Dr. Wayne Carman

Plastic Surgeon, M.D., F.R.C.S.C.


Cosmetic Surgery Institute
325 Eglinton Avenue East
Toronto, ON, M4P 1L7
Tel. (416)322-7108

American Society of Plastic SurgeonsAmerican Society for Aesthetic  Plastic SurgeryCanadian Society of Plastic Surgeons

Breast Augmentation Surgery

General Overview

The success rate and overall safety of breast augmentation has helped it to become the most popular plastic surgical operation in North America. My practice at the Cosmetic Surgery Institute has emphasized this procedure for many years. I believe that my approach to planning and execution delivers the best results for a wide range of individual patient needs. All surgery is performed at my private clinic. Having a custom designed surgical facility such as this allows patient care to be extremely comfortable and efficient.

Surgical Technique

There are many variations of technique which allow breast augmentation to be performed in different ways. Choice of incision location, implant style and size, and placement relative to the chest muscle are all factors which help to determine the final outcome. Each patient has different desires and her own unique breast shape. The formula that gives one patient an excellent result may be totally wrong for someone else. When I consult with a patient, I suggest the surgical procedure which I feel will work best for her as an individual - my suggestion may be quite different than the plan which worked well for her friend. I explain that everyone is different and needs her own customized surgical plan.

Pain Management

Having surgery usually hurts! Some patients are understandably fearful of a painful experience - but fear can be exaggerated. I believe that our duty to patients is to make the surgical experience as comfortable as possible. Pain can be controlled and should not be the most lingering memory of having an operation. With this in mind, I decided long ago to undertake breast enlargement surgery with an overnight stay included as standard practice. Staying overnight with a qualified plastic surgery nurse ensures that my patients are properly cared for during the first night after surgery. It allows me an opportunity to check on my patients in the morning before they leave at which time I can answer any questions and review post operative instructions. I believe that I am the only Plastic Surgeon in the GTA to care for my breast augmentation patients in this way.


In my opinion, hiding the skin incision in the underarm has been the single biggest improvement in breast enlargement surgery in the past 20 years. Incisions can also be successfully placed under the areola or in the crease beneath the breast, but these locations tend to be somewhat more obvious. Unfortunately, not all patients are appropriate for an underarm incision - those with more breast overhang, or a tight lower curvature may need an areola incision to allow greater control of the breast shape. An incision under the breast is usually reserved for those women who require firmer cohesive implants to correct a breast shape that has settled a significant amount.

Breast Implant Style

The two main implant types of are those which contain saline solution and those which contain silicone gel. Each has certain benefits and limitations. I tell my breast implants patients that if there was one perfect implant, then all surgeons would use it and there wouldn't be any need for the other 80 or 90 styles. The choice of implant depends upon many factors including preexisting breast shape and size, incision location and the presence of asymmetry . Generally, the implant style is less important than patients may think. I commonly advise patients that if I used a different implant style on each side, they probably wouldn't be able to tell them apart. The final decision regarding implant size and style is determined during our pre operative consultation.


I advise my patients to take one week off following surgery to stay home and rest. Avoiding physical activity in the early days after surgery makes the recovery process much easier and more efficient. During this time I will prescribe medication to relieve any pain, and an antibiotic to prevent infection. A further two weeks of a more normal activity level, only avoiding heavy lifting or working out ensures that healing progresses efficiently. Most patients can return to their usual activity level three weeks after surgery. To learn more about breast surgery recovery, please visit this page.

Follow Up

I see my patients one week after surgery and again after 4 to 6 weeks. Most patients are fully healed by this time and do not require any further scheduled appointments. Long term follow-up visits are booked according to the wishes of the individual patient.

Implant Replacement

I am commonly asked whether implants need to routinely be replaced after 5 or 10 years. The answer is no! Implants do not have an expiry date. They do not have a mandatory replacement date. There is a great deal of confusion regarding this idea, however, I advise my patients that the only reason to replace implants that have healed well and are stable years later is to create a change in appearance. As time passes, our bodies change, our goals change, and a patient may consider a change in breast size. This is a personal decision. If a patient should wish to explore this possibility, I am available to discuss it at any time.

Additional Breast Augmentation Information:
Common Reasons for Breast Augmentation
How to Prepare?
Planning your surgery with Dr. Carman
Anesthesia for Breast Augmentation
Breast Augmentation Surgery
Sub-muscular Implant placement
Breast Augmentation Swelling
Breast Augmentation After Pregnancy
Breast Implant and Scarring
Breast Lift or Augmentation?
Breast Augmentation Galleries
Breast Augmentation Risks and Safety
Breast Augmentation Patient Financing
Recovering from Breast Augmentation

Breast Implants:
Breast Implant Types
Gel Filled Breast Implants
Silicone Filled Breast Implants

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