BREAST

Breast augmentation, also known as breast enlargement or augmentation mammoplasty, is a surgical cosmetic procedure to enhance the size and shape of a woman's breasts.

My philosophy is that any cosmetic procedure should withstand the test of time instead of chasing a trend. My preference is to perform breast implant surgery with a natural look using a modest sized implant. I think modest sized implants cause the least stress on your natural breast tissue and skin and thus increase the longevity of the results.

Do you place implants above or below the muscle?

I do both. I do a subfascial augmentation or a submuscular/dual plane augmentation. The decision depends on your anatomy, lifestyle and desired look.

Do you do fat transfer to breasts instead of implants?

Yes, fat grafting to the breasts will give the most natural look. Not everyone is a candidate for this surgery. You must first undergo liposuction to remove the fat then in the same operation, the fat is placed in the breasts. To have a noticeable result, the patients must have sufficient fat to harvest.

What is the implant made of?

Every implant shell is made with medical grade silicone, the inner material is either silicone or saline. Implants, like any other technology evolve and improve over time. Today’s silicone implants are made of a cohesive silicone gel, the material resembles the firmness of a “ gummy bear” thus you may have heard of the term “ gummy bear implants” . It means that in the event of a shell breakage or leak, the inner silicone stays intact like a gel.

Do I need to change my implants every 10 years?

No. Implants don’t have an expiry date. Today’s implants are made with better technology than implants from the 1960s. If you have an issue with implant rupture, capsular contracture, implant malposition then you will want to consider repeat breast surgery. If you are happy with your implants then you don’t need to have another operation.

What is capsular contracture?

A capsule forms around every implant and this is completely normal. It is a form of healthy scar tissue around the implant. When this layer of scar tissue becomes very firm, tight, causing pain and distortion, this is known as capsular contracture. If you think you have capsular contracture, you will need to contact your surgeon for a clinical assessment.

What is implant rippling?

Implants will naturally have areas of folding when it is held upright (ie: when the patient is in the standing or leaning position) this is completely normal and not a sign of a complication. How much you can see or feel the rippling depends on how thick the natural breast tissue is. The thinner the tissue, the more likely you are to feel or see the rippling.

What is the risk of implant rupture or capsular contracture?

Generally, the risk of implant rupture is approximately 1% per year. The capsular contracture rate for today’s implants is estimated at 1% per year.

Anesthesia: General anesthetic

Time required: 1.5 - 2 hours

Recovery period: Back to non-strenuous work in 5 - 7 days. Surgical bra wearing is a must for the first 6 weeks.

Technique: Implants are placed either below the pectoralis major muscle, above the muscle or a combination. I also do a pure “subfascial” implant placement in the appropriate patient. This subfascial technique is associated with a quicker recovery and does not have animation

Dr. Forbes' preferences: I always use a Keller Funnel and a “No-Touch” technique for breast implant insertion. This is the gold standard for this surgery to minimize length of scar, to reduce implant and tissue trauma and to minimize risk of infection and capsular contracture. My preference is to perform breast implant surgery with a natural look using a modest sized implant, this will place the least stress on your natural breast tissues and skin, giving you beautiful results long term.

Cost: The cost of breast augmentation with Dr Forbes is approximately $11450+.

Breast Lift, or "Mastopexy", is a surgical procedure that 1) reshapes the breast tissue to improve the elongated appearance of the breasts, 2) elevates the nipple position and 3) reduces areola (the area of pigmentation around the nipple) size. This procedure can also reduce the volume and weight of the breast.

Can I have a reduction at the same time as the lift?

Yes, the incision and access is the same for a breast lift and/ or reduction.

Will I lose nipple sensation?

Temporarily there may be a reduction in nipple sensation. For most people, sensation returns to normal within the first year. A select few will have a permanent change in nipple sensation.

How will my incisions look after surgery?

The appearance of the scars is largely dependent on your genetics. Some people tend to make pale scars, others make more pigmented scars. Scars will always look more red and bumpy in the beginning ( first 3 months) while they are fresh, then transition to a paler, flatter appearance. It is also normal to feel some lumpiness in the breast tissue itself during the initial postoperative period as there is internal healing that is happening at the same time.

I had a breast lift before, am I able to have another lift?

Yes, it is possible. It would help to have previous surgical records from the last surgeon although not every patient will be able to obtain these records. Our office can help you gain access to old surgical records with your permission.

Anesthesia: General anesthetic

Time required: 3+ hours

Recovery period: back to non strenuous work in 7-10 days

Technique: This procedure is done with either a “ lollipop” (my preference) or an “anchor” scar. The nipple position is elevated and the tissues are reshaped to reduce the elongated appearance of the breasts. Often this procedure is done in combination with liposuction to address the axilla region

Dr. Forbes' preferences: I prefer a small scar technique with an incision around the areola and a vertical incision down the breast. In most patients, I don’t need to add an “ anchor scar” along the bottom of the breast. I combine liposuction to better contour the lateral breast and the axillary region in patients who have extra tissue in these areas.

Cost: The cost of a Breast Lift/ Mastopexy with Dr Forbes is approximately $14950+.

Breast Lift, or "Mastopexy", is a surgical procedure that 1) reshapes the breast tissue, 2) elevates the nipple position and 3) reduces areola (the area of pigmentation around the nipple) size. This procedure can also reduce the volume and weight of the breast.

Can I have a breast reduction with just liposuction?

Yes, lipo-reduction of breast tissue can be done for some patients. Usually these are patients who like the position of their nipples and just wish for a lighter, smaller version of their current breasts. Liposuction alone will achieve a modest change in breast size.

Will my BC health insurance (MSP) cover breast reduction?

Yes, MSP will cover breast reduction surgery if your primary concern is the weight of the breasts and symptoms related to heavy breasts. MSP will not cover cosmetic breast lifts or liposuction.

For pediatric patients ( under 18) breast reduction is also covered by MSP to help with symptoms, hygiene, self-esteem and body image.

Anesthesia: General anesthetic

Time required: 3 hours

Recovery period: back to non strenuous work in 7-10 days

Technique - Dr. Forbes' preferences: I prefer a small scar technique with an incision around the areola and a vertical incision down the breast. In most patients, I don’t need to add an “ anchor scar” along the bottom of the breast. I will combine this procedure with liposuction if needed.

Cost: The cost of a Breast Lift Reduction with Dr Forbes is approximately $14950+

Breast lift with implants or “Mastopexy augmentation” combines a breast lift procedure with the insertion of implants. This procedure is indicated for patients who seek to elevate the nipple position or reduce the areola size in conjunction with increasing the overall volume of the breasts.

Anesthesia: General anesthetic

Time required: 3+ hours

Recovery period: Back to non strenuous work in 1-2 weeks

Technique: The incision is the same as a lift, the implant is then placed through an incision along the lower breast crease (IMF) either above or below the muscle

Dr. Forbes' preferences: I prefer to separate the lift and reduction into two stages to give the most predictable and aesthetic result, especially for implants beyond the 200cc range. In some patients who opt for one combined surgery, using an internal bra (Galaflex) is an option to support the implant and increase the longevity of the results.

Cost: Variable, a Breast Lift/Mastopexy Augmentation with Dr Diana Forbes starts at $ 16,800+ for a combined procedure not including cost of Galaflex.

Although breast augmentation is a procedure with a very high patient satisfaction rate, people’s desires and lifestyles can change over time. There may come a time when a patient wishes to have implants removed for various reasons.

Do you remove the implant only or the surrounding tissue as well?

You will need a formal assessment to determine what procedure is required. Some patients have very healthy capsules and wish for just implant removal, others may require either a tissue sampling or removal of the entire capsule.

Will I need a breast lift after implant removal?

It depends on many factors: the tissue quality, the nipple position after implant removal, the amount of natural breast tissue, and the size of the original implants.

Am I able to have implants again in the future?

Yes, this is possible. Alternatives include breast lift / mastopexy to improve shape or fat grafting for volumization using the patient’s own fat tissue obtained via liposuction.

Anesthesia: General anesthetic

Time required: Variable

Recovery period: Back to non-strenuous work in 5 - 7 days.

Technique: The implant is removed through a small incision below the breast, in the crease. If a capsulectomy is required, this incision may be extended.

Cost: The cost for implant removal with Dr Forbes is approximately $5900+.

Nipple Reduction is a surgical procedure which reduces the length and projection of the nipples. This small change can have a large impact on the overall appearance of the breasts. Elongated nipples can be due to genetics, hormonal changes, and post breast-feeding. Nipple reduction is a well tolerated procedure with a high patient satisfaction for both female and male patients.

Will nipple reduction surgery affect nipple sensation?

For most people, the nipple sensation returns to normal after nipple reduction surgery with the technique I’ve described. A small proportion of patients will experience a prolonged change in sensation, either increased or decreased sensitivity.

Will nipple reduction surgery affect breast-feeding?

For most women, sensation returns to normal after nipple reduction with the technique I use and should not impact your ability to breastfeed. I would, however, highly recommend that patients wait until after completion of breastfeeding to undergo this procedure to keep results beautiful and long lasting.

Is nipple reduction painful?

The procedure itself is not painful as I use ample local anesthetic. During the recovery period, patients say the nipples feel achy for the first 5-10 days. Over the counter Tylenol or Advil will greatly help with any discomfort.

Anesthesia: Local anesthetic, no sedation required.

Time required: 1 hour

Recovery period: No downtime. May resume regular work the following day

Technique: There are several ways to reduce nipple length and projection, including wedge resection, direct transection, and de-epithelialization.

Dr. Forbes' preferences: I prefer to use a de-epithelialization technique whenever possible. This technique takes slightly longer to perform but it heals with a nearly invisible scar.

Cost: The cost for nipple reduction with Dr Forbes is approximately $2000+.

Inverted nipple correction is done for both cosmetic and functional reasons. Inverted nipples are usually caused by tethering of the ducts that are within the nipples to the underlying tissues. These tight ducts are released surgically, allowing the tip of the nipple to evert above the skin. The scar is nearly invisible.

Will inverted nipple correction surgery affect nipple sensation?

For most people, the nipple sensation returns to normal after nipple reduction surgery. A small proportion of patients will experience a prolonged change in sensation, either increased or decreased sensitivity.

Will inverted nipple correction surgery affect breast-feeding?

Yes and no. It is possible that a reduction in sensation can affect breastfeeding but most women with severe cases of inverted nipples find it hard to breastfeed. It is possible that this procedure may help.

Is inverted nipple correction painful?

The procedure itself is not painful as I use ample local anesthetic. During the recovery period, patients say the nipples feel achy for the first 5-10 days. Over the counter Tylenol or Advil will greatly help with any discomfort.

Is there recurrence after inverted nipple correction?

We expect the results to be permanent, however recurrence is always a possibility. Most patients do very well. The chance of recurrence is higher in patients with pre-existing severe cases of inverted nipples.

Anesthesia: Local anesthetic, no sedation required.

Time required: 1 hour

Recovery period: Minimal downtime. May resume regular work the following day.

Technique: Depending on the severity of the inversion, ducts may be either stretched or released to allow the nipple to evert above the skin. Any incisions made are placed below the stock of the nipple where it is nearly impossible to see.

Dr. Forbes' preferences: Depending on the severity of the nipple inversion, I will either release some or most of the ducts tethering the nipple, occasionally an autologous material such as a dermal graft or fat graft may be required. I use dissolving sutures so patients don’t have to go through the stitch removal process.

Cost: The cost for inverted nipple correction with Dr. Diana Forbes is approximately $2300.