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Dr. Stephen Mulholland and his team at SpaMedica are experienced breast augmentation specialists. They are ready to offer you an attractive and safe breast augmentation experience. SpaMedica was founded by nationally renowned and well-respected cosmetic surgeon, Dr. Stephen Mulholland. The SpaMedica plastic surgery centre is a one-of-a-kind facility that combines the very best of high-tech cosmetic plastic surgery, with the service commitment of a day spa. SpaMedica will help you achieve the best breast enhancement surgery possible in a comfortable and confidential environment. Dr. Mulholland and his team are well-versed in all aspects of breast augmentation. They are experts in incisional approaches, all breast implant types and all potential pockets for breast implant placements. Dr. Mulholland is also one Canada’s leading experts in scarless endoscopic transaxillary saline breast augmentation. This procedure helps you achieve a naturally attractive look without any scarring. Dr. Mulholland and his SpaMedica team will discuss your breast augmentation and breast implant options with you as well as design an optimal breast augmentation treatment program for your individual needs. SpaMedica also offers complimentary Vectra 3D breast imaging, allowing our breast augmentation Toronto patients to see how their breasts will look like after surgery. This service helps them select the type and shape of implant that suits them best.

What is breast augmentation?

Breast augmentation is a plastic surgery procedure that uses high tech, man-made, Health Canada approved prosthetic devices, called a breast implant to augment the volume, proportion and shape of the breasts.  Breast augmentation is one of the most common procedures performed in North America.  Dr. Mulholland has been an innovator and a pioneer in breast augmentation, with the use of the VECTRA® 3-D pre-op breast imaging, to help patients decide which size and shape of implant best suit their conscious and subconscious goals for beautiful figure, shape and proportion enhancement. Breast augmentation can also be performed as well with one’s own fat tissue.  Fat can be harvested from areas where there is excess focal regions of fat accumulation and be purified and transplanted, through fat injections to the breast.  Generally fat transplantation is recommended for breast augmentation results that provide a modest one-half cup size improvement and is also good for fat grafting over implants that are already in place to enhance contour or camouflage implant edges, or correct asymmetry. Breast augmentation with breast implants themselves is by far the most popular method of breast augmentation and Dr. Mulholland has been performing breast augmentation for 20 years.  During this time, Dr. Mulholland has refined and pioneered the use of endoscopic, telescopic, through-the-armpit breast augmentation approach, both under the pectoralis major muscle and on top, as well as around-the-areola incisional insertion  and under-the-breast, in the breast fold incision and trans-umbilical (through the belly button)  breast augmentation procedures. By far the most common implant selected by patients is the cohesive “gummy-bear” silicon gel implant and, depending upon the size selected, these breast implants are inserted through the infra-mamary fold, or under-the-breast incisional approach.

 Breast Augmentation Toronto Breast Implant Insertion Incision Options

Figure 1. The various breast implant insertion incisions. The Trans-axilary, Peri-areolar and Trans-umbilical are all more commonly used for the saline breast implant procedure, while the infra-mammary incision is most commonly used for the  “Gummy Bear”, cohesive silicone gel breast implants There are a few reasons why breasts may lack volume and projection. Some factors include: genes, aging or after breast-feeding. As we age, there is a natural soft tissue deflation and loss of body and facial fat. Loss of body fat and shrinking of the breast gland can result in inadequate breast volume and projection for many women. If your breasts lack volume and proportion because of hereditary causes, natural aging, or post-baby deflation, breast augmentation implantation surgery may be the appropriate procedure for you.The social, professional and lifestyle benefits of breast implants and breast augmentation surgery are well-documented in medical literature. No amount of diet and exercise or will increase your breast size. In deciding whether to proceed with surgery,  breast augmentation Toronto patients must be realistic about the proportional enhancement that enlarged breasts can bring to their figure, shape and form, need to be in good medical condition and have no recent history of breast cancer.

How is breast augmentation performed?

Breast augmentation is a relatively quick procedure; usually performed in approximately 60 to 90 minutes. The procedure is performed as an out patient under light IV sedation, or general anesthesia. The breast augmentation procedure can be broken down into selection of an incision, a pocket and an implant.  The most common incisions include the under-the-breast or inframammary incision; the transaxillar or through-the-armpit incision; the periareolar or areolar incision; and the transumbilical or through-the-belly-button incision. (Fig. 1) The armpit, periareolar and belly button incisions can be used when saline or salt water breast implants have been selected, as the shell can be rolled up and inserted through an small telescope (also called an endoscope) and the implant inflated with saline (sterile salt water) when the breast implant is in the pocket, which allows for small incisions. Generally, for any moderate- to large-sized silicone, cohesive gel breast implant, the under-the-breast, inframammary incision is the optimal incision selected, as the cohesive gel breast implant is often too big to put through the smaller saline incision locations.  Once the incisional approach has been decided, then a pocket must be made for the breast implant. The breast implant pocket may be under the breast gland or under the pectorals chest wall muscle. It could also be a combination of both which is called the “dual plane”. The breast pocket’s location is often based on the characteristics of the patient’s chest tissues. Finally, the breast implants needs to be selected. There are many types of breast implant shapes and types; round, teardrop (called anatomic), smooth, textured, saline, low viscosity gel, highly cohesive and form stable silicone gel implants. It is now possible for a woman to select different heights, projections and widths within each breast implant classification to achieve an individualized and natural appearance. The vast majority of breast augmentation Toronto patients tend to have thin upper chest walls with visible ribs and collarbones and, therefore, the under-the-pectoralis-major-muscle, also called “under the muscle” pocket is generally the most favourable, providing soft tissue camouflage and coverage at the breast implant-chest wall juncture. For those Toronto Breast Augment patients who have a large amount of glandular  tissue that is somewhat deflated and mildly droopy, a sub-glandular, or under the breast gland and over the muscle pocket may be used, which is on top of the pectoralis major chest muscle, to give the breast enhanced projection shape and form.

Breast Augmentation Toronto Breast Implant Pocket Types

            A.                                 B.                                C.

Figure 2.  Breast Implant pockets. A. Sub-glandular: the breast implant is under the breast gland but on top of the muscle.  B. The Sub-pectoral pocket has the breast implant completely under the pectoralis muscle and C.  The Dual Plane, which has the breast implant placed under the gland in the lower breast pole and under the pectoralis muscle  in the upper pole. Once the pocket has been decided, the breast implant pocket is dissected and the implant is inserted inside the pocket.  A drain may or may not be used to facilitate removal of fluid from the pocket and, in general, a water-tight soft tissue incision closure is performed.  The sutures used are mostly absorbable and removal is not necessary. In the under-the-breast, inframammary incision, the scar ends up being the new inframammary refold and the incision usually can’t be seen in the standing, sitting or even lying down positions, without the breast itself being lifted. In order to assist in the selection process, Dr. Mulholland may use computer simulation surgery to give you the best possible sense of what breast implantation surgery results can be achieved. The breast implant surgery itself takes approximately two hours to complete and is most often performed under IV sedation. A general anesthetic is usually not required. Most breast augmentation patients who have their surgery performed under a light IV sedation have no recollection of the procedure. The IV sedation or general anesthesia is always performed by a fully certified anesthesiologist who cares for your medical condition while Dr. Mulholland performs the procedure.

What are the available breast implant selection options?

The modern era of breast augmentation surgery really evolved with the development of the cohesive gel, semi-solid, silicone gel breast implants, also called the “gummy bear” breast implant.  The “gummy bear” or cohesive gel breast implants have the advantages over saline breast implants of being more breast-like in feel and texture very rarely do they ripple or have visible irregularities; they do not leak; and they have a lifetime warranty provided by the manufacturer.  In contrast, salt-water, saline breast implants have been around for 30 or 40 years and have the longest history.  The problem is that the salt water, unlike the cohesive gel breast implants, which can hold the shape of the implant structurally in all positions – saline breast implants lack the viscosity and in certain positions, particularly bending over, one can often see collapse of the breast implant shell with ripples or visible rib-like structures under the skin.  Saline breast implants do have a risk of rupturing approximately 2% per breast, per year and eventually the saline breast implant will likely rupture and have to be replaced. The cohesive gel breast implants come in a wide variety of shapes (round or tear dropped, also called anatomical breast implants), heights, widths and projections. The cohesive gel breast implant comes with a lifetime warranty that there will be no structural integrity faults within the breast implant and any fatigue or failure of the structural integrity results in a complimentary procedure on the compromised side. Toronto Breast Augmentation patients will meet with Dr. Mulholland during their consultation, who, based upon his 17 years of experience performing breast augmentation surgery to use your specific anatomy to recommend the potential sizes that would meet your stated aesthetic goals and expectations.

Breast Augmentation Toronto Cohesive Silicone Gel Breast Implants and Saline Breast Implants

Figure 3.  Cohesive silicone gel breast implants and saline breast implants come in a large variety of sizes and shapes, heights, widths and projections. You will use the Vectra 3D breast imaging station to select PREOPERATIVELY, the best possible breast implant size and shape for you. What you see is what you will get, the Vectra 3D  imaging system will allow you to “try-before-you buy”

Who is a good candidate for breast augmentation procedures?

The best candidates for breast augmentation procedures are those Toronto Breast Augmentation patients who are realistic and have given careful consideration to the advantages of having breast implants to create more volume, projection, perkiness, proportion and figure enhancements.  Good candidates have often tried diet and exercise to achieve ideal figure, shape and form and generally use breast augmentation surgery to increase the projection and volume of the breast to better match their shoulders, hip and waist ratios. Contraindications to breast augment surgery may include unrealistic expectations, medical diseases that prevent general anesthesia and various severe and advanced forms of multiple sclerosis and ALS, scleroderma, rheumatoid arthritis or other immune diseases.

What kind of anaesthetic is used during my breast augmentation procedure?

Breast augmentation can be performed under tumescent local anaesthesia with oral sedation, but generally, IV sedation or General Anesthesia is the preferred choice for most patients, as the pectoralis muscle needs to be fully relaxed to allow subpectoral dissection and often also needs to be partially divided will while eliminating all sense of discomfort. The IV sedation, unlike traditional general anesthesia, generally does not involve a tube in the throat, ventilation or intubation, but more similar to the kind of IV sedation commonly used during colonoscopy.

Is breast augmentation painful?

Breast augmentation often involves dissection under the pectoralis major muscle and there is significant pain and comfort for the first 2-3 days and then the discomfort becomes more of a “bruised sensation”.  In terms of ranking the order of discomfort with breast augmentation, Toronto Breast Augment patients generally rank child-bearing as number 10/10 in pain; an 8/10 would be a tummy tuck, with repair of the rectus abdominis muscle; a 6/10 may be laser resurfacing of the face; followed by breast augmentation.  The pain of the dissection under the muscle and placement of the implant in that location is generally short-lived – 48 to 72 hours – after which most patients are fine using a nocturnal narcotic and anti-inflammatory medication during the day. Breast augmentation pain lasts approximately 48 hours, whereupon there’s a significant decrease in discomfort and the patient is able to gently massage the breast and start decompression breast massage exercises.

How long does the breast augmentation procedure take?

A busy breast augmentation surgeon like Dr. Mulholland has spent years refining and perfecting his technique into a very accurate and refined breast augmentation procedure –  and the procedure takes approximately 60 – 90 minutes.  The procedure is performed under a light IV sedation and most patients are usually ready to go home approximately two hours after completion of the operation.  The procedure is performed at Dr. Mulholland’s private surgical facility called SpaMedica, which has been performing general anaesthesia and IV sedation for over 20 years, is government certified and uses teaching hospital based, certified anesthesiologists, recovery and intra-operative nurses, most of whom have been working for Dr. Mulholland for over 15 years.

How long is the recovery following breast augmentation?

The recovery during the first week is characterized by pain and discomfort, but by the third or fourth day, gentle breast massage can start being performed to soften the implant pockets. After leaving the clinic, you will go home in an elastic breast band or soft, supportive bra. The breast band or bra helps keep the breasts in the correct position. Initial discomfort is controlled with oral medication. There may be some sutures that need to be removed. Light activities can be resumed almost immediately. Aerobic activities and upper body strength training can be resumed in approximately six weeks. The patient will be shown breast massage techniques which involve massaging the implants within the breast pockets during the post-operative period. The massaging reduces the frequency of wrinkling and the risk of capsule formation. In the first two to three weeks, the breast implants generally tend to appear to swollen and ride a little too high and take two to three weeks to drip down into the pocket and assume a more natural appearance. In general, by six weeks, most breast augment patients can return to full activities, including exercises which involve pectoralis major muscle, such as push ups.  Toronto Breast Augmentation patients should plan to look good in bathing wear, a cocktail dress and a tank top within a few weeks and should plan social events after surgery accordingly.

What will I look like immediately after my breast augmentation procedure?

Most patients look quite good in the first day or two following a breast augmentation procedure.  Once the drain has been removed and patients start to massage their breast implants, by the third week, most breast augmentation patients look very good.  Implant contour, shape and form continues to evolve or remodel fully over one year following the breast augmentation procedure.

What kind of results can I expect following my breast augmentation with Dr. Mulholland?

Dr. Mulholland is one of the few physicians who has mastered the use of the VECTRA® 3-D imaging machine that allows all patients to undergo a pre-operative imaging of their figure, shape and form and select a breast implant that best matches their send of beauty.  The imaged breast shape and form is very similar to what the implants will look like at 6 months. Like trying on a dress at a retail store, actually seeing your figure in 3D with the implants allows patients to make the right cosmetic decisions and allows the “try before you buy” assurance of being the right proportion.  By using the VECTRA® 3-D, most patients now can accurately predict what they will look like and this has eliminated the greatest risk of all, which, in the past has been selecting the wrong size or shape of breast implant.

What shape breast implants are available and how do I decide what shape and size is best for me?

Breast implants, either saline salt-water filled or the cohesive “gummy bear” solid silicone cohesive gel breast implants come in round and teardrop shape.  In general, round breast implants provide the most natural and attractive shape for those individuals who have some loss of upper pole volume and some flattening of the upper pole projection following weight loss, age, breastfeeding or combinations of those physiologic processes.  Occasionally, individuals with very little glandular material may benefit from an anatomic teardrop-shaped breast implant and the 3-D VECTRA® imaging helps decide which shape is best for you.

What kind of  results can I expect following my breast augmentation procedure?

You can expect larger and shapely breasts. Dr. Mulholland’s aesthetic judgment is for a natural-looking and proportionate breast enhancement. In general, modern breast augmentation involves pre-operative 3-D imaging with a tremendous amount of patient participation selecting the size and shape of the breast implant.  By selecting the size and shape of the breast implant that best fits their figure, shape and form, most patients are ecstatic with the results of their Dr. Mulholland breast augmentation procedure.  Dr. Mulholland’s insistence on using the 3-D VECTRA® imaging has allowed patients to participate in the size and shape selection of their breast implant or breast prosthesis and has greatly enhanced the happiness of those patients.

What are patients saying about their breast augmentation procedure?

Most patients who have their breast augmentation with Dr. Mulholland find his surgical team extremely supportive and the pre-operative process with the VECTRA® 3-D imaging very informative.  Most patients are extremely happy with their breast augmentation procedures, with well over 90% happiness index, with the cohesive gel being the most commonly-selected breast implant. Most patients are extremely happy with the results of their procedure and the care and attention given by Dr. Mulholland and his SpaMedica breast augmentation team.

Can you tell me what else happens in a breast augmentation procedure?

Breast augmentation can be performed surgically by going through the underarm area (axilla), going through the periareolar area (by the nipple) or through the inframmary area (under the breasts). Breast augmentation can be performed using saline implants (salt-water) or cohesive gel-filled implants (“gummy bear” implants). These implants come in two shapes; round or teardrop. Dr. Mulholland and his breast augmentation team will help you determine the most appropriate type of implant and surgical approach during your consultation. Medium to larger sized cohesive gel-filled implants can only be inserted using an inframmary incision. Smaller to medium sized cohesive sized implants can be inserted through the axilla. Saline implants are inserted through a small incision made in the armpit, periareolar or inframmary. If your procedure involves going through the armpit, Dr. Mulholland then uses a special telescope called an endoscope. In the armpit, periareolar and inframmary procedures, Dr. Mulholland creates an accurate and almost bloodless pocket for the implant under the chest muscle or directly under the breast gland. The chosen implant is then inserted through the armpit, periareolar or inframmary and positioned accurately. Generally, a drain is inserted for breast augmentation and the patient may go home approximately four hours after their procedure. The drain is important since it helps to decrease tissue swelling, turgor and discomfort. The SpaMedica staff removes the drain after 2-3 days.

How long will the results of my breast augmentation procedure last?

The results of a breast augmentation performed with a cohesive gel silicone breast implant, may well last the rest of your life.  If your breast augmentation was performed with a fat transplantation, there’s a natural loss of fat substance and volume as women age and there may be a loss of breast shape and volume over the 5-10 years following the fat grafting to the breasts.

Is there any maintenance required following my breast augmentation procedure?

There is no specific “in office” maintenance following your breast augmentation procedure, although it is recommended that a gentle massage is performed on a daily basis to keep the capsular collagen tissue soft and mobile and to feel for any suspicious breast lumps.  The cohesive gel implant brand of the breast augmentation procedure have devices (breast implants) that are  warrantied for life and should never have to be replaced in patients with relatively normal activities of daily living, including golf, sleeping on your stomach, normal intimacy and high impact sports.

How much will my breast augmentation procedure cost with Dr. Mulholland?

Breast augments generally cost between $5,999 and $8,000, depending upon the type of breast implant selected, the Cohesive gel breast implants being much more expensive than the saline breast implants.  However, with use of the VECTRA® 3-D imaging and other high-tech supports and great care and attention to detail,  Dr. Mulholland and his team to select just the right breast implant that is uniquely proportionate and beautiful for the patient in front of them.

Why choose SpaMedica and Dr. Mulholland for my breast augmentation procedure?

SpaMedica has a tremendous reputation as a facility with good service and excellent care and attention to detail.  By choosing Dr. Mulholland, you choose one of the most pre-eminent and recognized faces of plastic surgery, having spoken multiple times on CitylineBreakfast Television, CBC The National News, as well as numerous appearances on The Today Show and The Doctors Show in the United States. Dr. Mulholland is one of the world’s leaders in aesthetic plastic surgery. He has been using the 410 cohesive gel breast implant and the newer Inspira® cohesive gel breast implant exclusively for over 10 years.  Dr. Mulholland has an excellent reputation amongst Toronto Breast Augmentation patients for delivering natural beautiful breast augmentation results.

How do I schedule a breast augmentation consultation with Dr. Mulholland?

If you’re looking for more information about breast augmentation or any other cosmetic or surgical procedure you can continue browsing our website to learn more. If you have any questions regarding your face and body treatment options, don’t hesitate to call us to schedule an appointment. Our SpaMedica Toronto office can be reached at 877-695-2835. Alternatively, you can book a consultation online.

Interesting Breast Augmentation Treatment Facts

Dr. Mulholland was one of the pioneers and leaders in developing the endoscopic armpit incisional approach to breast augmentation surgery. In 1997, Dr. Mulholland was one of the first plastic surgeons in Canada to introduce tear-dropped, anatomic shaped breast implantation. Saline implants, either round or tear-dropped and small gel implants, can be inserted through the armpit, leaving the breast mound without scars. Dr. Mulholland also helped pioneer the use of low level arconium laser systems to greatly minimize, if not eliminate, capsule formation.

SpaMedica® YORKVILLE
Cosmetic Surgery and Laser Skin Care Spa:
66 Avenue Road Suite 4
Toronto, Ontario M5R 3N8
Tel: 877-695-2835