No-Touch Technique of Breast Augmentation


Before the Keller Funnel was invented, surgeons would place the silicone implant through an incision by hand. The force required to place the implant in this fashion, could weaken the implant shell as well as cause bruising.

In 2009, breast augmentation saw its latest technological advance when the Keller Funnel method was introduced. This technique has completely changed and refined the art of breast augmentation and the next generation of this surgical procedure.

The Keller Funnel offers a no-touch delivery technique. The Keller Funnel is a clear, cone shaped tool that provides doctors with more manageability and ease to deliver breast implants safely into the breast during surgery without the doctor physically touching the implant with his/her hand.

This allows very little room for bacterial contamination or buildup on the implant surface. Due to the fact that the tool is clear, it allows surgeons to easily visualize and position the implant correctly before inserting it into the breast.

With the Keller Funnel system, insertion of the implant is much gentler for the patient and smaller incisions to the breast can be made.

There are four important benefits of using the Keller Funnel method in the breast augmentation procedure with silicone breast implants.

Smaller Incisions
The doctor is able to make smaller incisions by using the Keller Funnel. This means that there are more options for placing incisions during a breast augmentation procedure. It also means smaller scars and an easier recovery with less pain.

Decreased breast implant contact
Being able to use additional anti-bacterial measures with a Keller funnel reduces the risk of breast augmentation complications. It offers less risk of damage to the breast implant during insertion, helping to minimise the risks of pre-insertion damage to the breast implant product by reducing the  need to manually handle the breast implant. Excessive manual handling of implants has been identified as a potential factor in the compromise of the implant shell, reducing the longevity of the implant.

Quicker Healing
Using the Keller Funnel can also minimize trauma to the breast tissue. This makes for a quicker healing process, reducing post-operative pain.

Less Stressful to the Implant
The Keller Funnel is designed to minimize stress to the breast implant itself, which prolongs the implant’s lifespan and reduces the risk of the implant rupturing. The Keller Funnel’s slippery internal coating allows the surgeon to position and insert the implant with a minimal amount of pressure. In fact, research has proven that using the tool reduces the forces applied to an implant during breast enhancement surgery by 95 percent compared to the finger push method.

The implant is at lower risk of rupturing for the simple reason that less force is applied to them during insertion. This matters, because stress on the implant during insertion can eventually cause rupturing—even years later.



The Keller Funnel is the latest advance in Breast augmentation. This tool has completely revolutionized the plastic surgery industry by reducing risk, surgery time and over all stress to both patient and surgeon. The funnel has indefinitely been the only innovative tool used by plastic surgeons that has been able to fulfill the need of providing benefits to both the doctor and patient going under the knife. At KIES-U Plastic Surgery Korea, we believe that this tool is so ingenious that it has become absolutely necessary for our doctors to perform faster, safer and satisfying results to our patients, all while cutting down the risks of contamination and complication by a grandiose percentage.


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Composite breast augmentation Korea KIES-U Plastic surgery

Hello everyone. Today, I would like to share about composite breast augmentation.
This involves using the implant for augmentation and using fat to cover up the implant to make the breasts look more natural.

If you see the internet, you would be able to find some words on if the clinics make the patients choose between “implant and fat graft”. There is a clear classification between the two therefore if it difficult to say which is better than the other. Fat graft has longer history than implants. Czerny already conducted a successful transfer of a lipoma from the buttock to the breast in mid 1800’s. Fillers were used on the breasts from early 1900’s. The silicone implants that we use today were first developed in the 1960’s.

Fat graft is good in a way that you are using your own fat but it is difficult to know the engraftment success rate therefore, there is no unity in how the result would be. Using implant can lead to expected results but it is a foreign substance therefore your body reacts to it that could end up in complications. Therefore we can apply the two together to cover up each other’s weaknesses.

We can make a pocket and put in the implant. We can inject the fat into the breast envelope (tissue cells that cover the breast). This could be done as one stage or in two stages. I would recommend two stage procedure but most patients prefer the one stage procedure.

Then, how can the composite breast augmentation be applied?

Most patients who want breast augmentation have low level of BMI. Those patients who are thin or somewhat average tend to want the breast augmentation. If an implant is used on a very thin person, then others would recognize this easily. As the ratio of implant thickness : breast envelope thickness becomes bigger and bigger, there is a higher possibility that the implant can be seen from the outside and that there would be rippling and separated breast deformity. The breast envelope is as below.



Thin person using large sized implant would have more possibility of having the problems stated above. But, if you have large original breasts or if you use small sized implants, you would not experience such problems.



There are patients who want revision surgery due to separated breast. Also, you can see on the internet that those with separated breast have less fat between the two breasts.



An implant is a foreign substance. If the gap between the implant and the breast skin is not filled with fat, then there will be more edged look on the breasts. This leads to shadows and more artificial look of the breasts.



This unnatural look can be avoided by minimizing the size of the implant. But if the implant size is too small, then the goal of breast augmentation cannot be achieved. This is why it is better to use fat and implant together. We call this composite breast augmentation.

First, we need to exactly measure how much fat to inject after inserting the implant.
The engraftment is really important in fat graft therefore, a certain amount of fat must be injected for the engraftment rate to increase to maximum possible level. Usually about 500-700cc of fat is collected. When you remove the impurities, about 100-250cc would be left to use.

Cellular fat graft method is mandatory and the surgeon must be careful in carrying out the collection properly with no damage and no pollution on the fat. There are people with less fat in the upper body compared to the lower body (lower stomach, thigh, buttocks, etc). Those who do not have much fat in both upper and lower body cannot apply this composite breast augmentation.

The fat should not enter the implant pocket, but be injected from many direction to fill the gap between the envelope and the breast all evenly.
 


The fat used not for the purpose of making the breast look larger, but to cover up the implant for more natural work therefore the fat is injected on the margin of the implant and the boundary of the breast.

The fat used can slip downwards therefore you need to use correction bra after the augmentation. The correction bra helps hold the fat from slipping downwards.

Does the composite breast augmentation have any complications?
The most common one is the Touch-up. This means that there can be follow-up surgeries. The engraftment rate of one-stage fat is not as successful therefore we would need to inject more fat into the breast boundary after a few months.

The possibility of capsular contracture is about the same as when you only use the implant. The same applies for infection/inflammation.
More complications can be followed on the fat collected spot if you take out too much fat.

Composite breast augmentation is simple and it has many advantages. It is very effective for thin person to cover up the unnatural look that can be had from using implants. If is good to apply when you are thin but want to have large sized implant. It is also good if you want to change body line in the lower body (stomach, thigh, etc).

This is very effective if you want to correct some unnatural look on the breast or if you want to fill up the volume in some spot of the breast.

Today, we shared about composite breast augmentation. I hope you find this helpful. Thank you.

Is the result good?

This is one question that everyone would ask after a cosmetic surgery. Whether it is the nose or the eyes or any part of the body, the patient would be curious about how his/her body has changed.

Today, I would like to share about “what is a good breast augmentation?” and “what is the standard of a good surgery?” All results can be objective at the earliest between 2 to 6 months.



1. Location of the implant

Breast augmentation involves making a pocket and putting a foreign substance, implant, into that pocket. This is rather a simple procedure. The surgical method is not too complex. It may be one of the simplest surgeries.

But the problem arises after the implant is put in. The implant does not stay in that particular location. As times passes, the implant tends to move to another spot. We can estimate such movement. Capsular contracture is one of the main reasons that lead to this movement.

If the implant is out of its location, the breasts may look asymmetric, look like the upper volume is lost, and the breasts may look too far apart or too close to one another.



This happens when the capsule formed, pushes the implant to one side.
We can know the exact location of the implant by observing where the nipple is pointing towards. When you look at the breast gland, the nipple should be located in the middle. If the implant is located at the upper part of the breast, then the nipple would be pointing downwards. If the implant moves to lower part, then the nipple would point upwards.

If the implant moves more inside, then the nipple would point outwards. As such, one can know if the implant is in the appropriate position or not, by looking at where the nipple is pointing.



Just talking about it is easy, but one needs to consider many factors of the breast before the augmentation surgery because of all the complications that may follow. There are many cases where the patients have unaligned breasts before the surgery.

Therefore, we need to look at each breast separately; right one by itself and left one by itself. But the patients take a look at their breasts together at a glance and state which breast or nipple is higher than the other. Also, your eyes are positioned higher than the breasts, therefore when you see the mirror, it is difficult to judge the position of the implant objectively. It is better to take a photo in order to make more objective judgement but the position and the direction of the camera lens has to be horizontal with the position of the nipples.

2. Feeling of the breasts

There is no objective way to determine this. Everyone feels different towards whether the breasts feel soft or hard when they touch them. How soft should the breast be for you to feel that it is good? How hard should the breast feel in order to know that it has capsular contracture? What is the accepted level of feeling that there is a foreign substance?

There is no answer to all these questions. This is the difficulty of judging how the breasts feel after the breast augmentation. Below is the relatively simple standard that I have made.

1) When you push the breast to 12, 3, 6, or 9 o’clock position, it should not feel that the breast is stuck down or be resistant to the push

2) The implant should move together with the breast skin (If there is a capsular contracture, the implant would not move but the skin will. If the pocket is too large, then the implant would move far greater than the breast skin)

3. Infection and inflammation

I have shared much about infection in the past. There are 4 symptoms of infection : oppressive pain, swelling, red reaction and fever.

“Pain” itself cannot mean that there is and infection. There needs to be some symptom of infection in order for you to know accurately.

When you push a certain spot on the body and if that hurts, we call this oppressive pain. But we need to know for sure if that particular spot is hurting or not. When we put in the implant into the body, there is a high possibility that germs build up around the implant.

There are findings that these germs are the source of capsular contracture and when they become active, they could lead to severe case of infection damaging the tissue cells around. This can be notices with in the first 2 or 3 weeks of the breast augmentation. After this period, capsule is formed around the breast that stops the oxygen and nutrition reaching the germs, making them obsolete. The wound or puss from the infection is already formed at this stage.

The infection is at the peak level within the first few weeks of the breast augmentation.

4. Breast symmetry

There are many reasons on why breasts on each side look different.
First is the asymmetric position of the two nipples. This is important because there are many patients with one nipple higher than the other. In most cases, the left nipple is higher than the right nipple because we have different organs located at different sides of the upper body. There is a heart on the left side, and the lungs on each side look different as well. Most people have left rib that is higher than the right. The skin acts as a cover therefore the skin on the left side is tighter than the right.

For the same reasons, the inframammary folds are asymmetric as well. You can find this 90% of the time.

Second is the bone asymmetry. The bones composed in the chest are, sternum in the middle, ribs on the sides, and spine on the back. There are very rare amount of people with sternum exactly in the middle. Most people have sternum a little to the right or left. This limits the area of the implant pocket that can be made on each side. The side with a larger chest would have more space for the pocket, vice versa. This is why we also need to limit the size of the implant.



Also, there are many with curved spines. It may be because of the computers, but there are many patients with bend neck and spines. Curved spines mean that the breasts cannot be symmetric. This cannot be treated in cosmetic surgery.

Third is the volume asymmetry. Most patients have left breast that sticks out more than the right. The left chest is larger therefore the bottom area of the left chest is higher than the right. In most cases, we use small volume implant on the left to match the size of the right.

In order to fine out the symmetric result of the breasts after the augmentation, we need to know that original status of the body before the breast augmentation. If you have smaller chest and lower inframammary fold on the left, you may have a dilemma. Using a larger size implant would pull down the inframammary fold more downwards. You need to talk about such things with the surgeons beforehand. Of all the problems that you can have after the breast augmentation, breast asymmetry is the most difficult one to treat. Your original breast and chest are all asymmetric.

Today, we looked at what a ‘good surgery’ is. I hope the contents have helped you out.
Thanks a lot and have a great day.

Is it OK to get breast augmentation in the summer?

There are many patients who consider the weather for breast augmentation.
There is peak season and off season in breast augmentation also where peak season is the time when everyone wants to get the breast augmentation and the off season is the opposite.



The peak season for breast augmentation is during the school break.
Like the school break, the adults have much time during the New Year’s and Thanksgiving.

Also in December, when most college students have winter break until February. This is a very important peak season.

Now-a-days, there are much difference in peak season and off season, also we have 40 hour week with many replacement holidays therefore the busy seasons are not what they used to be.

Why do you think there are many who want breast augmentation during the cold season?
The schools have longer winter break than summer here in Korea, but there are particular reasons why the patients do not want cosmetic surgeries during the summer.

What are the reasons?
When it is hot, you sweat a lot. The sweating can lead to infection and there are those who think that scars or wounds get worse during the summer. Some think that the cold weather kills bacteria and the wounds can get treated better.

Such perception arises from the thought that wound recovery can be delayed due to infection and inflammation and that this infection and inflammation get worse during the hot weather.

It is very discomforting to have bandage around the body during the summer. It is difficult to have shower as well.
But, what about the wound?



It doesn’t get any worse.
There are hotter countries around the world. Currently it is 32 degree in Seoul and 37 in Tokyo.

Hong Kong, Philippines, Taiwan, Thailand, Brazil, Florida, Singapore and all hotter than Korea. You would not be able to breathe properly in Hong Kong during July because of the heat and the humidity. If you do not turn on the air conditioner throughout the day, you will find mold on the walls.

So if the people in these countries get cosmetic surgeries, there should be much news about wounds not healing, and high incidence of infection and inflammation. But, we do not hear such information. There are no recording of doctors in such hot countries that state ‘patient’s condition gets worse due to the heat”.

Actually, healing takes longer during the warmer season than the colder one.
Hot weather increases superficial hematocele in order to release the body heat. Nerves coming out during the hot weather are caused by the enlargement of the nerves under the skin. This would help the blood flow and if there is good blood circulation, the bacteria causing the infection would not be able to penetrate easily.

Bacteria getting into the body are called infection and the immune system fighting this bacteria is called inflammation. Pus is the dead exposal of bacteria from white blood cell and others. Therefore inflammation is something necessary and it is not a bad thing. Infection is a bad thing happening to the body. Active inflammation can kill the infection that penetrated into the body.
 
The body must not lose heat during the cold weather therefore it decreases the amount of superficial hematocele. Not much blood flows through the skin therefore the skin becomes white. There is not much blood circulation into the wounds as well. This makes the body weaker to infection. The support of immune system is slower meaning not much oxygen and nutrition are provided to the damaged cells.

We use air conditioners when it is hot and use heaters when it is cold, therefore there aren’t much differences in what happens to the wound due to the weather. This is just the principles that I wanted to share.

There are some differences in how experts think and normal people think. But there are no evidences that surgeries in summer are worse or dangerous. Wounds can be healed without much trouble during the warmer days.

The recovery may take longer during the colder days. Sweating is the exposal of liquid in our body. This is not harmful or a bacteria. There is no evidence that sweating causes more inflammation.

Due to the usage of air conditioners and heaters, there are not much differences in the body heat during the different seasons. Therefore, there is no better weather or season for cosmetic surgery. But, if you ask me in which season the wounds get healed quicker, I would say warmer days without any hesitation.
 
I hope that you don’t get sick from the heat. It might be better to restrict outdoor activities in such hot weather.
Thank you and have a great day.

Breast augmentation Korea
Today I would like to share 3rd posting on matching implant and tissue structure.



We have shared that in order for the breast augmentation to be successful, the foreign substance (implant) has to match properly with the body, and that size and form stability are important.

Today, I would like to share about the implant filling and the shell type. All are important but there are no accurate information on them.
Silicone implant is consisted of exterior (shell) and the interior (gel).
The shell has filling inside it. If the shell can be composed of max 250cc gel and has such amount, we call this 100% filled. In reality, most products are not 100% filled.



280cc shell is filled about 95% which is 266cc. Such product would have volume of 266cc marked on the package, not 280.

Almost all round type implants are produced such way. Why is that?
As the implant gets filled up to 100%, it becomes more form stable and strong. For stability means that the implant is able to maintain its shape no matter where and how it is positioned. Such problems could follow.

- If the disc shape is maintained when standing, upper block would look worse
- If the disc shape is maintained when lying down, the breast would look unnatural because there is no gravity pulling it down
- The breast would feel hard rather than soft
The manufacturers consider such factors and therefore produce products that are no 100% filled. Less than 100% filling leads to,
- Upper block cannot be found when standing
- Breast lean towards the outside when lying down, looking natural
- Feels soft when you touch the breast



However, such less filled implants have problems. Let’s look at some of them.
If the implant is not completely filled, one part might more gel than the other. There is no balanced distribution. Such could lead to wrinkling of the shell. The wrinkle from outside looks wavy and you can feel it when you touch it. We call this rippling. More accurately, it is called underfill rippling.

If there is much friction on the rippled part due to much movement, there could be some damage to the shell. This leads to high possibility of damage.
If you have ridden bicycle a lot, then you might know this. If you do not fill up the air in the tire and ride the bike, you might experience more flat tires. If you fill up the air, then there is less chance of you getting a flat tire.



The breast skin loses elasticity after giving birth and/or breast feeding. Loss of skin elasticity leads to sagging breasts. If underfilled implant is used on such breast, the breast would look like it had lost more elasticity than before.
Using underfilled implant on the patient with sudden weight loss or skin aging would not be good also.

The advantage and disadvantage of 100% filled implant, i.e. form stable implant is exactly the opposite. Fully filled implant feels hard and not smooth. The gel disperses less when the implant leans onto one side. But the durability is good therefore there is less chance of collapse and although the skin loses elasticity, the implant can maintain the shape of the breast. Such form stable implant is more effective in correcting tuberous breast as well.

If the disc shaped implant is filled as much as possible, and if the round type implant is filled as such, the implant would shape like a ball. This is why the round type implants are not 100% filled.

Most of the implants imported are underfilled ones. Micro textured implant from Sebbin, Motiva, Bellagel are introduced as 100% filled implants but the shells can extend easily therefore they are not form stable implants.

Micro textured implants have smooth exterior skin therefore although there is much filling, the implant is not form stable.



If you want close to complete filling and form stability then the best implant would be anatomical type. When the anatomical implant is filled 100%, it does not become round like a ball. The anatomical shape is maintained looking natural.
This is why 100% filled implants are mostly anatomical implants. Under filled implants are mostly round types.

Then, which implant is good to use? This may be the question that you want answered.

Like the title of the post, I wanted to express that the matching of the implant and the body is important. The answer to the question is that the implant selected must be in consideration with the status of the patient’s breast.


If the breast skin is very tight and you do not want large volume, you can use less form stable implant that avoid upper block. Round type implant would be recommended to you.

But if you have tight skin and want large volume, using the round type implant would lead to upper block. Although the implant is under filled there are much skin tissue covering the implant. Therefore, in such case, anatomical implant would be recommended.
If you have sagging breasts with loss of elasticity, or if you have tuberous breasts, then anatomical implant would be good for you. In rare cases, form stable round type implant would be recommended (this is very rare in Korea).



If you have good shaped original breast with good balance and skin status but want to make the breasts larger, then you can use any type of implants for cosmetic purposes. Smooth, textured, round, micro texture, anatomical, polyurethane, all would lead to satisfying shape of the breast.

Today we shared about how much implant shell is filled with gel. I hoped you understood this core concept in understanding what the implant is.
Thank you and have a great day.


Breast augmentation Korea KIES-U

About Form stability

[breast augmentation Korea]
The two key words that I share while I talk to the patients or write on this blog are “form stability” and “dual plane”.

Form stability of an implant is one of the core concepts in forecasting how the breast augmentation result would be. But, to most patients, this term would be very new to them.


Most of the information on the internet is about how the breast feels after the breast augmentation. The information is rather one dimensional.
The information is one the result such as soft implant, hard implant, implant that spreads easily while lying, and implant that feels natural.

No matter how soft the implant is when you lay it on top of the table but you feel that the breasts sag a lot after the augmentation, would you be happy with the result?

Although you were attracted to the fact that the implant balance shifts downwards and feels natural when lying down, you might suffer from rippling effect. Would you be satisfied with this?



There are some conditions that need to be met when using implants in breast augmentation.

Can we correct and control the shape of the breast as we want?
Will there be no complications or failure in the long term?

These are a few.
There are basic must-haves such as form stability and position stability in order to satisfy these conditions.
Breast augmentation has a lot of variables.
FDA statistics show that 20% of all breast augmentation leads to reconstruction due to dissatisfaction and complications. The reason for this is due to the loss of control.
We can expect any outcome if there are different results or some satisfying or dissatisfying results.

We cannot say that this was a successful surgery.

It may be impossible, but we need to estimate the outcome and control the process to result in a successful surgery. Also, there must be minimum level of complications and no reconstruction in the long term.

Of course, all these factors do not just depend on the implant itself. The surgeon needs to study the body properly, plan out the whole process properly, apply the appropriate plane method / desquamation method, efficiently close the wound with least amount of bleeding when inserting the implant, and conduct post-augmentation check-ups with proper management.

It is correct to say that the surgeon needs to select the implant that matches perfectly with the patient.




Stating which implant is the best or better than others is just a marketing tool.
All implants have their purposes in usage that determine the outcome.
It’s like selecting the right ingredients for a delicious meal.

We cannot use the same hot sauce for a pizza and soup. We need to select the right implant for a particular situation in order to derive the best result possible.
There is no one implant that leads to a successful outcome 100% of the time. The success is made by the surgeon and the implant is just one of the tools used.

One would be able to estimate and control the result with least complication by using a 'good implant'. But there is not just one implant that satisfies all these conditions.
The doctors selects the best implant possible and matches that with the patient’s body in order to achieve that goal.

The implant that we use currently is called a ‘cohesive gel’ implant

The terms such as micro texture, smooth, and macro texture are words that describe the shell of the implant. The substance inside the implant is all cohesive gel.
‘Cohesive’ means well integrated.

Many patients ask how micro textured or silk surface is. But there is no one who asks what cohesive gel is.

Why do the manufacturers use cohesive gel?

They use it because it does not leak out like the water does if there is some damage to the implant.

But more importantly, it is because of ‘form stability’.
The ability to maintain the form makes it easier for us to estimate how the shape would be and also helps us to correct the shape if necessary. Also, it helps to fill the upper block of the breast for a long period of time.

It helps to maintain the shape/form although the implant collapses. We call such characteristic form or shape stability.

But if the gel is formed similar to water, the one dimensional feeling can be good.
The state has to be close to water if you want the implant to feel more soft.

I don’t know if you would remember my writing on how using liquid silicone, illegally, can result in the best outcome possible if there is no complication. The more liquid it becomes, the gel becomes very soft and wavy leading to a very good sense of touch.

But if the implant collapses, the shape disappears as well. Your breasts would end up looking weird.

If you have breasts that need to be corrected such as sagging breasts, such result would be meaningless. You will not be able to change the shape of the breasts properly and the shape of the implant would also change.

You will suffer from complications such as rippling. Upper volume of the breast would not be filled and the gel would all move downwards.

Cohesive gel came into the market in order to be a substitute for such liquid silicone. Gel is sticky and feels a lot stronger than liquid silicone. It is more close to solid than liquid. The difference is from touching a white cream with your hand to touching rubber ball. This is the difference of liquid and solid.

The reason why "cohesive gel" was made by the manufacturers is to avoid any shape related problems due to implant collapse, less filling of the upper volume and others although the patients want the breasts to feel soft.

This is why cohesive gel was born. The cohesive implant is classified by how much cohesive the implant is. The more cohesive the implant is, we call the implant form stable. The less cohesive the implant is, we call the implant less form stable.

The most form stable implant that we use today is Allergan’s Style 410. It is an anatomical implant and is sold the most around the globe.



Form stable implants feel strong and hard. It also maintains the shape the longest and the upper breast do not loose volume as you age. The best part is that you can correct the shape of the breast easily. It is best for those patients with very short distance between the nipple and inframammary fold or the distance between the clavicle and the nipple.

The gel does not leak easily when the implant collapses and the shape is maintained for a very long time. There will not be any rippling of the implant as well.
I will share more on the details in the future but there are critics on Style 410 with the rough texturing that causes double capsuling, seroma, and lymph nodes making the doctors avoid this product.

Then which cohesive gel implant has the least form stability?
It is Mentor/Allergan smooth round type implant.

The gel’s elastomer is very thin and the shell is about 90% filled which means there is more possibility of implant collapse or folding.

The inner density level is very low therefore it feels more like water.
The implant feels very soft and wavy.

Also the implant shifts one sided when you lie down towards one side. This might feel natural to you but if you have less elastic skin or much fat then such outcome would be less welcoming.

Luckily, there are many implants that we can choose from and there are many spectrum that we can choose in between.

Bellagel, EuroSilicone, PolyTech and Cervin have micro textured cohesive gel implants that have just an average level of cohesiveness.

The implants are near to 100% filled.

The implants do not feel like gel but the shell’s elastomer elasticity is high which makes the implants feel somewhat good when you touch them.

Such implants have less texturing so they do not stick properly to the skin wall. So the implants might not be able to maintain their positions inside but move about so such implants cannot be made as anatomical type. (All micro texturing implants are round type)

I have stated previously that in principle, the implant has to match the tissue structure of the breast. It is best to select an implant that matches with the shape of the breast and helps balance the growth of the breast skin.

If you are young and before pregnancy (In the 20’s), have tight skin and somewhat good breast shape and volume, the best solution might be just to make the volume larger and maintain the shape.

If such is the case then the form stability of the implant is not important. You can use any implant that you like. We would recommend smooth, round type or micro textured implant.



If you gave birth, have less elastic skin, and upper volume is less filled then it is important to change the shape of the breast to make the breast look balanced. The implant must not collapse therefore we must use form stable one. Such implant would change the shape of the breast and provide much volume. Most of the form stable implants imported to our country are anatomical types.

We need to choose an implant that matches the patient’s breast characteristics, and the state of the breast skin tissue.

In summary,

If my breast is tight and hard, then I would need soft implant
If my breast is less elastic then I would need tight implant
This would balance out the breasts. Implants are used as a complement to the human body and what we use depends on how our bodies are.

We will share more in the next post. Thank you for reading.
 

KIES-U Plastic surgery Korea
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
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Does transaxillary incision always hurt? Does inframammary incision not hurt?

Many patients want inframammary fold incision because they want to recover quickly. Some say that they do not feel much pain so they want to avoid transaxillary incision.
We cannot say that this is completely false but as you think about it, it is not correct to say that the approach method, incision, is the only cause of pain in breast augmentation.



The conclusion is that pain is not caused simply by just one factor.

There are many factors combined that lead to pain after the breast augmentation. The incision spot may be the least important factor of pain.
Then what is the most important factor? I have summarized this into a diagram as below. These factors are the ones that lead to pain after the breast augmentation.


 
Going into the explanation, the pain caused after the breast augmentation takes place when implant with much volume goes into the body and takes up some space. The surrounding skin pressures the implant and the pain receptors feel this pressure. This is the origin of the pain. People have different level of pain receptors in sensitivity, location, density, etc. The most sensitive ones are near the bones. The skin feels much pain as well but anesthesia helps relieve the pain. The pressure goes through epithelium, muscles and to the bone leading to much pain.

This is why there is more pain if the implant is located above the pectoralis muscle and almost no pain if the implant is positioned above the muscle. This is more important than the incision spot.

More pressure leads to bigger impact on the pain receptors, therefore that larger the implant is, there will be more pain. If the skin surrounding the implant put much pressure, there would be more pain as well. The implant puts pressure on the clavicle resulting in pain which means that the size or the tightness of the implant can result as such.

So if you want quick recovery, then it is wiser to use small sized implants rather than thinking about the incision spot.

It is also important that the surgeon carefully operates without causing much tissue damage. If there is much trauma on the bone or if there is much bleeding, the tissue cells will swell up. The pressure from the swelling will stimulate the pain receptors. Therefore it is important that the surgery is complete with least amount of tissue damage and bleeding for quicker recovery.

Finally, that last important factor is the individual differences.
Pain is a subjective matter. The doctor is just another third party in the patient’s perception. The doctor just hears about the pain that the patient is feeling, he/she cannot feel the same pain therefore the doctor’s information on the pain are all abstractive.

Internal medicine and neurology department use pain scale. They want to make the subjective matter measurable.




Personally, I do not think that the level of pain can be differentiated into different level. This is why we say that there is individual difference. Same level of stimulant will be felt differently from one person to another. One person might have more pain receptor in stimulating spot and the other may not have much pain receptor. There is no way that we can know this until we poke someone. In same aspect, we cannot know if someone will suffer from pain unless we conduct the surgery.

Although we do not have the exact measurement, we have much gathered data through experience and come up with a method that could result in least amount of pain. First, you should not be greedy regarding the size of the implant but choose a size that is most appropriate for the body. Those in 20’s or are in stage before pregnancy have very tight skin so these patients must be more careful.  If you have much volume or fat already in the original breasts then having the plane above the pectoralis muscle is recommended. Also the surgeon must concentrate and be careful so that he/she does not damage the tissue cells.

Does axillary incision hurt? Not, always. Then does the inframammary incision not hurt? It does not. The factors shared above are more important when considering pain. There might be little differences but this is a general tendency.

This is all for today. Thank you for reading.

[KIES-U Breast augmentation Korea]
This applies to all foreign substances that are put into the human body, but it is very important to know that the breast implant used in breast augmentation matches well with the body or not.

The success of breast augmentation depends on the implant therefore; the implant must match the body.

The implant makes my body look better and this means that the implant must be fitting for a certain individual. Therefore, stating that the implant matches the body is very important, and we call this implant – tissue structure dynamics.



There are 2 concepts to breast augmentation

Making the breasts larger + Filling up the breast volume appropriately

Breast augmentation requires filling up the volume to make the cup size bigger and this is not everything.

We need to consider the tissue structure and conduct the surgery appropriately. In doing so, we would be able to avoid any complications and maintain the beautiful shape for a long period of time.

We tend to think about many things when we put on our clothes. We choose the clothes that are fitting to our body. But, we also want our body to fit into the clothes that we like. We use correcting inner wear or even lose some weight in order to wear such clothes.

We need to consider the breast tissue structure and conduct the breast augmentation accordingly, but at times, in order to get the result that we want, we force a change in the tissue structure.

If your original breasts have ideal shape but not much volume, there is no reason to put on much stress on the tissue structure. The shapes does not need to change therefore just inserting the implant would be good enough for the volume.

We wouldn’t need to consider many things in such case. This case would be similar for a woman with great body shape wearing a dress, pants or anything.

But this is not the case all the time. There are cases such as asymmetric breasts, contour or bird chest, sagging breasts, etc where you need breast correction to solve the problems.

This would be similar to wearing clothes that have some attractive points that would cover up certain parts of the body.



Let’s say that you have one breast that is sagging a lot and the other is normal. What implant would be good for you?

It is not right to think that an implant that is currently the most widely used would be fitting for you. Breast augmentation is not as simple as you think.

Sagging breasts means that there is no upper filling in the breasts but there is much volume in the bottom part of the breast. If the breast status is the opposite, then you would need to fill up the bottom part.

We would need to apply dual plane for the sagging breast and insert the implant filling the upper volume. The implant must hold up the upper breast shape properly therefore the implant must be a form stable one. You would not need such implant if you already have much upper volume in the original breast. You would need to use an implant that stretches downwards.

The type of the implant, size, and other factors must be considered in order to select an implant that matches your body. Also we would need to know what happens when the implant and the tissue cells come together.

Selecting the size of the implant

Everyone would think cautiously about the size of the implant.
We need to think about this with some common sense.

If you use a very big implant, it would look awkward and it would be recognizable as well.
In opposite, if you use a small one, then there would be no reason for you to get the breast augmentation done.



Most people think that “the more is better”. Those with small original breasts would be more interested in the size. This is like a little chubby person wanting to wear tight clothes.

Although the expected outcome of the surgery is good, we should avoid it if we know that the skin tissue could be damaged or something that cannot be fixed could happen.
Selecting the implant size just through subjective reasoning of the patient and the doctor could lead to a harming situation.

Large implant puts on much pressure on the skin tissue and the bone that the implant is positioned on and this could lead to some unexpected negative results.

- Breast skin layer becomes thin and the breast tissue cells contract
- This results in small volume in few years
- The implant line becomes visible
- Clavicle erodes making the bones sink

If such activity takes place, there is no way we can correct it therefore it is important that we try to avoid such situation from the beginning.

Then what is an appropriate size of the implant that would not damage the tissue cells and end up with the best shape possible.
This is the main focus point.



If your body is big enough, you can use large sized implant.
If your body is small, then you need to use small sized implant.

Everyone can know this.

But, how can we judge if our body is small or big?
There are women who are 170cm tall but have narrow shoulders and thorax.
Such patients cannot use large sized implants.

There are those who are small in height but have wide shoulders and large thorax. Such patients would need to use large sized implants.

The size of the implant would match with the size of the body in such cases.
We do not stick the implant on the outside, but insert it into the body.

Therefore, it is important to know how much the skin surrounding and covering the implant can stretch out.

If you are wearing a dress that does not stretch much then you would need to wear bigger size. But if you wear something that stretches very well then you might be able to wear a smaller sized dress.

If your skin stretches easily then you can use large sized implant. But if your skin is the opposite, then you will not be able to use a large sized implant.


In conclusion, there are two factors that determine the volume of the implant.

- Diameter of the breast
- Expansibility of the breast skin

Height, weight and other physical structure are not important.
Putting in something big to make the breast bigger is not important. The implant needs to fill up the volume properly and improve the look of the breasts. The weakness that you have in your breasts must be corrected and possibilities of any complications must be minimized simultaneously. These are all factors that we need to consider when we say that the implant matches well with the tissue cells. This is the key point.

We will share more on this topic in the future. Thank you for reading.


[KIES-U Breast augmentation Korea]
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
YouTube: www.youtube.com/kiesu0202

How are breast implants inserted during breast augmentation?

There are many patients who ask how the implant in insert in during the breast augmentation.

Today, I would like to briefly share about this process.

If someone judges just by looking at the breast augmentation, then he/she might think that the overall process was quick. But as always, what you see from the outside is not so important as to what is happening on the inside.
If the implant is to be put in properly without any contamination, there must be some principles that the surgeon must follow.

The first is a principle on trauma.



If the surgeon gets too tough during the breast augmentation and hurts the tissue cells, the skin and the tissue cells at the entrance point do not regenerate.

The incision part must be very clean and the skin tissue, epithelium, muscle and other parts must cared for with minimum damage for the cells to regenerate at the point of entry. This will lead to normal state of inputting the implant.

If there is much damage to the skin and entry point along with bleeding, we will not be able to open the entry point properly making it difficult to put in the implant.
Careful desquamation, non-damaging surgery, and clean insertion of the implant are mandatory in breast augmentation.

Second, we need to conduct desquamation accurately in size and direction. 

If we approach from the areola then we need to desquamate between the gland and the skin layer. The desquamation must be precise and enough. This makes a tunnel for the implant to come out.

If we approach from the axillary fold, then we need to make a path above or below the pectoralis muscle. This path must be big enough as well. The tunnel that the implant passes through to get to the pocket must be accurate and big enough.

This applies the same on inframammary fold as well. This is really basic stuff but if the desquamation is not accurate or big enough, we may face hard time putting in the implant which could also lead to implant damage, skin damage, scar and failure in putting in the implant. In the long term, all this could lead to implant collapse or capsular contracture.



Third is the no-touch technique.

The most concerning part about putting in the implant is the contamination. Implant is a foreign substance to the body therefore if pathogenic virus infects the implant that stays within the body for a long time; this could lead to bad results.

One of the worst complications is the capsular contracture. Then where does this infection source come from? It can come from the surgeon’s hygiene gloves, or the blood that gets on the implant as the implants goes into the pocket from the entrance, or the surgical equipment used or even from antiseptics. Also, the implant from the manufacturing plant might not be hygienic enough.

The source of infection cannot be seen by the human eyes. There is no way if there is any infection caused during the surgery therefore it is best that the surgeons be careful during the surgery and take preventive care.



No-touch technique means that we do not touch the implant with our hands. We use funnel-like equipment for insertion and squeeze out the implant. Nowadays we do not use the funnel that much, but use latex gloves called insertion sleeve.

Also, the implant must be unwrapped just when the desquamation is complete and when the preparation for the insertion is complete. We need to minimize the time that the implant gets exposed to the air. We also need to minimize the number of touches we make on the implant once it is inserted.

All the 3 factors of minimizing trauma, accurate desquamation, and no-touch technique are all applied by the surgeons in all clinics. These must be carried out in order to minimize the possibility of implant collapsing, getting infected, rotating, or leading to capsular contracture.

This is all for today, thank you very much.

Inflammation and infection are two main adversaries of breast augmentation

Hello everyone. Today I would like to share about one of the most common theme in cosmetic surgery, the inflammation and infection with their results and further complications.

In science, we always ask “is that true?” and go through various stages in order to find out the opposite. Some people suffer because of what we try to change at present, but we cannot avoid these moments in order to find out the truth. The same applies to the medical field.

There are many surgeries that require implants. I am sure that there will be many products made in the future that could be used in the human body. Artificial tooth, ie. Implant (titanium), artificial knee, joint, artificial veins, pacemaker, etc are all these type of products. Silicone, artificial skin or ligaments and implants used to enlarge the breasts and buttocks are some common implants used today.



The reasons for using these implants are that the surgery can be quick, and we use already made products with perfect shape and features that make the overall result dramatic. It is much cheaper (due to mass production) than bone graft or cartilage transplant.

But an implant is a foreign substance. It is not made inside the body but in a manufacturing plant. People get suspicious about complications in using these products. Many complications do take place in reality.

The biggest problem in breast augmentation is the capsular contracture. We use implants for volume fulfillment but if they become hard and not smooth, there would be no meaning to using them. This is why all the doctors have been studying why capsular contracture is formed from the moment the implants are inserted.



Many studies show that the capsular contracture has been formed through contamination by germs. A lot of animal testing and clinical testing show such results.

Implants come with packaging with sterilization however we cannot say for certain that they are 100% hygienic. We also sterilize all the tools and equipment that we used during the surgery but can we say for certain that we killed all the germs? The surgeons use hygienic gloves and sterilize the operation room but there are always germs, bacteria in the air and there is no place around the world without them (except sterilization laboratory and immunity deterioration room). Therefore, there is a possibility that these germs get into and contaminate the implants and the pockets during the surgery.



If you have normal level of immunity then you can win certain level of germs that are acceptable and also recover properly. The same applies for breast augmentation patients. The human body makes the immune system active to kill and clean off the germs.

However, an implant is a foreign substance therefore it does not have the immune system. If the implant gets contaminated and there are much germs or if the surgery is too destructive and the tissue cells cannot have proper immune system, the germs will not disappear but live among the implant. These germs do not go away but make a wall for protection that leads to a thin film like structure around the implant.

We call this biofilm and this biofilm is resistant to sterilization and protects the germs therefore the germs can live for a long time causing worse level of inflammation on the body. Such inflammation works together fiboblast leading to severe case of capsular contracture. This is one of the most accepted theory.

Usually the patients cannot differentiate infection and inflammation. Infection refers to the allowing of outside germs to penetrate to the body and inflammation refers to the body reaction towards the germs.

If there is bad infection during the breast augmentation, you will have fever and also swelling on the breasts. When we say you have ‘inflammation’, it usually means that you are infected. Capsulation contracture is not a form of severe inflammation but a weak one. It is caused when there is minor inflammation that cannot be visually noticed that makes the body react with thick capsule leading to hard feeling breasts.

So what can we do to prevent such situations? Below is the 14 point plan that world known cosmetic surgeons around the world accept as capsular contracture preventing methods. I would like to clarify that massaging and taking prescription are not one of these.

1) Insert antibiotics during anesthesia
2) Avoid areola incision
3) Cover up the nipple during surgery
4) Be careful not to cause too much damage during the surgery
5) Careful hemostasis
6) Apply dual plane or form subfascial pockets
7) Use antibiotics or antiseptic solution to clean the pocket
8) Use sleeve (funnel, to avoid skin contact) to insert the implant
9) Change hygienic gloves before touching the implant
10) Reduce the time that the implant gets exposed (Unpack just before insertion)
11) Do not touch the implant a lot in order for proper placement
12) Stitch up layer upon layer
13) Avoid using drain tube (can be the cause of contamination)
14) Use antibiotics if additional surgeries are necessary
(There are some doctors who question No. 2, Avoid areola incision)

The conclusion is that the surgeon must conduct the breast augmentation properly. If there is severe case of capsular contracture after the breast augmentation, there is no reason for you to spend much money getting massages and taking medicine.



No matter how careful the experienced doctor is, he/she cannot completely avoid all the germs getting through. If the patient is unlucky, she might suffer from minor case (Grade 1~2) of capsular contracture. Such contracture does not require breast augmentation revision surgery.

There may be future implants that improve on this problem. There is a high possibility that texturing implant who disappear although it has been made to avoid the capsular contracture. There may be implant with sterilized or antibiotic coating. We expect there to be less cases of capsular contracture and inflammation once these products are in the market.

Thank you for reading.

Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
YouTube: www.youtube.com/kiesu0202

Microthane breast augmentation – Fact Check 1

We know that something is good, but there are many situations where we do not buy that good product.

There are many companies in Korea that utilize marketing that lead to purchase. The customers (patients) purchase based on the brand popularity rather than quality. Also
the doctors do not tend to recommend the implants that they do not have experience with.

Breast augmentation Korea KIES-U Plastic surgery

But, sadly, there are many online rumors on polyurethane (microthane) implants that are going around. Therefore, I would like to provide you with the facts.

1. There is no silicone in microthane implant  (False) 

Micro polyurethane foam in applied on the surface of the silicone gel implant.
There is silicone inside the microthane. The surface of the implant is not silicone but polyurethane.

Microthane breast implants surface

If you look at the surface of the polyurethane implant (microthane) with a microscope, you will be able to a hive-like structure. This structure minimizes the capsular contracture. Only the surface is different, the composition is the same with silicone cohesive gel implant. [Breast augmentation Korea]

2. Is microthane a new product?  (False)
Breast augmentation in Korea
The first modern silicone gel implant was introduced in 1964. The polyurethane implant was born next around 1967. The textured implant developed from polyurethane was introduced in the 1980s. This means that polyurethane as a history of about 50 years. This is not a new product but is an implant that has been used by many doctors over many years around the world.
 Breast augmentation in Korea
J.B.Tebbetts, Maxwell, P.Tonnard and other breast augmentation specialists around the world published their research results on the polyurethane implants. Therefore, this implant is not in the clinical test stage. There have been many publishment in world known essays for many years and the safety and the effect of the implant have been researched on continuously. This implant is new to few countries, including Korea.

3. Does microthane implant reduce the capsular contracture? (True)
 Breast augmentation in Korea
In 2009, clinical research date from Allergen showed that the incidence rate of Core study Stage 3~4 capsular contracture in the past 10 years was 19.3%.

The incidence rate of capsular contracture builds on therefore, the incidence rate would be much higher if you look that the past 15 years. However, the incidence rate with the polyurethane implant over the past 15 years was not more than 1%.



This is about 1/20 of silicone implants therefore there is a concrete result of microurethane implant capsular contracture. You do not need to worry about capsular contracture.
 
4. Does microthane cause cancer? (False)
 Breast augmentation in Korea
At first, there was a critique that polyurethane caused 2,4 TDA after animal tests. But the results from clinical tests showed quite the opposite on the patients. This has been certified by FDA also. Polyurethane does no lead to cancer. This is a scientific proven fact.

5. Does microthane disappear over time? (False)
 Breast augmentation in Korea
This is one of the most common misunderstandings of polyurethane implants. The outer layers of polyurethane implant dissolves with the epidemis. It does not disappear. It cannot be found in the blood or in any part of the body.

6. Is microthane more difficult for breast surgery? (False)
 Breast augmentation in Korea
We cannot say that the procedures for microthane and cohesive gel implants are different. The methods are rather the same. But, there are know-hows of the surgeon that lead to the best outcome possible.  You need to make a larger pocket for microthane implant compared to the cohesive gel implant. Also the incision must be longer (not as much as to lead to a wound)

7. Is microthane harder than the silicone gel implant? (False)
 Breast augmentation in Korea
When the polyurethant surface grows with the skin tissue for 6~9 months after the surgery, your breasts may feel hard. But after this stage, your breasts will feel the same as always.



In fact, the incidence rate of capsular contracture decreases a lot, therefore, there is a less chance of your breasts feeling hard. The augmented breasts must avoid capsular contracture in order to feel good. Therefore, it is rather wrong to say that the polyurethane implant feels less good.

8. Is it impossible to remove microthane implant? (False)
 Breast augmentation in Korea
There are some situations where it is difficult to remove the implant but most of the time, it is rather easy. The microthane is very flexible therefore it is easy to remove the implant from the body. There is more difficulty in removing the silicone gel implant if there is a capsular contracture because the epidermis becomes thick, hard and strong making it more difficult to remove.

We went through facts and rumors of microthane implants. I hope that the contents have helped out on your understanding. We will keep you updated with more information.

Thank you very much.