NOT been assured by implant companies and that implant companies are constantly changing their implants WITHOUT adequate safety testing, breast implant safety advocates have justifiably requested that breast implants come with a Black Box Warning, suggesting that there may be other complications that we are not aware of as yet.

Capsular contracture: It is normal for the human body to form a capsule around any foreign body, including a breast implant. However, in about 10% of patients with breast implants after 10 years, this capsule can become hard, painful and even move the implants. Treatment of capsular contracture varies from applied external pressure to complete removal of the implant, depending on the degree of contracture.

Implant failure: Breast implants are not guaranteed to last forever. If they deflate or rupture, surgery will be required to replace them. Otherwise, the results of the breast augmentation surgery may be long-lasting. Given the recent problems with breast implants, it has been recommended that breast implants be changed every 10 years.

Other complications of breast augmentation include reactions to anesthesia, bleeding and infection. Although rare, implant exposure or infection that does not subside with appropriate treatment may require removal of the implant. Changes in nipple or breast sensation may result from breast augmentation surgery, though they usually are temporary.

Montreal Breast augmentation : Post operative instructions after breast implants surgery

Our post operative surgery service is important to us. Immediately after your breast augmentation surgery, you can reach us at any time to address all your concerns ; that type of service differentiates us from other clinics in Montreal, performing breast augmentation surgeries.

In the first week after breast augmentation, be sure to :

  • Keep your dressing dry and clean ;
  •  Do not force with your arms ;
  •  Wash with a sponge unless Dr. Nicolaidis says otherwise ;
  •  Sleep ONLY on your back ;
  •  Wear your compressive band above the breasts at all times ;
  •  Walk at least 5 minutes every hour during the day (do NOT simply stay in bed constantly).
  • After your breast augmentation, your first post-operative appointment with Dr. Nicolaidis is very important, even if you feel very well.
  • After the first week of your breast augmentation surgery :
  • Continue wearing the compressive band until Dr. Nicolaidis says otherwise ;
  • You may shower with your back to the shower ;
  • Avoid bathing until Dr. Nicolaidis gives permission ;
  • Protect your new scars from sun exposure for a total of 6 months ;
  • Avoid lifting heavy objects after your breast augmentation surgery, until Dr. Nicolaidis gives permission ;
  • In order to avoid blood clot complications, keep moving (walk regularly during the day).
  • Please note :
  • It is normal to have swelling and bruising around the breasts in the first weeks after surgery involving breast implants. However, it is not normal if one breast becomes much larger than the other, in which case you should call us.
  • For your comfort, after your breast augmentation surgery, be sure to take your pain medication as prescribed.

If you have questions or concerns regarding your breast augmentation surgery, do not hesitate to call us. We are there for you.

For further information about breast implants, please click here : American Society of Plastic Surgeon