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Q: How long have you been performing breast implant surgery?
A: Dr. Lista has been a practicing plastic surgeon, including breast augmentation, for over 20 years. He is considered one of the top plastic surgeons in Canada. Dr. Lista is well respected by his peers, and has developed some of the newest techniques to ensure smaller incisions and quicker healing times. He has been invited to speak on breast augmentation by many national meetings including the American Society Aesthetic Plastic Surgeons and Australian Society of Plastic Surgeons. He has also been invited as a speaker or visiting professor at many university programs including University of Toronto, McMaster University, McGill University and Yale University.
Dr. Ahmad first worked with Dr. Lista during a medical school placement in 2003, and started his plastic surgery residency in 2005 at the University of Texas Southwestern Medical Center at Dallas. He is an accomplished surgeon who completed a breast reconstruction fellowship at the University of Toronto in 2010 and is on the staff of the plastic and reconstructive surgery departments of three downtown Toronto hospitals. Dr. Ahmad has been asked to present at national meetings, including the American Society for Aesthetic Plastic Surgery, the Canadian Society for Aesthetic Plastic Surgery, and the Canadian Society of Plastic Surgery. He has authored more than 25 articles and chapters in plastic surgery, including articles in Plastic and Reconstructive Surgery, and Aesthetic Surgery Journal.
Q: How many breast implant surgeries do you perform a month?
A: Dr. Lista and Dr. Ahmad perform approximately 35 breast augmentation surgeries per month.
Q: Who will I see when I come for my consultation?
A: At The Plastic Surgery Clinic all of our consultations are always with our Toronto plastic surgeons. You will never be seen by a nurse or health care worker. If you are thinking of having your surgery with Dr. Lista then your initial consultation will always be with Dr. Lista; if you choose to have Dr. Ahmad perform your surgery, you will see Dr. Ahmad. Dr. Lista and Dr. Ahmad believe that selection of implant type and position can only be properly performed by a careful examination and discussion between the surgeon and the patient.
Q: How many revisions of your own work, on average, do you perform?
A: That vast majority of our Mississauga / Toronto breast implants patients are extremely satisfied with their breast augmentation. It is extremely rare that a patient requires a revisionary surgery. Our current revision rate is less than 2% per year.
Q: What happens if I need revisionary surgery?
A: At The Plastic Surgery Clinic, if you have an issue that we feel can be fixed, then your revisionary surgery will be performed at no cost. This policy does not apply to requests for size changes or changes which occur through normal aging, weight change or pregnancy.
Q: What is the warranty on the different implants and what fees will I have to pay if it ruptures?
A: All breast implants come with a lifetime manufacturer's warranty. In the unlikely case that the implant ruptures, the manufacturer will provide you with a replacement implant free of charge. In addition, at The Plastic Surgery Clinic we will cover all the surgical costs required to replace a defective implant.
Q: If I have any other breast implant complications, what is your policy? Do you cover expenses?
A: If you have a complication that our surgeons feel can safely be fixed with additional surgery we will offer to correct this at no charge. This policy does not cover changes that are a result of weight change, pregnancy and normal aging. In addition, surgical fees to change the implant size will be charged to the patient.
Q: Can I see your before and after photos?
A: We have posted some before and after photos for you to view on our website. We can show you additional photographs that are most similar to your expected result during your consultation with Dr Lista or Dr. Ahmad.
Q: Could I speak with some of your past breast implant patients?
A: Yes. There are many patients who are pleased to discuss their experience at our clinic. We would be pleased to help arrange a discussion with one of our past patients.
Q: Is there someone on your staff who has been a patient?
A: Yes. Some of our staff members have received different surgeries. This contributes to their overall knowledge and their ability to better explain procedures to our patients.
Q: Are silicone breast implants or saline implants better for me, and why?
A: This is something that needs to be discussed during your consultation with your surgeon. Your surgeon will assess your frame and your current breasts and will be able to tell you which would be best for your body type. It is important to note that as a patient, you will have the final say as to what implant type you want.
Q: Is it true that one type of implant is better than the other?
A: No. There are advantages and disadvantages to using both types of implants. Some patients will achieve a better result with cohesive gel implants. Other patients will achieve an equally good result with lower risk using saline implants. Dr. Lista or Dr. Ahmad will discuss the implant that is right for you based on your body frame and lifestyle.
Q: Which type of implant do you use at your clinic most often?
A: We perform over 400 breast augmentations per year. Of these about half are saline and half cohesive gel. This makes Dr. Lista and Dr. Ahmad some of the most experienced breast implant surgeons using both implant types.
Q: What breast size do you suggest for my body frame?
A: This is also something that needs to be discussed during your consultation. Your surgeon will assess your body type and make a recommendation for you. Your surgeon will keep in mind your frame, the type of implant you select, the type of surgery, and any other issue to help prevent complications. The most important consideration is giving you a naturally shaped breast that suits your body. But you always have the final say.
Q: Do you recommend smooth or textured implants for me? Why?
A: When using saline implants we usually use smooth implants. Cohesive implants are available in smooth or textured. The use of smooth or textured cohesive gel implants depends on several factors, including position of the implant above or below the pectoralis muscle. If you are receiving cohesive gel implants, Dr. Lista or Dr. Ahmad will suggest which would be most beneficial to you during your consultation.
Q: Do you recommend round or anatomical implant for me? Why?
A: Saline implants are almost exclusively a round implant. Cohesive implants are more customizable and can be round or teardrop shaped. Our primary goal is to give every patient a natural-looking breast. Different patients may achieve a natural look by using completely different types of implants. The key to implant selection is to use the implant that is right for each individual patient. Generally, when implants are going to be placed above the muscle, we achieve the most natural result by using anatomic, teardrop-shaped implants. Occasionally we will use a round implant for patients who prefer a rounder, or “fuller up top” look. When placing the implant under the muscle, studies have shown round and teardrop-shaped implants give similar looks, so in these cases we generally use round implants as they have a lower complication rate. Dr. Lista or Dr. Ahmad will suggest which implant type and shape would be most beneficial to you during your consultation.
Q: Which placement (prepectoral, subpectoral) do you feel is best for me? Why?
A: Implant placement is an important consideration that will be made on an individual basis for each patient, depending on her body type, breast shape and desired result. Of all the implants performed at our clinic, about half our patients have their implants placed above the muscle and half below the muscle. Very thin patients who do not have much natural breast tissue usually have better results when their implants are placed behind the muscle, as this helps make the implant less visible. Patients with more natural breast tissue or who have a droopier breast often achieve a more natural result when their implants are placed above the muscle. You and Dr. Lista or Dr. Ahmad will discuss the optimal placement for you implant during your consultation.
Q: Will I be able to breastfeed after having implants?
A: Pregnancy and breastfeeding are not affected by breast augmentation, and most women can successfully breastfeed after breast augmentation. However, pregnancy and breastfeeding may change the shape of your augmented breasts. Also, if 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.
Q: Will mammograms be less accurate in detecting breast cancer?
A: When you request a routine mammogram, be sure to go to a radiology centere 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.
Q: Is it possible to prevent breast implants from rupturing?
A: You can live a normal life with breast implants. No special precautions are necessary. We have patients who are police officers, firefighters and martial arts instructors – they have not had to adapt their lifestyles as a result of their implants.
Q: Is it true that breast implants need to be changed every 10 years?
A: This is not true. Implants only need to be changed if a problem develops. Implants should not be changed as a matter of course. Most women will live their whole life with their original implants and will never require a revision.
Q: Will my implants sag over time?
A: Your implants will, for the most part, behave like normal breasts. Normal aging will occur. Usually breasts with implants tend to hold their shape longer and better than if the operation had never been performed.
Q: What will my breasts look like if I decide to remove my implants?
It's impossible to predict exactly what will happen when implants are removed but from past experience the changes that occur depend on how long the implants have been in place. Generally, if implants have been in place for a short time (about a year or less) then the breasts usually return to their original shape. Patients who have had their implants for many years or who have since become pregnant cannot expect their breasts to return to their original shape when they were younger or before they had children.
Q: What diet and lifestyle changes will I need to make before breast implant surgery?
A: Dr. Lista or Dr. Ahmad will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. If you smoke, it's especially important to stop at least two weeks before and after surgery. Smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.
Q: Will my regular pills (birth control, antidepressants, diet pills) affect the anesthesia?
A: Patients usually carry on with birth control and antidepressants. Patients who smoke should stop using birth control pills and should also stop smoking. Diet pills are not recommended. Your surgeon will provide all information and discuss which pills are safe to continue using prior to your surgery.
Q: What type of medical testing do I require prior to surgery?
A: All patients require blood work to be completed by a local laboratory and a pre-operative report to be completed by their family doctor. Patients over the age of 45 also require an electrocardiogram (ECG).
Q: Can I wear a plastic hole spacer in my piercing during the surgery
A: Usually, yes, but this depends on where the piercing is located and the incision being used. Please discuss this with your surgeon during your consultation.
Q: Do I need to purchase a particular bra for my surgery?
A: You will receive any necessary garments from The Plastic Surgery Clinic. Patients who have had saline implants will receive a binder that they will need to wear for 2 weeks. It needs to be washed in the washing machine and dried every day for two weeks. Cohesive gel implant patients will be given a special surgical bra that they will need to wear for 4 weeks.
Q: How is a breast enlargement surgery performed?
A: Dr Lista and Dr. Ahmad have 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. In addition, Dr. Lista and Dr. Ahmad are two of only a few surgeons who use a special operating room bed to allow them to perform this procedure with the patient in the seated position. In this way, Dr. Lista and Dr. Ahmad can ensure the implants look right: that the size suits the patient's body frame, that the two breasts are balanced, and that the patient is getting the look and size that she and the surgeon agreed on. This is one of the reasons why patients of Dr, Lista and Dr. Ahmad achieve such a natural look.
Q: How long will the surgery take? When will I be released?
A: The surgery only takes an hour. We will monitor you in the recovery room for about an hour and then we will call your caregiver to come and pick you up and take you home or to your hotel. Your caregiver should stay with you for 24 hours and then bring you back the next day.
Q: Which incision do you use the most? Why?
A: The position of the incision is a choice we let our patients make. Patients can choose to have their incision placed in the bra crease, around the areola, in the armpit or even the belly button. Not all implants can be placed through any incision, but Dr. Lista or Dr. Ahmad will explain the advantages and disadvantages of each incision type so you can make an informed decision together.
Q: If I need a revision in the future, can this incision be used again or will I need a new one?
A: Depending on what type of revision surgery is necessary, most incisions are able to be reused.
Q: Where will my breast implant surgery be performed?
A: Most breast augmentation procedures are performed right on site in the state-of-the-art facilities of The Plastic Surgery Clinic. Our clinic meets and even exceeds the requirements of many public hospitals. If you prefer, you can also choose to have the surgery at one of the hospitals where our highly skilled plastic surgeons, Dr. Lista and Dr. Ahmad, enjoy privileges. These include the Mississauga site of the Trillium Health Centre, where Dr. Lista was Past Chief of Plastic Surgery, and the University Health Network, where Dr. Ahmad continues to provide his services.
Q: Is the centre set up to handle a life-threatening emergency?
A: Yes, The Plastic Surgery Clinic is well equipped to handle a life-threatening emergency. It is a new, state-of-the-art surgical facility built from the ground up and completed in 2007. It meets and exceeds national, provincial and municipal standards for health care facilities providing general anesthesia. It also meets and even exceeds hospital standards in such important areas as equipment quality and infection control standards. The clinic is also licensed as an Independent Health Facility by the Ontario Ministry of Health for the provision of insured services.
Q: What hospital would I be taken to if there were a problem?
A: Even though The Plastic Surgery Clinic is set up to handle life-threatening emergencies, we will transfer patients to the Mississauga site of the Trillium Health Centre if any problems arise. The hospital is located just down the street from our clinic.
Q: What type of anesthetic will I receive (local, general, sedation)? Will a certified anesthesiologist administer it?
A: Most breast augmentation surgeries are performed under a light general anesthesia with the patient asleep. The Plastic Surgery Clinic is a specialist-only clinic, meaning that a board-certified anesthesiologist will administer your anaesthetic, stay with you during the entire operation, and will be there as you wake up.
Q: If I have an emergency after going home, how can I reach you? What should I do?
A: You can contact our clinic and we will ensure that you see one of our on-call surgeons or one of our nurse specialists. If something happens outside clinic hours, we will provide you with an emergency hotline number. The operator will contact one of our on-call surgeons who are available 24 hours a day.
Q: What do you recommend to reduce scarring?
A: We recommend using Mepiform, Scar Fade or Arnica gel. They are available for purchase at The Plastic Surgery Clinic.
Q: What do you recommend to treat swelling, bruising, pain?
A: Prior to surgery, Dr. Lista will provide you with prescriptions to assist with pain and swelling. We also provide a homeopathic remedy to prevent swelling, bruising and bleeding.
Q: I've read about the pain pump. How does it work and will there be an extra fee for this?
A: The pain pump is available for all our breast augmentation patients. The pump automatically and gently pumps freezing solution into the breast pocket. The pump runs for 24 hours and is removed the day after surgery. The pump has been shown to greatly decrease pain. Less pain means faster healing, less pain medication and less nausea and vomiting. The pump is provided to our patients at no extra charge.
Q: Q: How long should I take off from work?
A: You should plan to take a week off after your surgery, limiting your activities to staying home, watching TV or reading books. You should not even be driving, let alone chasing after young children – so plan to make arrangements to get some help if you need it. We understand it can be hard to stop completely, but staying quiet in the first week actually speeds healing and helps achieve the best results from the surgery.
About two weeks after your surgery you can start to exercise gently: walking and stairmaster is allowed, but no upper body workouts, running or high-impact workouts should be done for one month.
Q: How long will healing take?
A: Most patients’ incisions heal in approximately 1-2 weeks.
Q: How soon can I get back to my regular exercise routine?
A: 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.
Q: How long before I can resume intercourse?
A: We suggest that you avoid any strenuous activity, including intercourse, for at least two weeks. Get plenty of rest and allow your body to spend its energy on healing.
Q: How soon after surgery can I shower?
A: The day after surgery we will see you in the clinic to remove your drains and pain pump. Two days after surgery you must shower and start washing your stitches with soap and water four times a day, followed by the application of polysporin ointment. Refrain from baths or hot tubs for eight weeks after your surgery.
Q: What is included in the surgical fee? What is not covered?
A: Our surgical fees cover your surgery and all subsequent post-operative appointments. Prescriptions and HST/GST are additional.
Q: Is implant removal included in the initial fee?
A: It is extremely rare for a patient to request that their implants be removed. In the unlikely event that a patient decides to remove her implants then we will do so at no additional charge.
Q: Is there a deposit required? When is it due?
A: Yes. There is a $1000 deposit that is required before we are able to confirm a surgery date. The deposit will be applied towards your surgery balance.
Q: Do you offer financing, or do you expect full payment up front?
A: Your full balance needs to be paid prior to your surgery. We offer several different financing plans for the benefit of our patients. These are arranged through major lending institutions that specialize in financing for medical and cosmetic procedures. The process is completely confidential. Since the companies involved specialize in plastic surgery patients, there are no embarrassing questions about why you require the funds. The application forms are available at our office. We can then forward the completed application to the company for approval or you can do it yourself.
Most patients are approved for their financing. Approvals are usually received the same day or within 24 hours. The interest rates are competitive with most major credit cards and are clearly outlined during the application process. Repayment is extremely flexible and is always totally open so that total repayment can be made at any time without penalty.
Q: Do you take credit cards?
A: Yes. We accept Visa, MasterCard, and American Express.
Q: Will my deposit be refunded if I change my mind?
A: The deposit is non-refundable. If you postpone or change your surgery date with more than two weeks notice, you will have available credit at our clinic for up to one year. If you cancel or change your surgery date with less than two weeks notice before your surgery you will forfeit your deposit.
Q: What are the possible risks of breast implant surgery?
Complications are rare with breast augmentation surgery. The vast majority of our Toronto, Ontario breast implant patients have no complications and are extremely happy with their results.
Nevertheless, all surgeries have their risks. The following list outlines some of the risks that do exist, as infrequent as they are:
When implants are placed in the body, the body’s normal response is to form a lining, or capsule, around it, just as it would with any foreign object. That process is completely natural, and capsular contracture itself is also natural. A problem only arises if the capsule squeezes too much, making the soft implant beneath it feel hard. If this occurs, the capsule may need to be removed, or the implant replaced.
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.
Changes in Nipple Sensitivity
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.
Fertility, Pregnancy and Nursing
As highly experienced Toronto breast augmentation experts, Dr. Lista and Dr. Ahmad assure patients that breast implants will not 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.
Very 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. Both saline and cohesive gel implants are particularly safe in the event of rupture. Saline is a salt solution that is similar to fluids that are naturally present in the body, and will be absorbed by the body if the implant ruptures. Cohesive gel is a solid similar in texture to a gummy bear, and in the event of rupture will not spread in the body.
If a rupture occurs, you will need a second operation to replace the leaking implant.
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. However, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology centre 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.
Q: What is the risk of an implant rupturing?
A: Many large studies have shown that the risk of implant rupture is 1% per year. That means at 10 years the risk of needing a replacement due to rupture is 10%, and at 20 years the risk is 20%. The rupture rate is the same for saline and cohesive gel implants.
Q: Will I lose any sensation in my nipples or breasts?
A: The vast majority of women experience no change in nipple sensation. Generally speaking, the farther away the incision is placed from the nipple, the less sensation will be affected. However, occasionally a small percentage of women report that their nipples become oversensitive or undersensitive. You may also notice small patches of numbness near your incisions. These symptoms usually disappear with time, but may be permanent in some patients. It is rare for this complication to occur, but it is best to understand any possible complication prior to your surgery.