Breast Augmentation Surgery in Toronto

General Overview

The success rate and overall safety of breast augmentation has helped it to become the most popular plastic surgical operation in Toronto as well as North America. My practice at the Cosmetic Surgery Institute has emphasized breast augmentation for many years. I believe that my approach to surgical planning and execution delivers the best results for a wide range of individual 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.

American Society of Plastic Surgeons
Toronto Plastic Surgeon
Wayne Carman,MD FRCSC
  • Canadian Society of plastic Surgeons
  • American Society of Aesthetic Plastic Surgery
  • American Society of Plastic Surgeons
Dr. Wayne Carman is the Director and founder of the Cosmetic Surgery Institute, an exclusive private surgical facility in midtown Toronto. A member of the Royal College of Surgeons of Canada in Plastic Surgery, Dr. Carman has been in private clinical practice for over 25 years. He is the Chief of the Division of Plastic Surgery at The Scarborough Hospital.
Wayne Carman MD FRCSC
American Society of Aesthetic Plastic Surgery
Wayne Carman MD FRCSC

Reasons for Considering Breast Augmentation

Breast size and shape can be affected by a number of factors, including genetics and volume changes due to age, pregnancy, and weight loss. Breast augmentation performed at the Cosmetic Surgery Institute can, in most cases, provide the correction required to make the breasts look fuller and more youthful. When properly planned, breast enhancement surgery can deliver the hourglass shape and overall improvement that most patients hope to achieve. Because of its solid safety record when performed by a qualified plastic surgeon, thousands of women successfully undergo this procedure every year.


At the Cosmetic Surgery Institute, my careful approach to breast augmentation planning helps me to achieve successful results. I find that my patients will commonly refer their friends, which tells me that they have had a positive experience. Patients will very often report improved self-confidence from their new physical appearance after undergoing this procedure.

During the consultation visit, each patient is given detailed information about pre- and post-operative care and surgical risks, as well as anticipated breast augmentation results. I will also help guide patients to determine the most appropriate breast implant size to suit their individual needs and wishes. A happy patient is my ultimate goal.

Breast Augmentation Surgical Technique

There are many variations of technique that 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 individual has different desires and her own unique breast shape. The formula that gives one person an excellent result may be totally wrong for someone else. When I consult with a patient, I suggest the surgical procedure I feel will work best for her as an individual — my suggestion may be quite different from the plan that worked well for her friend. I explain that everyone is different and needs her own customized breast augmentation plan.

Breast Augmentation and Pain Management

Having surgery usually hurts! Some people are understandably fearful of a painful experience - but fear can be exaggerated. I believe that our duty 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 augmentation 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 greater Toronto area to care for my breast augmentation patients in this way.

Dr. Carman welcomes any questions you may have about breast augmentation. For more information about what it could do for you, call (416) 322-7108 or request a private consultation.

Incision Placement for Breast Surgery

Surgery that involves the insertion of an implant - as with breast augmentation - naturally requires surgical incisions. Regardless of the type of implants, whether saline or silicone gel, internal placement must have a means of access.


In my opinion, hiding the skin incision in the underarm has been the single biggest improvement in breast augmentation 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 everyone is appropriate for an underarm incision - those with more 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 breast augmentation patients who require firmer cohesive breast implants to correct a breast shape that has settled a significant amount.

Incisions at the border of the areola or in the fold beneath the breast can potentially accommodate either type of implant - saline or gel - though I note that each patient has individual needs and a patient's goals, current breast size and shape, and overall health will help to determine the best choice of implant style, shape, and size. The third option, the transaxillary incision, is a more recent refinement in breast augmentation surgery. This approach effectively hides any scarring in a very inconspicuous location, and there is no incision on the breast at all!

That also means, however, that the implants are being inserted without direct incisions on the breasts, so the doctor performing the breast augmentation must be well trained and experienced at transaxillary incisions. I have successfully performed this procedure on more than 2,000 patients.

As with the other potential incision sites, I must determine whether a transaxillary incision is the best choice for each patient who seeks breast enlargement. While an underarm incision is ideal for some, individual factors that can impact safety, recovery time, and the final look of a breast augmentation procedure must be taken into account. The final surgical plan is individualized for each and every patient.

Communication is vital in every surgical situation, so be sure to speak up about what you're hoping for during your breast augmentation consultation, including your thoughts about incision location. The more information I have about you, the better I'll be able to work toward the results you're hoping for.

Breast Implant Style

The two main implant types for breast augmentation are those that contain saline solution and those that contain silicone gel. Each implant type has certain benefits and limitations. I tell my Toronto breast implant patients that if there were 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 you may think. I commonly advise my Toronto breast augmentation 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 breast implant size and style is determined during our pre operative consultation.

Implant Positioning in Breast Augmentation

Breast implants may be surgically placed behind the breast tissue only, under the pectoralis (chest) muscle, or under just the connective tissue layer covering the pectoralis muscle called the muscle fascia. Each of these locations can give excellent cosmetic results, but a single approach is not suitable for every breast augmentation patient. What is perfect for one patient may not be at all appropriate for another. My role as a consultant is to guide patients and recommend the best alternatives to obtain the best possible results.


Pros and Cons of Sub-Glandular Breast Augmentation

Placing the breast implant directly behind the breast (ie. behind the breast "gland") where it lies in front of the pectoralis (chest) muscle is the most traditional and still probably the most commonly used technique for breast augmentation. It is less invasive because the muscle layers are not surgically involved and some patients feel that they experience a quicker recovery than when the implant is placed in front of the chest muscle. If a woman has a fairly substantial thickness of natural breast tissue to conceal the implant, a sub-glandular approach can give excellent results. However, with bigger implants and thinner natural breast tissues, the risk of seeing or feeling the texture of the implant increases. In such patients, the unnatural round ball look can result. For women with thin breast tissues, the sub-glandular approach may not be ideal.

Pros and Cons of Sub-Muscular Breast Augmentation

Sub-muscular implant placement involves placing the breast implant behind the pectoral (chest) muscle and against the chest wall. The pectoralis muscle helps to soften the upper contour of the breast, giving it a more gradual slope and avoiding the "beach ball" appearance that can sometimes occur with poor surgical planning by other breast augmentation doctors. The muscle layer typically covers the upper half of the implant. The lower boundary of the pectoralis muscle does not extend to the lower curvature of the breast so "sub-muscular" implants are really only partially under the muscle.

Placing an implant under the muscle not only improves the contour of the upper half of the breast, but it also supports the implant and helps to hide the edges of the implant so the transition beyond the breast itself is smoother. There is a slightly lower risk of developing capsular contracture (or scar tissue) when the implant is placed beneath the muscle. Depending upon the implant style, most breast augmentation surgical approaches can be used for sub-muscular placement.

This implant position is particularly good for women who are seeking breast augmentation and who have thin breast tissue and skin damage such as stretch marks from pregnancy. The extra thickness that the muscle layer provides helps to achieve a smooth, natural shape.

Sometimes, if the pectoralis muscle is strong, there is some distortion of the breast when a patient flexes her chest muscles after her breast augmentation. The tension of the muscle against the implant is not painful and it does not affect arm strength, but the appearance can be bothersome to some patients. If this is a concern, then changing the implant position to lie over the muscle is a consideration. This is not a common request in the world of Toronto breast augmentation, even among fitness enthusiasts, but it's always good to know that there are other options to consider for the best possible outcome.

Pros and Cons of Sub-Fascial Breast Augmentation

The newest approach to implant placement in breast augmentation involves creating a space between the thin but strong connective tissue layer (fascia) that covers the front of the chest muscle but lies behind the breast tissue. Having the implant in this position gives a smoother contour, especially at the edges of the breast, but does not create muscle tension when flexing the chest muscles.

It is a more lengthy breast augmentation procedure, so the anesthetic time can be longer, but for thin, athletic women who like to do a lot of upper body resistance training, this can be a good choice. The incision location to create this implant location is placed just beneath the areola. Because of the requirements of the surgical dissection, an underarm incision cannot be used for sub-fascial implant placement.

Which Implant Location is Best?

Each implant location is a good one for the Toronto breast augmentation right patient. This decision is part of an individualized approach that I take with my patients during the consultation visit. We address all the pros and cons and establish the best choice of implant size, style and location to achieve the best possible outcome.

Breast Augmentation Recovery

I advise my Toronto breast augmentation 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 people can return to their usual activity level three weeks after surgery. Learn more about recovering from a breast augmentation procedure.

Toronto Breast Augmentation Follow Up

Post operative visits are scheduled one week after breast implant surgery and again after 4 to 6 weeks. Most breast augmentation 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 person.

Implant Replacement

I am commonly asked whether implants need to routinely be replaced five or 10 years after a woman's breast augmentation surgery. The answer is no! A breast implant does 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 Toronto breast augmentation 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 you may consider a change in breast size. This is a personal decision. If you should wish to explore this possibility, I am available to discuss it at any time.

Dr. Carman welcomes any questions you may have about his Toronto breast augmentation technique. For more information about what it could do for you, call (416) 322-7108 or request a private consultation.