2019 BRA Day Toronto Event

Throughout the course of my practice, I have seen many women who have undergone surgery to treat breast cancer and were unaware that there were opportunities available to them to reconstruct their breast. As a result, in 2011, I founded Breast Reconstruction Awareness Day (BRA Day). The vision and goals for this event were quite simple: provide education, access and awareness to women and their families regarding options for post mastectomy breast reconstruction.

In the inaugural year, we hosted 12 events across Canada. A logo was created with a variation of the pink ribbon that included a second internal loop. This ribbon, designed by my sister Lisa who was a cancer survivor, represented longevity and the concept that breast reconstruction plays a part in “closing the loop” on breast cancer.

With our initial success in Canada, BRA Day has now been adopted in over 30 countries around the world. It is estimated that BRA Day events have reached over 1 million participants worldwide.

The flagship Toronto event will take place this year at The Toronto Botanical Garden on Wednesday, October 16 from 6:30-10 pm. Attendance is free, but we ask you to register online in order for us to plan for number of attendees.

If you are interested in learning about options for breast reconstruction from local experts, please visit this link for more information:
https://www.eventbrite.ca/e/bra-day -toronto-flagship-2019-tickets-60750932675

Event Program

Doors open at 6:30 pm. Presentations start promptly at 7 pm.

  • Presentations from breast reconstruction surgeons and women who have had reconstruction and gone through this journey.
  • Show & Tell Lounge where women can see the real-life results of breast reconstruction and speak with women who have been through it.
  • Education Tables hosted by plastic surgeons who can answer your questions.
  • Exhibit Area with products and services to help women who have been affected by breast cancer
  • Snacks and Refreshments provided for all attendees

Presentation Schedule

Dr. Mitchell Brown – BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) What you need to know.

Dr. John Semple – Implant Reconstruction – Pre-pectoral or under the muscle.

Dr. Joan Lipa – Managing the other breast.

Dr. Toni Zhong – Options for tissue (flap) reconstruction.

Patient Stories


Education Tables

One-step direct to implant – Dr. John Semple, Women’s College Hospital
Reconstruction using implants – Dr. Mary-Helen Mahoney, North York General Hospital
Preventative (prophylactic) mastectomy – Dr. Mitchell Brown, Women’s College Hospital
Reconstruction using your own tissue – Dr. Joan Lipa, Sunnybrook Health Sciences Centre
Delayed reconstruction and radiation – Dr. Toni Zhong, University Health Network
Reconstruction options after lumpectomy – Dr. Melinda Musgrave, St. Michael’s Hospital
Post Surgery Recovery and Physiotherapy – Lindsay Davey & Lisa Chau, Registered Phyiotherapists
Hereditary Breast and Ovarian Cancer – Aletta Poll, Women’s College Hospital


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ASPS Meeting and 5K Run in San Diego

Dr. Brown had a busy visit in San Diego at the American Society of Plastic Surgeons annual meeting. He was invited to give lectures on “Tips for avoiding complications in implant breast reconstruction” and “Long-term outcomes in breast augmentation”.

Dr. Brown also participated in the Close the Loop 5K run.

“This event, along with the annual Breast Reconstruction Awareness Day events held around the world every October, have evolved from 2011 when I initially founded BRA Day here in Canada.

I was proud to wear the “close the loop” ribbon that was creatively designed by my late sister Lisa!” – Dr. Mitchell Brown

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Dr. Brown at the São Paulo Breast Symposium

Dr. Brown attended the São Paulo Breast Symposium in Brazil, where he gave talks on “Managing complications in breast implant surgery”, “Fat grafting to the breast”, “Shaping the breast with combined implants and lifting”, and participated on an international panel on the current status of ALCL.

Dr. Mitchell Brown with Dr. Ruth Graf from Brazil


Faculty dinner with Chairman Dr. Sampaio Goes of Brazil, Dr. Roy DeVita of Italy, Dr. Yoav Barnea of Israel, Dr. Ruth Graf of Brazil, Dr. Horacio Mayer of Argentina

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Transition Related Surgery – Trans Breast Augmentation

In January, Dr Brown had the pleasure of attending the 35th Annual Atlanta Breast Surgery Symposium, held in Buckhead, Georgia. This is North America’s largest annual meeting focusing on both aesthetic and reconstructive breast surgery.

Dr Brown was one of the invited international faculty and gave several presentations that included topics on breast implant selection, the use of fat in aesthetic breast surgery and, developing a successful transgender breast program.

One of the most unique aspects of this meeting is the live surgery component, in which surgeons are invited to perform surgery that is broadcast in to the auditorium to the symposium participants. This year, Dr Brown was asked to perform a trans gender breast augmentation on a trans female patient who came to Atlanta with Dr Brown from the TRS (transition related surgery) Program in Toronto. The surgery was very successful, but most impactful, our wonderful patient was able to share the important moments in her transition story with the surgeons in attendance and explain some of the unique challenges that exist during the journey.

If you are a trans female thinking about breast augmentation, here are some things to consider:

  1. The rib cage and breasts of a trans woman are usually wider than that of a cis woman of similar height and weight. To create an ideal breast shape and to have that breast fit on the chest wall means that the surgeon must take multiple, precise measurements, and select from a wide range of implants. While this “dimensional planning” is important in all breast augmentations, it is particularly important in the trans female patient.
  2. A trans woman’s nipples are usually situated more to the outside of the breast mound. This affects where the implant should be placed so that the nipple ends up relatively centered  on the breast mound. 
  3. A trans woman’s nipples are also usually situated low on the breast mound. The ideal breast has about 55% of the breast volume below the plane of the nipple and 45% above. While sometimes the implant needs to be placed below the natural crease of the breast in a cisgender woman to achieve that balance, it is necessary far more often in the transgender patient.  That position is critical to the result and must be planned exactly. Failure to properly determine where to situate the bottom of the breast and to keep the implant in that position are the two factors that account for most of the suboptimal results in transgender breast augmentation.
  4. Trans patients usually have thicker and tighter skin. Years of fluctuating breast size from monthly periods, weight changes, gravity, genetically thinner skin, and of course the substantial stretch with pregnancy can all thin skin further.  This tighter skin often results in breasts that are somewhat fuller and perkier, especially in the upper portion of the breast.
  5. The pectoralis major muscle is often (but not always) thicker in a trans woman. Rarely is it thick enough to create a problem; it just requires a greater level of attention to anesthetic and technical considerations during surgery. There may be a greater tendency for the muscle to push the implants slightly down and out over time, though this also can be an issue for cisgender patients.

For more information about transition related surgery please visit Transition-Related Procedures.

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Update on Breast Implant Safety and ALCL – December 2018

Dr. Mitchell Brown and Dr. Ron Somogyi, Toronto Plastic Surgery

Recently, there has been a surge in media attention regarding implantable medical devices. Coverage has focussed on regulatory agencies, the process for device approval, device safety as well as the importance of collecting accurate post-approval data on adverse events and outcomes. Many devices were discussed including pacemakers, hip and knee implants, cardiac stents, pelvic meshes as well as breast implants. One area of discussion has centered around breast implants and a possible link to a type of lymphoma called ALCL.

A great deal of research has been published regarding breast implants and cancer. We can say quite conclusively that breast implants do not cause breast cancer. For the past several years there have been published cases of women diagnosed with a rare type of lymphoma in the fluid or tissue surrounding a breast implant. This entity has been named BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma). ALCL itself is a cancer of the immune system and more commonly occurs in people who have never undergone breast implant surgery. Estimated rates of ALCL is approximately 1 in 10,000 people in the general population.

At present, there are approximately 600 cases of  BIA-ALCL reported worldwide and it is estimated that more than 10 million women have undergone breast implant surgery. To date, all cases of BIA-ALCL have been in association with breast implants that have a textured surface. The current lifetime risk with a textured implant is estimated to be 1:3800 – 1:30000. There is no risk of developing BIA-ALCL with smooth surfaced implants. It is important to know that all implants used at Toronto Plastic Surgery are fully approved by Health Canada as well as the FDA in the United States.

In the majority of reported cases, the initial presenting symptom is a distinct swelling of the affected breast. You would notice this as a substantial size change on the affected side. The breast might feel tense and firm. Usually the swelling comes on fairly rapidly, over several days or weeks, not over months or years. Typically, this occurs on one side only, but in exceptional cases, it can occur in both breasts.

If a person with breast implants notices any of these changes or symptoms, the appropriate action is to contact their surgeon for a follow-up visit. There are some very simple investigations that can be done to determine whether or not a person has BIA- ALCL. When detected early, it is very treatable.

It is important for you to know that both Dr. Somogyi and I have collectively been involved with the use of breast implants for over thirty years. We have followed our patients carefully and have published our experience on the safe use of breast implants and breast implant outcomes. We both attend medical conferences regularly and often participate as educators at these events. We want you to know that we stay up to date on the latest literature surrounding breast implants and breast implant safety.

In addition, it has always been our practice to encourage patients with any breast implant to return for regular follow up at least every 2-3 years. This is important so that we may inform you about new information or changes regarding breast implant technology and safety. Occasional assessment is recommended.

As new information becomes available regarding BIA-ALCL and breast implant safety, we will do our best to keep you informed. If you have any questions regarding breast implant surgery at Toronto Plastic Surgery, please feel free to contact us directly.

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