Asymmetry; Lift + 425cc Saline augmentation - Toronto, ON

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I am a 24 year old student, no children or weight...

I am a 24 year old student, no children or weight fluctuations, who has been saving for this for years. I've been the same size and shape since I was 14 (34C), and the asymmetry and large areola size have been extremely upsetting for me. I'm supposed to be in the prime of my life, and I've never had a chest I could be even somewhat okay with. I don't mind the look of my breasts in a bra, but when I get undressed to take a shower, I don't want to run past the mirror to make sure I can't see myself naked anymore. It has definitely hindered me in relationships and also personal life satisfaction, so it's time to do something about it.

After consulting with 3 surgeons I decided to book my surgery with Dr. Jugenburg in the end of July. The actual size of my breasts is fine for me, but if I only got a lift, I would still be asymmetrical as my right breast (the pictures are taken reversely) is approximately 75cc's larger than the left. My breasts are also very bottom-heavy, so I was told implants will also give me upper pole roundness/shape (thoughts anyone?) Two of the surgeons I consulted with recommended a reduction in the larger R breast before the lift/implants, so I will be getting a R breast reduction (to match the left), a lollipop incision lift on both breasts, and saline implants on both breasts.

I went back and forth on saline vs. silicone, and decided on saline. I was told that since I have a lot of breast tissue/thick skin already, I won't be able to feel the implants anyway by touch and rippling shouldn't show through as much. Cost was a big factor for me as well. But overall I just remind myself that the closest to breast symmetry is my main goal, and saline allows him to try to match them as much as possible in the operating room. Picking 2 different sized implants if I wanted silicone scares the crap out of me. I hope I made the right decision!

I am terrified of doing a lift and augmentation at the same time. I understand they are two opposing forces, and I've seen some horror stories of healing after doing both at the same time. If I had the money and time to do them separately, I most certainly would, but it is not an option for me. If anyone has undergone both procedures together, any words of wisdom would be appreciated!

Also, I have NO idea what size to pick for the implants. I'm actually fond of naturally small, perky boobs, but I've never had those and I think they'd look odd on my shape. So I'm opting for going bigger, hoping to get some of that upper-pole roundness (thoughts?). Without the sag I don't mind the size of my R breast, but as it will be reduced I need to try to guess what size is right to make me just a little bigger than my natural R breast size. I know the lift will also affect the shape/size as well, and I know they look smaller once they're in. For a long time I was just going to get a R reduction and lift, but I would still dislike the shape of my breast so for the extra couple thousand dollars I think implants are worth it in hopes of rounder shape. But I also need to consider that the bigger the implant, the more it'll affect my lift/healing/areola which is my primary concern so I'm tempted to go smaller... I have went to 2 sizing appointments at different clinics, and I'm all over the place. I'm thinking somewhere between 300-350cc moderate to moderate-high profile, but I don't know what will give me the closest to the wish pic? I honestly have no clue and would appreciate any input! (I have my final sizing appointment 2 weeks before my surgery, so I'll need to decide by then!)

I'll update after that appointment, but overall I'm super nervous. I'm not familiar with anyone who's had cosmetic surgery before, and the internet is only so helpful. Any insight is appreciated :)

Sizing appointment

Went for another sizing appointment, decided on 425cc (ish) high profile in both breasts since the R breast will be reduced to match the size of the L breast. Still happy with the saline decision so he can have most control over trying to reduce asymmetry in the OR. I'm nervous they may look too big or protrude too far, but I have wide shoulders and hips so I think it'll balance out? But I'm only 5'2. Also the base of the HP at that size is actually quite wide and seems to fit my frame, so fingers crossed!

Operation day/Day 1

I'm so grateful I got an early appointment (arrival 7:30, surgery 9:30am). The hotel did not have a room available until 2pm - have the person staying with you BE PERSISTENT! I managed to somehow get a room before the person who's surgery was before mine, and I'm sure it had something to do with the fact that the person I was staying with sat in the lobby for 6 hours watching them, and checked in all the time to ask about a room.

If any of you are looking for a play-by-play, here's how pre-op went:
-Kim double checks your medical information, takes weight and blood pressure, etc. She checked in on me and brought me a magazine since I had to wait alone for an hour which was nice; you are in good hands with this team.
-Dr. J re-takes two sets of photos, measurements, and draws his references on you
-I asked him if I could re-show him my wish pics just to remind him prior to surgery, and he said this is helpful, so I'd recommend having them on your phone or on your body when you go into pre-op. I told him I trusted him to pick a size proportionate to me in the OR, and reminded him that the lift and areola size were most important to me rather than the sizing, so any incisions he had to make to help me reach my main goals were fine.
-Met with the anesthesiologist, asked questions
-Went into the OR, met the nurses/assistant surgeon; strapped down, put on a drip, and sedated
-Procedure took approximately 2.5 hours (from what I remember), I was in recovery for about 45 minutes. They gave me percs and I threw them up immediately even though I hadn't been feeling nautious. They told me to start my antibiotics the next day instead of immediately back in the room because they didn't want me to throw them up. I threw up again once I got back into the hotel room; for the consideration of everyone, make sure to put the plastic laundry bag in the closet in the garbage can as they're not lined :)

Wheeled into the hotel room, luckily got 2 double beds (some people had to take a single king due to availability). I was pretty awake for a few hours after, no real pain (still coming off the drip), had some family visit me from out of town. It's amazing how everything changes within a few hours; by the evening the soreness came on, and I couldn't close the bathroom door on my own. I watched a few hours of TV and slept. I kept on top of my pain meds because it's easier to stay with them than to feel too much pain and try to catch up to it. I needed help from sitting to standing (have your supporter put their hand between your shoulderblades and push you up, not pull on your arms), and I couldn't close the bathroom door.

For Canadians out there, I wanted the donut-shaped ice packs for my breasts but surgery websites were charging $50 for them. All the reviews I read on this site were American and it seems like there's lots of places there that offered them, so I checked the same stores here. I checked Shoppers, Target, and Babies R Us pre-op and couldn't find anything - but then the Superstore! Seriously, go to the grocery store, they had a kit for $13.99 that has breast-shaped heat/cool packs and fabric casings so it doesn't stick to the skin, a bunch of underboob absorbant gauze pads, and then of course a journal and such intended for nursing mothers. There's no real research that shows icing does anything, but it's more of a comfort thing; my breasts are warm to the touch and I look forward to icing. I drank some ginger ale and ate a plain pretzel bagel which I kept down just fine, I'd recommend having crackers or pretzels or something easy in the room you can eat with your meds even if you don't feel that hungry.

I'm very sore but not really in pain, if that makes sense. My boobs are so swollen and warm but I really do love them so far! I'm so anxious to see the scars and size of my areola, but bandages can't come off until next week. I'm also excited for them to get softer and drop, because I was nervous that I have a wide sternum and I don't want them to look like two perfect circular balloons stuck to my chest and fake which they kinda do right now lol. But I know so much can change over the next 6 months. Of course one looks bigger than the other, they're high up and kind of square shaped, but seeing all the reviews and pics here helped me to expect all this :) That's why I wanted to pay it forward with my own, I hope this helps someone a little bit!

Day 3

The pain really set in last night and today. The first two days will deceive you and you'll think you're on the upswing, but give time for it to get worse before it gets better! My left breast has been burning on the side which I understand is normal, but it got to an unbearable point and I like to think I have a high pain tolerance. Any fabric, ice, air, anything touching it was perceived as heat in my body and it was extremely painful. I called the clinic and took an extra percocet. Though my right breast had 'more' work done to it (it was reduced, has more incisions from the lift, plus the implant), the left one is causing all of the pain. The left one has bruising all along the side of the breast, the right one is bruising underneath, some blood through the bandages but just spotting. Healing from breast surgery is certainly an interesting thing. Anyway I am excited for my appointment Tuesday to find out what they actually did during surgery (what incisions were necessary for the lift on each, and also cc's in each).

Day 8

I'm in the "don't panic, don't panic" stage. I've read so many reviews that I know I can't make any judgements until 6 months, but it's so hard not to! So I'm not going to allow myself to rant on here; I just need to let it go and be patient. My left breast is a lot bigger (which is so odd and scary for me, considering my asymmetry made my RIGHT breast bigger my whole life) and they're sitting differently, but that's to be expected at one week.

When I had spoken with him pre-op he had told me "matching scars" (lollipop) and I didn't want to go bigger than 425cc. I asked at my follow-up what happened and it turns out I have a lollipop on the right with 425ccs and and periareolar on the left with 480ccs (?!). I know people say there's no real difference between 50-100ccs, but there is obviously no truth to that logically; there was approximately 75-100ccs asymmetry between my breasts originally which is what made me want to get surgery in the first place! So like I said, I'm trying not to panic; trusting his judgement is part of the process... I'm really looking forward to them shrinking and settling.

I've had a rough few days; I was experiencing a lot of pain and burning, nausea, and vomiting, so I haven't been eating much which made things worse. I don't know why I was so surprised by that reaction, but I think things are looking up. I called Kim for advice when the pain was the worst a few days ago, and then called her again to ask for a couple more lorazepam since I think anxiety was playing a factor; one thing I really appreciated was that she didn't question my pain or need of the medicine, which when you're in that state is so helpful. Turns out the lorazepam wasn't effective after my first pill but I'm grateful I tried it anyway.

I went to my post-op yesterday and begged the nurse to take off the tape; I was having skin integrity issues, and have little blood blisters under the skin from where the tape was pulling so hard from the swelling. It was causing a lot of burning and pain that the double percocets and lorazepam weren't helping at all. Since its removal I actually slept for the solid 3 hours between pills for the first time! I don't want to compromise the healing, but I'll keep on top of my massages and the surgical bra never comes off so it should be okay. I'm to start gentle "massages" to move the implants around (not the skin). I nearly saw stars when he pushed them together to show me what to do - ouch! But it'll be worth it in the long run so I popped a T3 and have been very very slowly and gently doing what he told me to do, I don't want to irritate the incisions. Finished antibiotics today.

So my boobs are very large, sore, hard, and distal (outwards bumping into my arms), but I'm sure these things will improve with massaging and time! Optimism never hurts; I'm taking pictures of everything along the way so I can do comparisons down the line, the changes are pretty fascinating.

Pre pic

Wore 34C as best compromise bra (left breast was likely a B, right breast a full C that spilled out)

Day 16

I'm sleeping much better now. The surgical bra they provided did not fit me properly (design flaws of the bra itself; straps too big on me, rib elastic too right causing pain and skin issues), and got permission to switch to a sports bra that actually provides some shoulder support and doesn't cut into my skin. The response I received was great, Kim replied to me quickly about it.

They're softening with massage now, but still very hard. My right breast is still numb on the side that touches my arm, my left I have full feeling in. But overall I think things are going well! When I get caught up in little things I don't like about how they look right now I remind myself to be patient, and I look back at my post op pics... Then I love my boobs :) Follow up appointment next week, anxious to see the scars!

1 month

Still hard and sore when I stand up/move around. Though I have a few open stitches, I'm impressed with the way the other sutures are healing. I really hope they start to move inward/shrink but I'm doubtful - all shirts I've tried on pull awkwardly across the chest since they're so wide out, nothing fits right and it's making me really nervous. It's exactly what I didn't want to happen, why I never would have cleared 500ccs if I had been conscious (400 was supposed to be my absolute max). I've kind of strategically picked pictures for here that don't show the size difference, but I'm questioning why he put 75ccs more in one breast when the point of the reduction was so he could put approximately the same ccs in both? I was 75-100ccs asymmetric in my right breast pre-op, now my left breast appears a lot larger than the right and i find out he put 75ccs more into the left breast. That would make sense, if I didn't have the reduction... Now I'm asymmetric in size the opposite way. I'll be sure to ask the reasoning and justification behind it, after 6 months so I don't jump the gun, apparently these things can change. So I'm trying to be patient, it's only been a month but I'm certainly hoping they change. They look fine (albeit different sizes) if I'm nude and bring my arms in to push them inwards, but if I stand proper posture with my shoulders back or put a shirt or bathing suit top on they look really wide, fake, and large. Are they better than pre-op naked? Absolutely! Is it worth it if I look awful in clothes, how most people see me? I don't know. Fingers crossed for more healing!

Tape removal 1 month

I like the way they look more in person than in photos oddly enough. I wish the larger areola was a lot smaller but it is what it is for now. I can't say they're worse than pre-op! Can't wait to see how they continue to heal

Team review

I meant to add this to my last post. I had some rejected stitches that were causing pus to seep through the tape; after calling Kim, sending pictures via email and going in twice to have some stitches removed it seems they've calmed down. I'm now taking the tape off daily, cleaning and putting poly on the 2-3 little openings I have, and re-taping. No more weekly appointments, I'll be going back in 2 weeks though.

I feel like this is where Kim and the team deserve recognition. Though I've certainly had administrative issues in the past, once the surgery was completed I have had no issues at all. They have been far more prompt with my follow up appointments, always squeezing me in when 'emergencies' popped up, and always responding to emails and phone calls quickly along the way. I can't praise Kim enough; between quickly faxing a new prescription for me when I was at my worst, reassuring me when some of the stitches opened on a late Sunday night, and being supportive and prompt when I had issues with the surgical bra, I have really felt taken care of and respected through the recovery process. I think the team puts most of their time and energy into actual patients more so than at consultations (who knows how serious some people are for surgery? I don't blame them) so I can certainly see how that may explain the drastic shift in service (not like anyone was ever rude or unhelpful at any point in the process though!). Anyway I did want to send out kudos to the team, because when that panic sets in a little bit and you're wondering if things are going wrong, Kim knows exactly what to say to calm those anxieties and not make you feel bad for needing help!

What I've learned the most from this is to trust your gut. The surgical bra not fitting QUITE right, the little bits of pus that didn't seem like a big deal resulting in open stitches, the tape hurting more than what seemed fair (causing skin tears, burning, and weeks of sleeplessness), all of those things I felt like I was being a big baby about and were just part of the process. In fact, in each of those instances I waited days if not weeks before asking for their professional opinion, which means I was in pain a lot longer than I needed to be. So don't let your ego get in the way like I did, trust your gut and ask for a second opinion (not to put down any of the other RNs, but it seems like Kim has seen it all and is confident in her recommendations so I'd recommend speaking with her directly).

2 months

So disappointed in how wide they are, I can't fit into any tops without it stretching unnaturally and pulling. If I slouch and push my arms against them they look fine, but when I stand normally or move (see reaching pic) you can see they stick out width wise a couple of inches and it's awful. Areola also stretched quite large, and I was so adamant on small areola like wish pic 1. I'll see about revisions at 6 months, because tops are not fitting me due to the sheer width. I went from a D cup to DD, so I know how large boobs fit, and this is an unnatural width thing not a size thing. Is it because of the pocket he made? Anyway, I am very impressed with the scar healing and yes they are incredibly more symmetrical than pre op. But I have to admit how upset I am about the width and areola size. I've been wearing a pushup and pushing them in nonstop since cleared for it in hopes of bringing them in but I feel like it's too late...

Revision - Sept 2015

Dr. J kept following up with me so we could wait out the healing process, and then see what we could do from there. I'm very impressed that he stuck to his word when I first consulted with him - He'd said if there were any issues after the surgery, he would make sure I was happy, and he did.

We scheduled revision surgery in Sept 2015 to reduce areola size, to try to bring them up and closer together, and to change the implant to a textured one and also smaller. I'm SO happy he changed the implant, I feel like he went above and beyond to make sure the results would be more along what I expected this time. I definitely prefer the smaller size, and plan on going even a little smaller when these implants wear out their life span in a few years. Apparently the textured one is better for my needs as well.

The one thing I have to say I was disappointed about was that when I woke up, I was surprised to find out I had drains put in. This wasn't something we'd discussed, so I can only imagine it was something he decided to do mid-way through surgery to improve the healing process. At the end of the day I trust his professional opinion and I like to think if he knew he was going to do it beforehand he would have told me, so I'm sure it was an impromptu decision. And at the end of the day it worked out, he made the right decision!

As annoying as the drains were, they were only in for a week and the healing process was TOTALLY different from the first time! I had no bruising, very little swelling - it was fantastic! I was up and moving so much quicker than the first time around (whether that's because of the drains or because it was round two, who knows), and I was back to work in a week.

Anyway, I'm still healing but will post pictures when all is said and done. I'm giving major kudos to Dr. J for making sure I was getting as close to what I hoped for, even if the first results weren't "terrible" by any means. I'm sure there's lots of people who would have been happy with what I had after the first surgery, but it just wasn't what I expected or wanted. Here's hoping these results last a little longer than the first time around, but at least I know he tried his best!

It seems like a small thing, but the fact that he showed me full attention when I was asking questions was why I chose him. I am now very confident in my choice, especially after meeting with 2 other surgeons. He also didn't try to convince me that there was nothing wrong with my left breast as another surgeon had done, so I didn't feel judged. It also seems like he is competent with breast lift techniques (vertical sling) and as this is my main concern, it appealed to me. I've had some administrative issues with the clinic that are concerning to me (no one replying to e-mails, when I've left messages or canceled appointments they have not called back or canceled as per my message, incorrect cost quotes, them being 1-3 hours late for EVERY appointment I've had so far), so it hasn't been the most professional experience on that side of things. Also at my last appointment Dr. J noticed that they had ordered silicone implants for me when I had never considered silicone due to cost, so I'm extremely lucky I had made another appointment just before surgery and he double-checked or I would have had to cancel my surgery the day of as I cannot postpone my time off. Ultimately everything worked out in the end, and I found it most important to trust the surgeon than anyone else in the office at any clinic. The rest of Dr.J's office is extremely kind and quick to rectify problems (Nora has been fantastic at replying promptly to e-mails), so they do have a great team who will make you feel comfortable.

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