Breast Augmentation

Breast Enlargement or Augmentation Mammaplasty

Breast enhancement is chosen by women who feel their natural breasts are too small. Alternatively, women whose breasts have decreased in size following childbirth or from breastfeeding may also choose to have Breast Augmentation. It is essentially a surgical procedure used to enhance the size and shape of a woman’s breasts using implants. By inserting implants we are able to increase a woman’s bustline by one or more bra cup sizes.

Dr. Frederick Coville will perform breast enhancement surgery for a number of reasons:

  • To enhance the body contour of a woman who, for personal reasons, feels her breasts are too small.
  • To restore loss of breast volume after pregnancy.
  • To balance a difference in breast size.
  • As a reconstructive technique following surgery that removes breast tissue

What can and should be done in your case will depend on your consultation with Dr. Fred. The following introductory paragraphs have been designed to complement your consultation with him. We hope that they will be helpful and that you will not hesitate to contact us should you have any further questions.

Is a breast augmentation right for me?

Altering the size or shape of your breasts can change your entire appearance, the way you dress, and even the way you carry yourself. As a result, this may improve your self-confidence. Nevertheless, remember that it can’t transform who you are, or change your life’s circumstances. Please discuss your expectations thoroughly with Dr. Fred before deciding. The most suitable breast augmentation patients are physically healthy, emotionally stable women, who are realistic about what the surgery can accomplish. You should be looking for improvement, not perfection.

The Implants

A breast implant is a silicone elastomer shell filled with medical grade silicone gel or saline. Long-term experience with medical grade silicone shows that it is the least reactive substance in the human body of any man-made material that we know. Many people do feel that silicone-filled implants give a more natural look and feel to the breast than do other types. Dr. Coville will use Saline-filled implants in certain circumstances and in accordance with what you, the patient, ultimately desire. However, he does prefer silicone gel-filled implants due to their more natural appearance and feel. Due to his experience abroad, Dr. Fred has great familiarity using silicone-gel-filled breast implants, as they are the implants most commonly used around the world. Additionally, they have been proven very safe when used correctly and in the appropriate patient. Cornerstone Plastic Surgery and Aesthetic Medicine uses only the highest quality silicone gel implants manufactured in the United States by Allergan, Inc.

Are there any risks?

Breast augmentation is relatively straightforward. Nevertheless, all surgery carries risks and specific possible complications. The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This can cause the breast to feel hard. Treatments for capsular contracture include removing or ‘scoring’ of the capsule scar tissue, or perhaps removal or replacement of the implant entirely. This entire concept of capsule formation and possible capsular contracture is something that Dr. Fred will explain to you in great detail during your initial breast augmentation consultation.

As with any surgical procedure, excessive bleeding is possible and may occur following the operation. Frederick A. Coville, MD does everything possible to ensure that there are no vessels bleeding when your surgery is completed. However, the human body is incredibly complex and many things, such as your blood pressure rising too quickly in response to pain, or simply doing too much in the way of activity right after a procedure, can cause some post-operative bleeding. One of the signs we would look for in this case is out-of-the-ordinary swelling and pain. If this bleeding continues, a further procedure may be necessary to control it and remove the accumulated blood. Even more rarely, an infection may develop around an implant. If it is going to happen, it usually occurs within a week of surgery. Again, Dr. Fred Coville is meticulous in his operative technique in order to prevent any infection from occurring and will additionally keep you on oral antibiotics for at least a week after implant surgery as a precaution. However, an infection is possible in any hands and may mean that Dr. Coville removes the implant for several months until the infection clears, and then inserts a new implant later.

Sometimes, nipples become oversensitive, undersensitive, or even numb. There may be small patches of numbness around your incisions. These usually improve over time, but may be permanent in some patients. There is no evidence that breast implants affect fertility, pregnancy, or your ability to feed a baby. If, however, you have been breast-feeding in the year before surgery, you may produce milk for a few days after surgery. Although this may cause some discomfort, Dr. Fred may treat the condition with prescription medication if necessary.

Occasionally breast implants break or leak because of injury or even from normal compression. This happens more commonly with saline-filled implants than with silicone gel-filled ones. If a saline-filled implant breaks, it will deflate in a few hours and the body will harmlessly absorb the salt water. If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the surrounding scar capsule does not, you may not detect any change. If the scar capsule also breaks or tears, especially following a lot of pressure, silicone gel may enter surrounding tissue. The gel may then collect in the breast where a new scar capsule will form around it, or it may migrate to another area of the body. This may cause a change in the shape, or firmness of the breast. Both types of break will normally require a second operation to replace the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue after a rupture. The newer gels being used to fill implants are much more “cohesive” in nature. As a result, silicone migration is much less common than it once was.

Though some women have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions, research has found no clear link between silicone implants and the symptoms of what doctors refer to as “connective-tissue disorders.” Again, there is no evidence that breast implants cause breast cancer, but they may change the way mammography is done to detect cancer. When requesting routine mammograms, women with implants should be sure to go to a radiology centre where technicians are experienced in the special techniques needed to get reliable X-rays of implanted breasts. Additional views are required. Ultrasound examinations may help to detect breast lumps in some women with implants or to evaluate the implant. In some cases, Dr. Coville may elect to order an MRI or CT-scan of your breasts so that he may get a better picture of what may be going on. While the majority of women do not experience any complications, you should discuss each of them with Dr. Frederick A. Coville, to make sure you understand the risks and consequences involved in breast augmentation.


Dr. Coville will initially evaluate your health and recommend which surgical techniques are best for you based on your age, prior medical or surgical history, the condition of your breasts, and your skin tone. If your breasts are sagging somewhat he may also recommend a breast lift. Discuss your expectations fully and frankly with Dr. Fred. You will find that he will be equally frank with you, describing your choices and the risks and limitations of each. He, or our staff will offer you copy of the manufacturer’s usage instructions and additional crucial information that come with the implant. Cornerstone Plastic Surgery & Aesthetic Medicine will also provide you with information that we have put together just for you. We do this for you in an effort to keep you fully informed every step of the way. Be sure to tell Dr. Coville if you smoke, and if you’re taking any medications, vitamins, or other drugs. He will also explain the type of anesthesia to be used, the facility where the surgery will be performed, and the costs involved. Most insurance companies do not consider breast augmentation medically necessary and so do not generally cover the cost of this procedure. Please make sure you ask our staff about financing options available to you. These may be appropriate for your particular situation.

Every patient and every physician will have a different view of what is a desirable size and shape for breasts. It is very important, therefore, to discuss your expectations fully and frankly with Dr. Coville. He will examine and measure your breasts and discuss the variables that may affect the procedure. Things such as your age, the size and shape of your breasts, and the condition of your skin, Dr. Fred will describe the procedures he feels will work for you in detail and explain any risks or limitations.

Dr. Coville will also ask you about any medical conditions that could cause problems during or after surgery, such as high blood pressure, blood-clotting problems, or any tendency to form excessive scars. Be open, particularly about smoking and any drugs, medications, or vitamins you are taking – aspirin for example can affect clotting. Dr. Coville will also explain the type of anesthesia to be used, where the surgery will be performed, and the costs involved. Do ask any questions you may have about discomfort, healing time and so on. The Cornerstone Plastic Surgery & Aesthetic Medicine team 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. Be sure to arrange for someone to drive you home after your surgery and to help you out for a few days if needed.

What happens?

How your new breast implants will be inserted and positioned depends on matters such as your anatomy, your preferences and what Dr. Coville recommends. This why it is so important for you and he to fully understand each other. Dr. Fred believes that having both the surgeon and the patient “on the same page” in terms of expectations, goals and risk factors, is the key to avoiding any problems or misunderstandings later. A short incision can be made either in the crease under the breast, or around the areola (the dark skin surrounding the nipple), or in the armpit.

Regardless of the location of the surgical incision, Dr. Fred Coville makes every effort to ensure that the resulting scars are as inconspicuous as possible. Working through the incision, Dr. Coville will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue (subglandular) or underneath your chest wall muscle (the pectoralis muscle) (submuscular). There are different reasons for placing the implants on top of or underneath the muscle, he will discuss the pros, and cons of these alternatives with you before surgery to make sure you fully understand the implications of each. Drainage tubes are rarely, if ever needed following this operation, which usually takes about one and a half hours to complete.

After Surgery

You will feel a bit tired and sore for a few days, but should be up and around in 24 to 48 hours. Dr. Fred will have prescribed pain medication, (along with your antibiotic), prior to the surgery to control most of your discomfort. Generally, women who have had the breast implants inserted under the breast tissue but above the chest muscle (subglandular) have less pain and discomfort than those that have them placed under the chest wall muscle (submuscular). Either way, within a few days any dressings will be removed by Dr. Coville and you may be asked to wear a light surgical bra. Our team may ask you to wear a light strap across the top of your breasts if you have had a submuscular breast augmentation. Please make sure you wear it as directed by our team. Some patients may experience a burning sensation in their nipples for about two weeks – though this will subside as the bruising goes away. The swelling in your breasts may take a couple of months to go completely.


Most patients can return to work within a few days. Follow the advice given to you by Dr. Fred and his team on when to begin exercises and other normal activities. Your breasts will probably feel sensitive for two or three weeks, so you should avoid most physical contact. By three to four weeks after surgery, they should no longer be sore. Your scars will be firm and pink for at least six weeks. However, those with very fair skin, such as redheads may have scars that stay pink a bit longer. If you have darker skin coloring, you may find that the scars begin to take on a darker pigmentation. Always let us know about these changes, as he is expert and helping to make these scars as unnoticeable as possible. All scars may remain the same size for several months, or even appear to widen. After several months, however, your scars will begin to fade, but they will never disappear completely. Routine mammograms should continue after breast augmentation for women who are in the appropriate age group. Dr. Fred Coville will make sure you are clear as to your responsibility for mammograms in the future.

Will I Be Happy?

Many women find having larger breasts satisfying, even exhilarating. Some women may however go through a short, but limited period of sadness after their surgery. This usually passes very quickly and our patients are exceedingly happy with their choice to have breast augmentation. Regular examination by your surgeon and regular mammograms for those in the appropriate age groups will help ensure that any complications, if they occur, can be detected and treated early. Your decision to have breast augmentation is a highly personal one. Not everyone will understand. The important thing is how you personally feel about it. If you have met your goals, then your surgery is a success.

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