Managing breast augmentation and its side effects

There are those who are ask questions such as “How do you take care of capsular contracture in this clinic?” when I talk to the patients.

I have felt that many patients are unclear about what the hospital can do if the patient suffers side effects or other complications after breast augmentation as they gather information on the hospital.

Today, I would like to share about a complication that patients are most concerned about, capsular contracture.

1. Can it be avoided? Why does it happen?
Let’s first look into this and then carry on.
Capsular contracture is something that the doctors are still not biochemically clear about to this day.

It happens to some, and it does not to others. It gets formed to some within 6 months and disappears. One might not have any problem for 5 years but then suddenly it gets formed. What is the reason for this? We still do not have an answer.
The incidence rate, referred to a publishment and FDA report, is found to be at less than 20% but Tebetts and others have stated that it is less than 1%. The fact is that the incidence rate of capsular contracture is dramatically low at present than that in the past.

In the past, there were much bleeding during breast augmentation, and it was done above the pectoralis muscle. There was no method or concept such as dual plane. Also, not many textured implants were used. The doctors may not know the cause of the capsular contracture, but they have built up knowledge on how one could avoid it, therefore, limiting its incidence rate. However, we cannot make the incidence rate 0% with the usage of silicone implants. It can be formed although you take much care of your body.

One common cause that most doctors agree on is that the capsular contracture gets formed with infection in the part of the body that we cannot see and the inflammation that is caused. When substance such as an implant goes into the body, it gets polluted with air outside. Such pollutant reacts with the body and the matabolism system causes a capsule that is strong and hard. This capsule which makes the breast hard is called capsular contracture.

The most effective method in preventing the capsular contracture would then be to prevent pollution as much as possible. There are techniques for this, and these techniques are shared in my other posts.

2. Who is responsible for capsular contracture?
Unwanted happening after a surger is called “side effects” or “complications”.
One would argues if complications such as capsular contracture after breast augmentation is medically responsible or if it is something that happens naturally. It is difficult to say that this is something that is caused through medical reasonsing based on the sources and experiments conducted so far. This means that it is not caused due to the surgeons’s act, misdirection, or any other related actions.

Then, can the patient not have the hospital responsible for capsular contracture?
This is not true either because a doctor has a responsibility to do the best he/she can to achieve best result for the patient.



Although, there is no medical fault, the doctor needs to be somewhat responsible for the result. Therefore, he/she has the responsibility to make things right. Therefore, is the capsular contracture is formed, there are invasive methods such as correction, or non-invasive methods such as massaging that can be conducted. We, at our clinic, provide non-invasive methods for free of charge. If correction is necessary, it is free also. However, we charge for anesthesia, medication, and other material costs.



The gel within the implant gets dispersed and at times may feel that it gets folded
If there is malpractice or medical fault such as leaving the gauze near the implant, not knowing about it, and causing inflammation, I think that the hospital cannot charge the patient for breast augmentation. If the hospital does not react to such problem quickly enough leading to worsening of the inflammation and implant collapse, then this is a medical accident and the hospital must be reliable for compensation as well.
However, this is not the case for capsular contracture. That is the solution to it is vague and the hospital cannot give a clear answer.

3. Does correction help recover from capsular contracture?



When corrrecting a severe case of capsular contracture, we open up the epithelium. A complete removal of the epitheium might be necessary at times. The implant can be replaced as well.

There are patients who ask if the recurrence of capsular contracture can be completely avoided. The recurrence is avoided 90% of the times after the epithelium is opened up.
There are many who search for “capsular contracture” on the internet and think that it is the scariest complication. From my much experience, I believer that it is not the worst complication that one can suffer. Also, your interview with the doctor is very important before the surgery.

Therefore, you do not need to worry or be scared off capsular contracture. This applies to those who are waiting for the breast augmentation and those who already have got one. The assumptions from the internets are much different from statistically known facts.

I hope that today’s content has helped you. Have a great weekend. Thank you very much.

How large does the breasts become after the breast augmentation?

Q. I will be using cohesive gel 275cc (or 300cc) and my breasts are currently AA cup. How will the size change?

Let’s look at how we measure the cup size before we answer the question above. When the difference between the upper breasts circumference and the lower breasts circumference is about 12.5cm, we call this B cup. The cup size increases for every 2.5cm.



Although the top bust is big, visibly big, but if the under bust is small, your cup size can be A or AA.

If your top bust is not so big, but the under bust is very small, then your cup size could be G or F.

So the answer for the question above is:

Breast cannot be measures by the cup size that determines the size of your underwear, and you shouldn’t measure in such a way either. Also one cannot estimate how much the upper bust gets bigger with the implant.



Implant size and volume; Volume differs from one person to another although they use the same sized implants, therefore one should rely on the experience and the judgement of the surgeon (Cohesive gel 250cc, 275cc, 300cc implants)

1)    When the implant is put it, it get pushed down by the skin, muscle, fat, etc therefore the original shape of the implant is not maintained. So if you measure the upper bust size, it will not be aligning with the size of the implant.

2)    Our body has liquidity and flexibility, therefore if a substance gets inside the body, the substance will press down on our tissue. The bigger the implant is, more it will press down on the skin, therefore, it is difficult to estimate the breast size. The degree of pressing down differs from one person to another.

3)    I tried to make an formula that will measure the size differences before and after the surgery by looking at the chest as a oval. One needs to calculate the indefinite integral to get the circumference of the oval but this is complicating so I came up with a simpler version as below.




L is the circumference of the oval. A is the major axis and B is the length of the short axis.
You can see the change in the breast size before and after the surgery by looking at the image below.




The problem here is that one cannot estimate the ‘b’ unit. One cannot know what level of the implant would come across the line that passes through the two nipples and also one cannot know how much the implant would press on the tissue. So we cannot apply this equation before the surgery.

4)    There are many errors and variables as above, so we cannot know how much cc of implant would lead to a particular cup size (how much the circumference of the breast increases).

5)    However, many people ask this question. So I would like to use “volume” to share how large the breasts become.
If you use the implant, the cup size increases, but the volume does not only depend on the height, but it also considers the width. This means that the volume may not increase as much as the cup size.
Also, the purpose of the breast augmentation is not to increase the cup size, but it is to have more volume.

I tell my patients how much volume increase there is after the breast augmentation and this comes from my experience.

Your clothes have sizes such as 44 / 55 / 66. 44 is extra small, 55 is small, and 66 is medium size. The implants can be measured by volume is such a way.



This model wears 55 size. One can say that that she is using a medium sized implant.


Small size (~235cc) ;

Polytech TMS 220cc, Natrelle Midrange 222cc, and Mentor Moderate plus 225cc are in this group. The width of the implant is about 9~11cm. We recommend this when the diameter of the breast is 10.5cm.

Although you use a small sized implant, a person with A cup can become a C cup. The high profile implant is 235cc and the height is about 4.4cm, but the volume does not increase as much.

Small size implant leads to ‘appropriate big size’.

Medium size (240~265cc) ;

Polytech TMS 255cc, Natrelle Midrange 253cc, Mentor Moderate plus 250cc are in this group. The width is about 10.5~12.3cm. These implants can be used if the diameter of the breast is about 11cm.
Medium size implant leads to ‘relatively large’ size.

High Medium size (270~285cc) ;

Polytech TMS 285cc, Natrelle Midrange 272cc, and Mentor 275cc are in this group. The width of the implant is about 10.8~12.5cm. These implants can be used when the diameter is about 11.5cm. High medium leads to ‘large breast’.

How large the original breasts are, how tight the tissue is, and how high the implant are the determinants on whether your breasts become B cup or C cup.

Large size (290~315cc) ;

Polytech TMS 315, Natrelle Midrange 290, and Mentor moderate plus 300 are in this group. The width is about 11~13cm. The diameter of the original breast needs to be about 12cm. Also, the original breast tissue should not be too tight but loose so that the implant can be put in easily, shoulders need to be broad, and the chest size needs to be big for the person to use the large sized implants.

Large sized implants lead to ‘very large breasts’ with any cup size of B / C / D.

But fi you have small original breasts, and if your tissue is tight then your breasts may not be larger than B cup. This does not mean that you have a small volume. This just refers to how the cup size is measured.

Extra-large (320cc or more) ;

In US, it is common to use 400cc or larger implants. Patients with big sized body and sagging breasts use such implants.

It may seem like one should not use large sized implants for sagging breasts but since there is no volume on the breasts, the implants would put much volume.
So one needs to choose long diameter implant in such case.

The cup size is not important in breast augmentation. Cup size does not have any meaning. The cup measurement has limitation on how much the volume can be. One needs to know how the volume would be changed but the cup size is very subjective. Saying you are short or tall is subjective and this applies to breast size as well.

No matter how large the implants are, one may not feel that the breasts are large enough. A person who is 166cm tall and 48kg might feel that she is fat and go on a diet. It just feels that one cannot objectively judge her own body.

 
Today we looked at how large breasts become with the implants.

Thank you for reading.