Our Philosophy
At the Plastic Surgery Clinic we perform approximately 200-300 breast implants a year. This makes Dr Lista one of the most experienced breast augmentation surgeons in Ontario, Canada. If you've seen women who have had breast augmentation surgery, either in person or on the internet, you know that there are a lot of different ways of performing a breast augmentation. Dr Lista has one main philosophy: to make all his breast augmentation patients look as real, soft and natural as possible.

A breast enlargement is an operation where an implant is placed behind the breast to increase the breast size. The operation gives the breast a fuller look and fills out the entire breast but especially the cleavage areas and upper part of the breast. The operation improves the shape of the breast in women who feel that their breasts are too small. This procedure also restores breast shape and volume in women who have noticed a change in the breast following childbirth or breast-feeding.

How Breast Enlargement is performed
Most augmentation operations are performed at The Plastic Surgery Clinic. Dr Lista performs all of the procedures personally. He does not have any assistants or students assist with your surgery. Dr Lista is Chief of Plastic Surgery at the Trillium Health Center (The Mississauga Hospital) so your operation can also be performed at the hospital if you prefer.

During the operation a small incision, usually an inch in size, is placed in an inconspicuous spot to allow insertion of the implant. There are 4 spots where an incision can be placed to insert the implant: around the lower edge of the areola, in the armpit, under the breast crease or in the belly button. Dr Lista has a great deal of experience with all of these techniques. We will discuss with you the technique which will suit your body and your lifestyle the best. The patient always has the final say on where the incision will be placed.

Type of Implant
Most patients choose saline filled breast implants. Saline is a salt solution which is totally natural to the body. The implants actually come from the manufacturer empty and are filled after they are placed in the body with intravenous saline. This is the same solution which is given to patients when they have an IV. The implant is prepared using the "no touch technique" where the implant is coated with an antibiotic solution before being implanted. A closed filling system is used so the solution, which is placed in the implant, never comes into contact with the air and therefore remains sterile. These and other techniques significantly reduce the risks of surgery and make capsular contracture (hardening of the scar tissue around the breast) a rare occurrence.

Cohesive gel implants are a new type of implant which can be used in some patients. These implants are useful in very thin patients who need an implant placed above the muscle. They help prevent some problems such as rippling or the ability to feel the implant which can be a problem with saline implants. These implants are different than the original silicone implant because the internal gel is solid rather than liquid. In this way the silicone will not come out of the implant in the event of a shell rupture. The choice of implant is made with the patient after a discussion with your plastic surgeon.

To learn more about cohesive gel implants click here.

To read about how to choose the correct implant for you click here.

Position of Implant
Breast implants can be placed either above or below the pectoralis muscle. There are advantages to each of these techniques and the method that is best suited for the patient is made during the consultation with the plastic surgeon. Generally implants are best placed under the muscle in thin patients who have no breast ptosis (droopiness.) This technique has the advantage of giving a soft natural breast which does not interfere with breast feeding, covers the edges of the implant and thus makes the implant less visible. It also decreases the risk of feeling the implant and makes it less likely to result in rippling of the breast. A disadvantage is that intense movements of the pectoralis muscle can result in movement of the breast.

Implants inserted above the muscle are located immediately behind the breast tissue. This technique is best suited for patients who have more breast tissue to start with or who have more breast ptosis (increased sagginess of the breast.)

The risks of hardening, rippling and external visibility of the implant are greater with this technique. The decision as to which kind of implant is best for you is made in consultation with Dr Lista.

The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle.

The Office Visit
Dr Lista prefers to see all his patients at least twice before surgery. In the consultation process we spend considerable time obtaining a careful history and physical examination. We also spend a long time discussing the patient's desires, goals and expectations. It is important that the patient discuss with the plastic surgeon her desired size and shape of breast. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard and at The Plastic Surgery Clinic we have computerized digital imaging, which allows Dr Lista to show the patients examples of how she may look after surgery.

Size and Shape of the Enhanced Breast
Choosing the correct size of your new breast is very important to giving you a result which you will be happy with. There are many ways of letting your surgeon know how large you would like to be after surgery. Some patients like to bring in pictures of breasts that they have seen on the internet or magazines. Other patients try on bras of various sizes in order to get an idea of how big they would like to be. Other patients try sizers in a sports bra. You should spend as much time as necessary with your plastic surgeon discussing your expectations. Dr Lista encourages his patients to discuss these issues with him and to take as much time as they need in letting him know exactly what they expect from their breast augmentation surgery.

Giving the patient the correct size is very important in breast implant surgery but it's not the most important thing. The most important aspect in breast enhancement surgery is to give the patient a natural looking breast. The breast should look and feel natural, it should suit the patient's body and should look real. To do this the surgeon needs to carefully examine the patient and determine the correct implant type and placement for them. There is no single implant which is correct in all patients and patients should be wary of a surgeon who only performs the operation a certain way or only uses one type of implant. At The Plastic Surgery Clinic, Dr Lista has a great deal of experience with both saline and cohesive gel implants, placed both above or below the muscle, through all 4 of the most commonly used incision sites. Different patients need different procedures depending on their pre-operative breast shape and size. In addition Dr Lista is one of only a few surgeons who performs this procedure with the patient "sitting up." Once the patient has been anesthetised, we use a special operating room bed so that the patient is sitting up while they are asleep. In this way Dr Lista can ensure that the look of the new breasts is correct, that the size suits the patients body frame, that the two breasts are balanced and that the patient is getting the look and size that they discussed before surgery. This is one of the reasons that Dr Lista's patients achieve such a natural look.

The Operation
The operation is performed either at our clinic or in the hospital. At the Plastic Surgery Clinic anesthetics are administered by specialist physicians who are board certified in the specialty of anesthesia. These doctors give the anesthetic, stay with the patient during the entire operation and are with the patient while they are waking up. The operation takes one to two hours. A friend or relative will need to come and pick you up and stay with you for 24 hours. The patient has two small drainage tubes that are removed at the clinic the next day. These tubes help reduce swelling and hardening by removing any blood or fluid that may collect around the implant.

The Pain Relief Pump
The Pain-Relief Pump is a new device being used by Dr Lista at the Plastic Surgery Clinic which relieves almost all pain after surgery. Click here to learn more about the significant benefits of the Pain-Relief Pump.

Recovery
Patients need to take one week off after surgery. This means staying at home and no driving. During this week off, the patient should stay fairly quiet keeping arm movements at a minimum. We suggest sitting around the house watching television, enjoying videos or reading. Patients with small children will need help at home. While this sounds excessive to some, staying quiet in the first week, actually speeds healing and helps obtain a good result from the surgery. Pain pills are prescribed to help reduce post-operative pain. Patients can gently exercise in about 2 weeks. This means walking, stair-master or treadmill walking is allowed but no upper body workouts, running or high impact working out for one month.

The Result
Dr Lista strives to achieve a natural appearance in every patient. If there are no complications the breast should look and feel like a natural breast. The size of the newly augmented breast should suit the patient's body style and general build. Patients who have this operation can return to a normal life and carry out normal activities. Dr Lista has patients who are female firefighters, police officers, skydivers, aerobic instructors - and all are able to return to their normal lives.

Risks and Complications
Complications are rare with breast augmentation surgery. The vast majority of patients have no complications and are extremely happy with their results. No operation however is perfect and all surgery has risks, no matter how rare. If complications occur, further surgery may be required.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

Very rarely women may develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body. If this occurs you will require a second operation and replacement of the leaking implant.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Breast Implant Lifespan
Implants only need to be replaced if a problem develops. Routine replacement of implants is not required. Implant manufacturers guarantee their implants for the life of the patient. Should an implant rupture, the companies will supply a new implant at no charge. Saline or cohesive gel implants are particularly safe in the event of rupture. Saline is a salt solution which is natural to the body and will be absorbed by the body if the implant ruptures. Cohesive gel is solid and in the event of rupture will not spread in the body.

Pregnancy and breast feeding are not affected by breast implantation. Numerous large and well-controlled studies have conclusively proven that breast implants do not increase the risk of breast cancer in patients who have undergone this operation.