PLASTIC & COSMETIC SURGEON416.447.6176     1.855.447.6176


Breast Enlargement
(Augmentation Mammoplasty)

What Is It?

Breast augmentation is a very popular procedure for women. Whether the implants are saline or the more recent cohesive gel silicone, they provide many women with an improved sense of well being and femininity. Both types of implants have a silicone shell and according to all the latest studies, they are completely safe.

Breast implants can be considered by women of all ages, once they have reached an age of physical and emotional maturity. Commonly the implants are used in women whose breasts have never developed adequately, or in women who have lost substance to their breasts because of pregnancy or weight loss. Some women have breast implants to correct breast asymmetry.

Breast implants can provide women with an enhanced feeling of well being, however it should be noted that they rarely will save a failing relationship.

Breast implants help achieve excellent breast contour, but they typically feel a bit firmer than normal breast tissue. Implants do not "flow" to the sides of the chest in the same way that normal breast tissue does when a woman lies down. In very thin patients, the implant edges can sometimes be visible or palpable, especially when not covered with muscle. Breast implants can make mammography (where the breasts are squashed) more difficult, but generally do not interfere with ultrasound or MRI. There is no association between breast implants and breast cancer. While these imperfections to implants exist, they still provide women with great joy and satisfaction.

Patient Examples

Click on any photo for larger version and more views of that patient.


In the initial consultation, Dr. Neu will take a detailed history of the patient’s past health, and review goals for breast augmentation. The breasts will be carefully examined and measured to determine what type of implant and what type of procedure will best accommodate the wishes of the patient. It may be necessary to consider a breast uplift, with the augmentation, if there is loose sagging skin.

Dr. Neu will also explain that there is a limit to how much the breast skin will stretch to accommodate a large implant. Unnaturally large breasts can lead to excessive skin stretching with stretch marks, and can increase the potential for deformities in the long term. Positioning of the implants is most often done beneath the muscle to better conceal the edges of the implant, particularly in thin patients. When implants are under the muscle, chest muscle exercising can briefly distort the natural shape of the implant; this may be a concern to body builders.

There is debate over whether cohesive gel implants or saline implants are better for patients. Dr. Neu will review the benefits and disadvantages of each. The form-stable anatomical cohesive gel implants tend to be more natural in appearance, with less fullness above and more fullness below. This teardrop configuration is particularly important in women with very little breast tissue as the entire breast shape is then determined by the implant.

For women who seek more upper fullness, a saline implant may be more desirable. There are many considerations when deciding which style of implant will best suit a patient's needs, and no one implant is appropriate for everyone.

The Surgery

Breast augmentation is typically done by Dr. Neu as a day surgery procedure under general anesthetic. Patients are carefully marked prior to surgery, according to the size, shape and style of the implant determined preoperatively.

Once the patient is asleep, the breasts are infiltrated with a long-acting anesthetic that eliminates most of the discomfort when patients waken from surgery. (Studies now confirm that patients who wake up with little pain have much less total pain, and have a lower total requirement of pain pills.)

The incision lines for the surgery are most commonly below the breast, or around the nipple. The armpit approach is used less commonly because it can leave a more visible scar, and there is a greater risk of breast implant height unevenness. Cohesive gel implants cannot be inserted through the armpit.

The incision lines are 3 to 3.5 cm in length for saline implants, and about 2 cm longer for a comparable cohesive gel implant. All incision lines are closed with an invisible mending suture beneath the skin to give the best possible scar. These stitches are dissolving, and do not need to be removed.

Resumption of Activity

Following breast augmentation surgery, patients usually resume sedentary activities within four to five days and sports within three weeks.