Bigger is Better

Breast augmentation, or augmentation mammoplasty, is a surgical procedure that increases the size of your breasts with silicone or saline filled implants. Pleasing results can only be achieved by an experienced surgeon like Dr. Ronald Levine in Toronto.

Simply put, you're flat. You don't have a chest and whatever is there now doesn't do anything for your overall body contour. You don't fill out your tops and any dress you wear looks awkward on your body. You just don't feel like a woman and padded bras don't help.

Breast augmentation has been the most commonly performed plastic surgery procedure in North America since 2006. In 2014 alone, 286,000 breast augmentations were performed. With numerous studies showing its safety and effectiveness, you have the option of getting what you feel you're missing. It's time for you to have bigger breasts that will contribute to a sexier, more womanly shape.

Why you want breast implants

  • You want to increase the fullness and projection of your breasts.
  • You want to accentuate your body shape with a curvier look.
  • You want to improve the balance of your figure
  • You want to enhance your self-image and self-confidence
  • You want to feel more attractive and sexier.

If you would like to make your breasts perkier, a breast augmentation lift can be performed.

Beautiful woman with large breasts after breast augmentation.

How do I choose the right size?

Size is one of the biggest concerns for patients. Dr. Levine spends a great deal of time in the pre-surgery planning phase to help you choose the right size. While you may have a rough idea of what you'd like, Dr. Levine will give you a range of sizes that will allow for a lower complication rate, give you better looking results and reduce the chance of you having to undergo a revision surgery. He does this by considering two factors: your skin laxity and your body dimensions.

Skin laxity determines the maximum size. This is because your skin will only stretch so much.

Body dimensions, including the height and width of your breasts, are measured to determine how big of a pocket can be made for the placement of your implants. Currently, many plastic surgeons in Toronto perform this technique, known as dimensional breast augmentation. They learned it from Dr. Levine, who has been a professor at the University of Toronto for decades. If you choose an implant that is too big for your body dimensions, it will go beyond your natural breast mound. This leads to a number of complications, including "bottoming out" (the implant falls out of the pocket), symmastia (your breasts joining together as one) and abnormal looking breasts.

Why Dr. Levine is a Master of Surgery

Dr. Levine conducts research on breast augmentation

Most plastic surgeons are not interested in conducting research to contribute to the advancement of the medical field. They rely on the research of others to select which techniques to use during surgery. Dr. Levine is not one of these surgeons.

While Dr. Levine does remain up to date on advancements in the field, he is also dedicated to improving the surgical experience of patients by performing his own research. That means he is continually refining his techniques. His ultimate goal is to make your surgery the safest possible and obtain your desired results with the least invasive methods.

Dr. Levine is the principal author of an abundance of research papers devoted to breast augmentation and other body contouring procedures, including tummy tucks and liposuction. He is currently researching the complication, capsular contracture, and whether breast implant type and incision location are contributing factors.

To help advance the field as a whole, Dr. Levine routinely presents at national and international plastic surgery meetings to share his findings with his colleagues. To date, he has delivered 40 to 50 presentations. The majority of these are focused on cosmetic breast surgery. As a result, Dr. Levine has become one of the leading breast augmentation surgeons in the world.

Excellent results and low revision rate

Dr. Levine is incredibly meticulous. He believes that if you're going to do something, you should do it right the first time. That's probably why his patients enjoy pleasing results and don't require a revision. Patients who undergo a second breast augmentation often do so several years later, usually to change their implant size to accommodate aging or new lifestyle.

You'll know exactly what will be done during your surgery

Many surgeons don't explain what they're going to do during surgery. Patients are often left in the dark. However, Dr. Levine believes that you should know what's going to happen so you can feel more comfortable. He'll explain what he'll do during your surgery and even show you your implants. This is all part of proper patient education.

Reduced complication rate

Nobody wants to experience complications after surgery. Dr. Levine is extremely conscientious about providing you with a safer surgical experience to reduce the related risks of breast augmentation. He applies the following techniques to make this happen:

  • Dr. Levine can place the incision around your areola (periareolar), within the breast fold (inframammary), or in your armpit (transaxillary). However, based on research he has collected of the breast augmentations he's performed, Dr. Levine has found that the inframammary incision is associated with the lowest complication rate and incidence of capsular contracture.
  • In an effort to speed up the surgery, some surgeons perform blunt dissection, which is simply stretching or "ripping up" the tissues to create the implant pocket. This is done with a tool that looks like a hockey stick, or their fingers. It is even done without seeing exactly what tissues are being damaged. You can imagine how much pain and bleeding this would cause! Dr. Levine never does this. He always makes precise incisions under direct visualization of the area he's working on, so he can see exactly what is being done.
  • Dr. Levine reduces the risk of capsular contracture with bloodless breast augmentation, a technique that he has taught aspiring plastic surgeons to do at the University of Toronto for decades. He cauterizes the blood vesels in the implant pocket so there is no blood that can collect there. He also packs the pocket with sponges that have an adrenalin solution. This ensures that there is no blood flowing. It also helps to determine if the pocket was accurately formed.
  • To minimize the risk of infection, Dr. Levine always irrigates the implant pocket with an antibiotic solution. Before he handles the implants, he changes his gloves to avoid contamination and places the implants in an antibiotic solution. This is all done prior to insertion.
  • Dr. Levine performs a three-layer closure of incisions. He sutures the breast tissue, subcutaneous layer and skin. This totally covers the implant and reduces the risk of wound separation. Dr. Levine uses permanent nylon sutures when closing the incisions at the skin level. Theoretically, these sutures lead to better scarring. They're removed 10 days after surgery.

At a Glance

  • Price $7,600 - $8,200
  • Recovery Go home same day
  • Length Of Surgery 1 - 2 Hours
  • Back To Work 3 - 4 Days

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Consultation

Your initial consultation with Dr. Levine is a crucial step on your path to a better you. Based on the information you provide, Dr. Levine will first assess whether your expressed goals and expectations are possible. It is important that you are considering breast augmentation for your own reasons. You should do it for yourself, not to please someone else.

Dr. Levine takes the time to thoroughly discuss your expectations, concerns, and outcomes before an examination even begins. He can then assess what the best possible surgical steps are, what the potential risks are for the procedure, and what you can expect pre- and post-surgery. You will not feel rushed or hurried through the consultation process and every question will be answered carefully and thoroughly. Your first consultation with Dr. Levine is free.

Beautiful woman with firm breasts in black bra with hair blowing.

Do you use The Keller Funnel?

Some surgeons use The Keller Funnel, but Dr. Levine has found it to be unnecessary. The device is used during the insertion of the implants, so that the surgeon doesn't touch them. It is promoted as being able to reduce the risk of capsular contracture, but it has not been proven with medical studies. In addition, if The Keller Funnel is used but the implants need to be adjusted, the surgeon still has to use their hands to do so. That kind of defeats the purpose of using it in the first place, doesn't it?

Surgery steps

Preparation

  • Maintain general good health and avoid smoking for 4 weeks before surgery.
  • If you have a history of breast cancer in your family, you may be asked to get a baseline mammogram before your surgery.
  • You should have a family member or close friend help you after your surgery, during the first day or two.
  • Wear a button up shirt instead of a pullover on the day of your surgery. You will have an easier time putting on your shirt after the procedure as you will be advised not to lift your arms above your head.
  • Do not eat or drink after 12:00AM on the day prior to your surgery
  • Avoid applying lotions, creams, deodorant and makeup to any area in or around the breast on the day of your surgery.

Surgery

  • Your surgery will be performed at a state-of-the-art surgical facility. The facility is fully accredited, adhering to standards that are actually higher than those for a public hospital.
  • You will be administered anesthesia for your comfort.
  • Incisions are made inconspicuously to minimize visible scarring and an implant pocket is meticulously made.
  • A breast implant is inserted into a pocket either under the pectoral muscle or under the breast tissue.
  • Layered sutures are used to close the incisions. These incision lines will fade over time.
  • A surgical bra is placed.
Woman showing off her large breasts in black sheer bra.

What will my scars look like?

In addition to size, scarring is probably another big concern for you. You can be assured that your scars will heal properly with care techniques that Dr. Levine will prescribe. You'll also receive a free therapy session with our scar therapist, a licensed nurse who specializes in scar treatment.

Recovery period

  • Before leaving the surgical center, you will be given specific instructions that will include how to care for your breasts following surgery as well as medications to apply or take orally to aid healing and reduce the risk of infection.
  • Your breasts will be sore after the procedure but prescribed pain medcation will improve your comfort.
  • You should take 24-48 hours to rest undisturbed.
  • You'll need to wear your support bra for 5-7 days after surgery.
  • You should avoid strenuous activity for 2-3 weeks.
  • No matter which anesthesia is used, you will likely not experience a “hang-over” effect when you awaken. You may be groggy when you wake up from your surgery but this feeling will fade quickly. The lack of nausea and vomiting is due to our experienced anesthesiologist, who has been personally selected by Dr. Levine.

Frequently Asked Questions

Can I get breast implants?

If you have breasts that are too small for your liking and are relatively healthy, have realistic expectations of the surgery and understand the related risks, then breast augmentation may be suitable for you.

Saline or silicone?

There are two main types of implants used in breast augmentation – saline implants and silicone implants. Both are contained in an outer silicone shell, and both are durable. Neither type of implant has been known to hinder breast health. Both are safe, common, and do not interfere with a woman’s natural aging process.

Saline implants are filled with sterilized salt water once the shells are in place inside the body. If the implants leak, they will collapse and the saline will be naturally absorbed and expelled by the body without any health risks. The remaining silicone shell will need to be removed by Dr. Levine and a new implant can replace it at that time.

Silicone implants are pre-filled with a smooth, cohesive gel. They look and feel the closest to natural breast tissue. However, if they rupture, they will not collapse and the gel will remain within the shell or in the breast. Most ruptures occur without any symptoms. These are known as “silent ruptures.”

Although both materials are durable, it is important to note that breast implants may not last a lifetime. While it is uncommon, you may need to have your implants replaced if they are damaged. Even after breast augmentation, your breasts can change with your age, weight, or hormone levels.

While the choice is ultimately yours, Dr. Levine has found that silicone implants provide a more natural looking result. However, if you have a nice breast shape and sufficient tissue to begin with, then natural looking results can be achieved with saline or silicone breast implants

Should I get smooth or textured implants?

Smooth breast implants are the softest feeling. These implants can move with the breast implant pocket, which may be more natural looking. However, they are associated with a higher risk of palpable or visible rippling unless they are placed under the pectoral muscle.

Textured breast implants develop fine scar tissue to basically stick to the implant, making them less likely to move around inside of the breast and get repositioned. They have also been shown in several studies to diminish the risk of capsular contracture, a condition where scar tissue builds up causing the breast to become overly firm, distorted in appearance and painful.

Will I be able to exercise, sky dive or do any other rigorous physical activities after surgery?

In general, a woman should be able to do any physical activity after recovering from breast augmentation surgery that she was able to do before it. Both saline and silicone implants are strong and will not rupture under the pressure that such activities may cause.

You can climb Mt. Everest, SCUBA dive, skydive, fly in an airplane, and visit the Dead Sea with silicone and saline breast implants. Changes in pressure or altitude, wearing a wetsuit or parachute harness will in no way affect your implants. Once you have recovered from surgery, you can resume your normal activities without concern. Generally, you can resume full activities after about a month.

It is important to note that breast augmentation, while giving you the firm, full breasts of your youth, does not prevent the effects of gravity and aging. Breasts sag because of gravity and aging. The more you support them, the less effect the weight of the implant will have on the tissue of your breasts. Big or small, there is little doubt that a bra reduces the pressure of the implant on your skin. So the more you wear a bra, the better your breasts should age over time.

Can I breast feed with breast implants?

There is no clear way to know before birth if a mother, with or without implants, can breastfeed fully, needs help due to a low milk supply, or can partially breastfeed but needs to supplement with formula. Genetics, hormones, and the ability of the baby to appropriately latch on all play a part in breastfeeding. However, how breast augmentation surgery is done can impact how it may affect breastfeeding.

It is possible to breastfeed after breast augmentation procedures but it is important to wait until your breasts are fully healed before attempting it. Some women do experience milk loss, but ways to increase your milk production can be discussed with your primary physician after breast augmentation. Dr. Levine will discuss your breastfeeding plans during your consultation including ways to preserve the mammary ducts through alternate incision sites.

What are the incision sites for breast augmentation?

Dr. Levine prefers the inframammary approach. Based on his research, he has found it to be associated with the most pleasing results and lowest complication rate. However, there are other incision sites. Implants can be inserted into your body via a crease under your breast (inframammary incision), via the areola (periareolar incision), or via the armpit (transaxillary incision).

Inframmary incision: The inframammary incision in breast augmentation is the most popular technique among plastic surgeons. Inframammary incisions are made in the fold where the lower part of the breast meets the chest wall. It offers direct access to the areas where a pocket will be created for an implant, without damaging the surrounding muscular tissue.

Periareolar incision: Periareolar incisions are made at the outer edge of the areola, following the curve that separates the darker skin of the nipple from the rest of your breast. Because the colour around the areola is darker, the scar is usually well-camouflaged, sometimes virtually invisible within a few weeks after surgery. However, this type of incision is more likely to interfere with breastfeeding as milk ducts and nerves might be severed in the nipple.

Transaxillary incision: Transaxillary incisions are made in the natural fold in the armpit. Once the incision has been made, a channel to the breast is created, and a pocket is made for the implant. Both saline and silicone implants can be used in this method. Transaxillary incision tend to leave the breasts looking untouched and is less likely to damage the mammary gland than are inframmary or periareolar incisions. One downside to transaxillary incisions is that the incision location can only be used once. If revision surgery is required, new scarring will occur in a secondary location. Transaxillary incisions are also most likely to result in capsular contracture.

Should I go over or under?

The placement of breast implant under the muscle and over the muscle for breast augmentation.

Your implant can be inserted into a pocket in one of two places – partially under the pectoral muscle (submuscular) or directly behind the breast tissue over the pectoral muscle (submammary/subglandular). Often times, deeper implant placement helps camouflage implant related imperfections, which is true for submuscular placement. That's why it's preferred for very thin, lean women. Because the muscle better conceals implant characteristics, edges and rippling may be less visible.

In a subglandular placement, the implant is placed in a pocket behind the breast gland, entirely on top of the pectoral muscle. If your breasts are slightly sagging, subglandular placement offers a lift effect unrestricted by overlying muscle.

If an inch of tissue can be pinched in the upper pole of your breasts, then subglandular placement may be better. This is because the results look more natural (since there's no breast tissue under your muscles).

Your incision site and implant placement will be decided during your initial consultation with Dr. Levine and will be based on your lifestyle, desired breast outcome, and anatomy.

When will I see my results?

You should wait about 4 months to see your results.

What are the risks of a breast augmentation?

As with any surgery, there are inherent risks with undergoing a breast augmentation. Possible breast augmentation surgery risks include:

  • Changes in nipple or breast sensation, which may be temporary or permanent
  • Breast contour and shape irregularities
  • Breast asymmetry
  • Poor wound healing
  • Unsightly scarring
  • Wrong or faulty position of the implant
  • Implant leakage or rupture
  • The formation of tight scar tissue around the implant (capsular contracture)
  • Fluid or blood accumulation (seroma or hematoma)
  • Wrinkling of the skin over the implant
  • Possibility of revisional surgery

Many complications can be avoided by precisely following Dr. Levine’s pre- and post-surgical instructions and returning for periodic follow-up appointments.

What is capsular contracture?

Capsular contracture (CC) is a complication of breast augmentation surgery. CC occurs when scar tissue that normally forms around the implant tightens and squeezes the implant and becomes firm. It is generally caused by an immune response to having a foreign material in the body and can happen in patients with artificial joints, prostheses, or pacemakers as well as those who have breast implants.

Capsular contracture is rated on a four-grade Baker scale as follows:

  • Grade I – the breast is normally soft and appears natural in size and shape
  • Grade II – the breast is a little firm, but appears normal
  • Grade III – the breast is firm and appears abnormal
  • Grade IV – the breast is hard, painful to the touch, and appears abnormal

Placing implants beneath the pectoral muscle, using textured implants, limiting the handling of implants, allowing minimal contact with the chest wall skin before insertion, and irrigating the sites with antibiotic solutions have all decreased the incidence of CC in breast augmentation patients.

In a 15 year study of 1,400 breast augmentation patients, 26.9% experienced capsular contracture of some sort. These were linked to implant type, pregnancy after implantation, infection, and hematoma. Experiencing previous radiation treatment, and undergoing radiation treatment after a breast augmentation for breast cancer can also greatly increase the likelihood of experiencing CC.

Capsular contracture can be corrected surgically by removing the scar tissue in a procedure known as capsulorrhaphy.

What happens if my implants rupture?

In a report released in June 2011, the FDA supports the safety and effectiveness of silicone implants when used as intended, but states that women should fully understand the risks before considering getting them. Breast implants are not lifetime devices. The longer a woman has them, the more likely she is to have complications and need to have the implants removed or replaced.

Some possible causes of implant rupture are:

  • Capsular contracture
  • Compression during a mammogram
  • Damage by surgical instruments
  • Damage during procedures to the breast, such as biopsies and fluid drainage
  • Normal aging of the implant
  • Over-filling or under-filling of saline-filled breast implants
  • Physical stresses to the breast such as trauma or intense physical pressure

Currently, when a saline-filled implant ruptures, the saline leaks into the body and is absorbed and expelled naturally. This may leave the breast feeling deflated, uneven, or soft.

In the case of silicone gel-filled breast implant ruptures, some women may notice decreased breast size, hard knots, uneven appearance of the breasts, pain or tenderness, tingling, swelling, numbness, burning, or changes in sensation. However, most ruptures occur without any symptoms. These are known as “silent ruptures.”

Magnetic Resonance Imaging (MRI) is currently considered the most effective way to detect a rupture of a silicone breast implant. Many implant manufacturers recommend that women with silicone gel-filled breast implants undergo MRI screening three years after they receive a new implant and every two years after that for early detection of a silent rupture.

Current breast augmentation procedures are the product of nearly 100 years of research and development. When silicone implants began rupturing in 1992, the Food & Drug Administration of the United States immediately pulled silicone implants from the market. When they were allowed back on the market in November 2006, manufacturers were required to conduct follow-up studies on the long-term safety and performance of implant devices. The results were conclusive with consistent and convincing findings of no association between breast cancer and breast implants. A 2015 long-term review of 32 studies further concluded that there was no conclusive link between silicone gel implants and long-term health outcomes such as breast cancer.

Woman with long black hair wearing tight white tank top with large breasts.

Your cup will runneth over

Breast augmentation gives you the bigger breasts you've tricked others into believing you had with your padded bras. You'll finally enjoy having the sexier body you've always wanted.

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