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.

Breast augmentation, also known as mammoplasty, is a surgical enhancement procedure to accentuate the size and shape of a woman's breasts. While breast augmentation will make the breasts larger, the surgery will not move the breasts closer together or lift sagging breasts.  Breast augmentation is tremendous help to patients who desire a fuller profile, who have lost breast volume due to pregnancy or nursing, or who have undergone breast reconstruction and want to gain a more natural look again.

Reasons for Considering Breast Augmentation:

• Enhance body shape if breasts are too small.
• Increase breast volume after pregnancy and nursing.
• Equalize a difference in breast size (cup size) to gain breast symmetry.
• Reconstruct breasts following a mastectomy or injury.

General Procedure

Breast augmentation involves making a small incision to insert a breast implant into the breast area in order to enlarge the breast.  The surgery is commonly performed on an outpatient basis at a hospital or state-of-the-art surgical unit while the patient is under a general anesthesia and asleep.  There are several possible locations for the small incision that will be used for inserting the breast implant.  The most frequent technique utilizes an incision made in the lower portion of the breast.  Another technique, though less frequently used, involves making an incision in the armpit.  A third technique makes an incision around the areola (the darker skin surrounding the nipple).  A newer technique uses an incision in the belly button, thus reducing the chance of scarring in the breast area.  The best technique will be decided together between the patient and the surgeon during the consultation.

During surgery, the breast tissue is raised to create an open pocket under the breast tissue or beneath the chest wall muscle.  Inserting an implant behind each breast can increase a woman's breast size by one or more bra cup sizes.  Implants typically contain a saline solution (similar to saltwater) although in special cases the implants can contain a silicone gel.  In some circumstances, particularly those in which there is breast asymmetry (uneven breast size), an inflatable implant may be used to allow the surgeon to adjust the level of inflation to attain breast symmetry and balance.  Surgery typically lasts from 1 to 3 hours.

Recovery Process

Generally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and recovery time.  Bandages are applied right after surgery to aid the healing process and to minimize movement of the breasts.  Once the bandages are removed, a specialized surgical bra will need to be worn for several weeks.  Patients sometimes report minor pain associated with the surgery.  This pain can be treated effectively with oral medication. While complications are rare, patients can minimize potential problems by carefully following the directions given by the physician after surgery.