[Breast augmentation Korea] Dual Plane breast augmentation

 


Today, I would like to share about the dual plane breast augmentation.
Questions such as what implant is used, how large is the implant, and where does the implant go in through are commonly asked.

1) What type of implant is used?
2) How large is the implant?
3) Where does the implant go in?

All these three decision making factors are important, but there is one that stands out the most. It is the question of “which plane does the implant go in?”


4) Which plane does the implant go in through? 

There are 4 planes of above the muscle, subfacial plane, below the muscle, and dual plane.
This refers to the depth of the implant put in. There are many of those who do not about these planes although they are highly interested in breast augmentation.
Let’s refer to the images for more explanation.

Above the muscle

click image to enlarge

The implant is located between the pectoral muscle and the breast parenchyma. The advantages are that the implant shapes the breast and the implant is not pushed by the pressure from the muscles.
But as time passes, the upper part and the inner part of the breast become thin ending up with less tissue covering the implant. Also, it is very vulnerable to capsular contracture. The implant also gets in the way of the breast cancer x-ray.

click image to enlarge

Below the muscle

click image to enlarge

If the implant is put in below the muscle, the implant cover thickens leading to unnatural shape, rippling, and high possibility of capsular contracture. The muscle contracts and relaxes repeatedly pressuring the skin tissue causing the implant to move to another location. There can be dual wrinkle in the sagging breast as well.

click image to enlarge

Dual plane

click image to enlarge

As you can see in the image, the upper part of the implant is placed below the muscle, and the lower part of the implant is placed above the muscle.
Dual plane can cover the both the advantages and disadvantages of above and below the muscle methods.

In this dual plane method,
The implant is covered completely therefore there is no concern about the natural feel. The edges of the implant do not pop up due to the thin skin tissue. There is low possibility of implant getting pressured by the muscle. Also the chances of capsular contracture are minimized. You can also prevent dual wrinkles as well. 




There is enough skin cover at the upper part of the breasts, therefore the skin will not become thin over time.
There is no pressure in the lower part of the breast, therefore the implant would not move to another position.

Has this post helped you understand dual plane? This is a method that is very safe, and provides secure results over a long period of time without any complications or side effects.

Thanks a lot.

Breast augmentation – Inframammary fold (Incision and scar)

Anatomical implants are mostly used in breast augmentation today.



Whether you do anatomical augmentation or not, you would choose the type (round cohesive gel or anatomical cohesive gel) and the size of the implant before the breast augmentation. Next you would need to choose on the part for the incision. This is one area that you would think about a lot. I would like to share on this point to help you out.

I would like to refer to very prestigious contents. The two references below are authored by world renowned Dr. Spear and Dr. Tebbetts.



There are two competing goals in breast augmentation; providing comfortable access to the breast, while placing the incision in the most inconspicuous location possible and less exposure of scar. For many surgeons, it is the inframammary fold approach that provides the best balance between these two aspects of incision location. (Surgery of the breast, Scott L. Spear. 2006 Lippincott Williams & Wilkins)




The inframammary approach for breast augmentation is the most widely used incision location for breast augmentation. …. Reasons for popularity of the inframammary approach include direct vision for optimal control, minimal tissue trauma, and minimal bleeding. … Each of these reasons directly impacts patient outcome short and long term. (Augmentation Mammaplasty, John B. Tebbetts, 2010, Elsevier Inc.)

As you can read in the contents above, most surgeons around the world are already aware that the inframammary fold incision for breast augmentation leads to least complication and other problems providing best results. Inframammary fold approach is the most popular one in US, EU, South America.
Also, inframammary fold approach has been getting a lot of attention after the certification and sales of anatomical implants.
It is ideal that inframammary incision is done for the anatomical implants.

However, this approach is not comfortable by many surgeons in Korea. This is because many young patients preferred the axillary crease approach. I have had interest in inframammary fold and have applied it for a long time. I would like to post on some of the strong points of inframammary fold incision.

Below is the summary of different incision methods.






1) Axillary crease



Incision on the axillary crease means that the incision is done far away from the breasts therefore, it is recommended to those who are sensitive about having a scar on their breasts. However, there is no visual so we need to use the endoscope (long surgery time) and the distance from the input to the breast is long, meaning that there is that much more change of damaging the tissue of the entrance path. There can be pain after the surgery due to this cause. There are many nerve and vessel stimulants in the armpit therefore there can be some related symptoms caused. Also, it is not easy to put in form stable anatomical implant through the axillary crease and we need to study more on the possibility of implant rotation.



2) Areola



One thing that worry the patients about the areola incision is that the breast feeding may be disabled because of the areola incision. There is no such problem if an experienced surgeon performs the procedure.
Areola incision is a very good method for most breast augmentation including sagging breast and combination of 2 or more surgical methods.
However, there is a concerning point in which the incision on the breast may lead to tissue penetration causing trauma.

Also, as the implant is put in, the implant can come in touch with skin tissue cell that might lead to infection, inflammation, and even capsular contracture.
If the diameter of the areola is big enough, there would not be much problem with using the anatomical implant for areola incision method.



3) Inframammary fold 



The reason that inframammary fold incision does not cause pain is because it can be desquamated quickly. Also, it has a clear vision therefore the procedure is quick. Pain and complications are caused when there is not much visual and if one needs to damage the skin tissue.
Inframammary fold has best visual compared to any other methods and so it is the safest method as well. There is less trauma and less invasiveness.
Also, desquamation is easy and one can stop bleeding near to 100%. It is the easiest method when using the anatomical implant.
The scar can be covered by the breast skin therefore the scar is not easily visible.



4) Belly button



Belly button method leads to least pain and least visible scar that is far away from the breast. However, it is impossible to use cohesive gel silicone implant for this case. Only the saline bag type can be used. Of course, anatomically shaped cohesive gel implant cannot be used also.

 
Today, we looked at globally used breast augmentation incision method of inframammary fold.

I think that this method will be applied more and more with the usage of anatomical implant.
Also, many doctors believe that it is the safest incision method that can be applied.

Thank you. Have a great day.

Form stable implant

There are many who do not understand what form stable implant is.
Today, I would like to share about what a form stable implant is.



Form stable implant is one that does not change its shape irregularly but stays in uniform shape.

What is form stability?

The gel has high cohesiveness and density. As the filling rate, volume of gel compared to exterior skin, approaches 100%, the exterior shape remains stable.




 
Advantages of form stable implant

1) Durability (Low possibility of collapse or leakage)
2) Low possibility of capsular contracture (Theoretically; not clinically proved)
3) Low possibility of rippling
4) Good for filling up the volume in the upper breast
5) Low possibility of breast parenchyma contraction (Need more clinical data)
6) The gel does not leak although there is damage on the exterior skin

Disadvantages of form stable implant

1) Requires high technique for surgery
2) Costly
3) Large incision for the implant
4) Patients feel that it is not as soft
5) Not good for those who want large sized implants



The important point here is that there is no absolutely form stable implant made by the manufacturers today.
Anatomical implants are said to be rather stable in form or shape in our country.
The most representative product is anatomical implant from Allerga, Style 410. There are other such as CPG (Contour profile gel) by Mentor, and anatomical implant from SiliMed.

Truform2 from Allergan Inspira is a round type implant but it has a high fill rate therefore provides high form stability but not as much as Style 410.




Implants that have weak form stability are,
Mentor round type implants (Mentor MemoryGel)
Soft touch products in Allergan anatomical implant
Polytech silicone gel products

Such variety of implants are produced by the companies and it is difficult to know each one of them.
If you feel that you need a form stable implant, you need to think and consult with your doctor on whether you want highly stabled or lowly stabled implant.

In most cases, the form stable implants are recommended for,
Sagging breasts
Tuberous breast
Constricted breast
Low volume in upper breast
Other factors such as when your original breast needs big make over

Thank you for reading. Have a good day.

When can I start to exercise after the breast augmentation surgery? (Breast augmentation recovery) 

Today, I would like to share about the recovery from breast augmentation surgery, i.e. when you can start exercising after the breast augmentation.



First, the type of exercise is important.
Second, one needs to consider the difference in the outcome of the surgery for each patients.

The first week of recovery from the breast augmentation surgery is quick and active. The body reacts to the implant that is in the body all of a sudden, and the implant pocket begins to heal therefore, this period is unstable.
It is recommended that you avoid heavy activities or exercises and just do daily chores.



Strong capsule, epithelium, is formed around the implant after 3 weeks.
There can be difference in the thickness but this epithelium is formed in all bodies with silicone.

If this epithelium becomes too thick, it can be the cause of the capsular contracture, but this epithelium also helps implant to maintain its position stable within the body. There are two sides to the coin.

Therefore, you will be able to do just about any exercise after three weeks.
Normal muscle movements do no shift the implant to a different position.



You can exercise on the running machines, you can enjoy cycling, weigh training, and yoga. After a month, the epithelium becomes stronger therefore even massaging the breasts would not lead the implant to shift or move to another position.

Therefore, I tell my patients that it takes about a month to enjoy normal exercises.
But you need to be a little loose about this time period.

Your body knows what is best for you. If you want to swim after the breast augmentation, you might do a little warm up. If you feel ok, then you can swim more the next day but if you don’t feel good, then you should stop at that moment. You need to feel your body and control the pace of your recovery so that at the end, you can get back to your original condition..




I conducted breast augmentation on a professional body builder. We communicated a lot and I am aware that it took 2 months for her to do the normal body building exercises that she did before the surgery.

Professional body builders can resist the heavy weight but normal female patients cannot.
 
So it takes less time for a normal patient to get back to normal condition.
Today, we looked at the time period of exercising after the breast augmentation. I hope that this post has helped you out.

Thank you and have a great day.

Anatomical implant for breast augmentation?
KIES-U Breast augmentation Korea

Most think that this is good because the augmented breasts would look anatomical. Also patients like it because the anatomical implants avoid the upper fullness.

Breast augmentation Korea KIES-U

Actually, in order to answer this question, I need to provide explanation on the relationship between the human body and the implants. Here is the conclusion, first.

Why is the anatomical better than the round type?

It is safe and secure (Form stability)


Anatomical implants are

Maintains stability for a long period of time
There is a lot possibility of implant collapse
Has stable, uniform result in any type of body used

Some like it because the anatomical implant does not lead to upper fullness.
This is true for those patients who are really thin and do not have much shape in the original breast.
However, if you have some amount of volume, there would be not much difference, whether you use the anatomical or the round type.

When the implant goes inside a human body, it’s shape would look differently than that when you place the implant on top of a table.

All types of implants look stable when placed on the table

But, when the implant gets into the body, it does not lie down as such, but remains standing up.




When the implant stands up, the upper part of the implant squeezes down. (Textured implant squeezes less than the smooth round type implant, therefore, as a result, the upper part of your breast would be filled up more with the anatomical type when compared to the round type)

It is wrong to say that the round implant leads to upper fullness always.

But, if you have tight skin and are young and thin, you will have a greater possibility of having the upper fullness.
Your skin presses on the implant, therefore, the original shape of the implant is maintained.

Let’s look at the MRI of the implant that is standing.

Hammond, Aesthetic Breast Surgery, 2009, Saunders, Elsevier

 
This is a MRI of a patient with 322cc round smooth type cohesive gel implant. The implant is folded and wrinkled. The gravity pulls down the implant therefore, the shape is broken down. Therefore, the round type, although the implant is round shaped, cannot maintain its original shape.
This looks similar to anatomical implant because the patient’s skin tissue presses on the soft implant to make such shape.

As such, the smooth type round implant (from Mentor) seems less full. If you touch it, it is very soft. Such implant loses shape as the breast presses on it. So the shape that is made from the manufacturing plant is not implants, but the original shape of your breast is important when considering the shape after the breast augmentation.

Hammond, Aesthetic Breast Surgery, 2009, Saunders, Elsevier

This is a MRI of a patient with 280cc anatomical implant. The implant maintains its form whether the patient lies down or stands up. There is no fold on the implant as well.

Such textured anatomical implant (from Polytech) looks like it is all filled up. If feels tight and strong when you touch it. The original shape of the breast would not be important in such case as the implant would determine the final shape of the breast after the augmentation.
You will be able to see the result right away of what type of implant you have chosen after the breast augmentation.

Molding form of the anatomical implant (From Mentor).

There is a textured round type implant as well. The Polytech’s implant is filled up a lot. The implant does not lose the original shape because of the skin tissue but the implant does fold. It maintains its form better than the smooth type but not as much as the anatomical type.
Why?





Let’s summarize

If you are very thin and young (in 20’s) then, your breasts would look in the shape of the implants that you use.
If you use the anatomical type, then your breast would look anatomical. If you use the round type, then, your breasts would look round, and there would be upper fullness.
Therefore, whatever the other say about this, using the anatomical implants would make your breasts look more natural.

If you do not have much elasticity, (in 30’s, pregnant, or after giving birth), then there would not be much difference whether you use the anatomical or the smooth type. Your implant folds at the top part, just as you see in the images above.

But, if you lose elasticity in the breast in addition to this, then your breasts loses strength to hold on to the implant. The upper part of the beast would look empty. The anatomical has firm and stable shape therefore, it does not lose its shape whether your skin is elastic or not.





Some doctors perceive that the softness and the breast pressing on the implant leads to natural results therefore, recommend this to the patients.
I think that this is good for the short term, but in the mid to long term, this should not be recommended to the patients because, we saw the folds on the implant in the images above. Such folds lead to friction in the long term and makes the friction point of the implant weak. This weak point could be the reason to the damage on the implant.

Whether an implant is a round type or cohesive gel type, an implant with enough viscosity would be better in terms of durability


These are the reasons why we use the anatomical type implants.

It is good to use anatomical implants for breast augmentation.

This is all for today. Have a great day.

Q. What is bottoming out of breast implants? Can it be revised?

A. Bottoming out is when the breast implant slips below the inframammary fold as the implant does not receive enough support to remain in the proper position.

Bottoming out is caused if there is an over-dissection of the implant pocket or if the upper epithelium pushes the implant downwards.





One can explain this effect with the image above.

If the original inframammary fold is clear and the implant was placed under the muscle, then it is highly likely to have the bottoming out and the double bubble effect together.

If the original inframammary fold is unclear, and there is no sign of double line effect, the implant slips downwards and the bottom part of the breast mound becomes hard with the upper part loosing volume. This makes the nipple face upwards.



One must first check where the nipple faces in order to diagnose the bottoming out effect. If the nipple points forward, then one can safely state that the implant is in the correction position. If the nipple points downwards, then the implant is pushed upward. If the nipple is facing upwards, then one should be suspicious about the bottoming out effect.

Bottoming out can be caused with the over-dissection from the first breast augmentation and it can also be caused as the implant slips down over time after the breast augmentation.

Less critical bottoming out effect can be treated with the correction bra over 2 to 3 months, but one would require revision surgery for a critical case.
 

Most common revision is the sewing of the capsule under the breast in order to push the implant higher in the pocket. If this is connected with the capsular contracture, the one needs to remove the implant, and remove the skin along the inframammary fold.





The degree of bottoming out effect would determine what treatment method could be applied therefore it is important for you to visit a doctor who is highly experienced.

Today, we looked at the bottoming out effect. Thank you for reading. Have a great day.

Reason why your skin condition is important when choosing your breast implant size 

Many are interested in why size implant to use for the breast augmentation.

The name of the cosmetic surgery is breast augmentation, i.e. breast enlargement. It is obvious that many want their breasts to be larger.

KIES-U Breast augmentation Korea

However, for some, there aren’t any problems when using large sized implants but there are also others who might have difficulty in putting in the large sized implants and have future problems.

First, we measure the width of the breast and then select the appropriate implant. This actually determines the size of the implant.

The width of the breast simply means that if you have a large body, you can use a large sized implant, vice versa.

However, this is not as simple as we think it is. Measuring the width of the breast is mandatory but this is not a 100% solution in selecting the implant. Another consideration point is how elastic the outer skin covering the breast is.

This is very important. It is like when choosing a house. The size of the house might be fitting for 4 persons but if you utilize the interior structure properly, you might have enough space for 6 people.

If the skin is elastic, you might be able to use a large sized implant although you have a small body. If your skin is tight, then you might have to use a small sized implant although you have a large sized body.

KIES-U Breast augmentation Korea

The outer skin that covers your breast is formed by many things. There are flesh, subcutaneous fat, muscle (pectoral muscle), fascia, and others.

We are talking about the fat that covers the implant which lies on top of the ribs.

As you get older, your skin loses elasticity and sags much also. This leads to sagging breasts.

As you give more births, your breast skin sags much also.
When you gain fat, and then loose about 10 ~ 20 kg in a very short time, your breast skin loses elasticity as well.

If you put implant in such loose skin, it is easy to put in even a large size implant. This is very easy. The shape looks natural in a short time as well.

If you have not given a birth, or if you are very young, you would have strong elastic skin. The skin would not extend easily. Also, it would be very troubling to put something in it. Although, somehow you put in a large sized implant, your breast would not look natural.

Breast augmentation Korea KIES-U

Those aged patients who have given birth to many children and have sagging breasts can use maximum sized implants. The scar / wound disappears quickly also. The scar/wound is formed when the pulling strength of the skin is strong.

If the weight of this large implant is heavy, the weight would pull down the breasts making them sag more. Therefore, one needs to consider the size and weight together appropriately.

Young, single women with no experience in giving birth have many restrictions in the implant volume size. The skin pulls strongly. One needs to have a big desquamation spot in order to put in the implant. Also, the breast would look unnatural after the breast augmentation. As time flies, your breast would look more natural. But, there is one thing that you need to remember. The more elastic your skin is, the more difficult it is to put in the large sized implants.
Let’s summarize. First, we need to consider the width of the breast when choosing the implant size. Second, we need to consider how elastic the skin is.
If you have large body and elastic skin, you can use a large sized implant.
If you have small body and inelastic skin, you need to use a small sized implant.

If you are small but have elastic skin, you can use a large size implant.
But, if you are big but have inelastic skin, you need to use a small sized implant.

Before and after breast augmentation

Today, we looked at considering points focused on skin elasticity when choosing the implant size. I hope that this content has helped you.

Thank you and have a nice day.

Are breast implants safe for flight attendants (cabin crew)?

Somethings about breast augmentation and going on flights

Few years ago there was a very noisy, I do not know if you have seen many of these related articles. (An international flight interviewer touched the interviewee who had a breast augmentation)

Touched flight attendant (cabin crew) applicant’s breasts … Controversy on recruitment

A spokesperson from 000000 Airline stated “We already explained and received an agreement from the applicant for the body inspection. When a flight attendant (cabin crew) with breast implants get on plane, health related problem can be caused due to the low pressure. This is why we touch and feel the breasts.” “Also, our country has religious restriction on as to having tattoo on the body.” (Yunhap News)(Herald Economics)


This was a very ridiculous story. If the news agency accurately translated what the airline spokesperson said, then this is something that should have not happened.
It might have been a different story if they were selecting a pilot for a space ship.

An international flight normally flies at a height of 10,000 ~ 11,000 meters above ground level and the pressurization system within the airplane maintains the pressure that of 3,000 ~4,000 meters above ground. Therefore, the flight attendants would feel the pressure that of Baekdu mountain. It is difficult to understand that a silicone gel implant would collapse at this pressure level. It would be a different story if these flight attendants were in a space station. The offender of this sexual harassment event is giving a real stupid excuse.

There are virtually zero number of patients who worry about implant collapse in the airplane. They are aware that the airplanes have double or even triple layers of security system and the environment in the airline is not that different from that of the ground. Most patients are worried only about going back to their usual lifestyle after the breast augmentation.

-      I am a flight attendant (cabin crew), how many days do I need before getting back to work?







A flight attendant (cabin crew) is an occupation that faces a lot of face to face encounter with the customers therefore, requires high level of labor and also long recovery period.
Many patients go through much concerns after the breast augmentation therefore, they tend to take long vacation days off work. But hard labor occupations such as flight attendant(cabin crew) do not need to take much recovery period. 3 days are enough to get back to work.

But, if you have a double eyelid cosmetic surgery, it would be different. You would not be able to work with swollen eyes. There are many types of eye related cosmetic surgery, but 7 days are enough for recovery.

Also, there are many who are concerned about how to manage the recovery, what happens to the body after the cosmetic surgery, and what they need to do. I would like to introduce an instruction sheet for breast augmentation recovery that we use at our clinic.

 
Things to do on the first day after Breast augmentation surgery

Wake up, have breakfast, and then take the medication for the pain.
Take shower with warm water and also wash your hair.
Try driving, put on the seat belt, and also try closing the car door by yourself. It is important that you try to get back into daily routine and getting used to it. 
Take an afternoon nap if you can. Do not take a long nap but try again to move about your body. The more you move, the better you would feel about your body. If you do not move much, you will not feel good. 
As your day ends, you might feel that your body has swollen, but this is natural.
You might feel pain on the ribs and back. This is caused by the body fluid that is moving circulating. The pain would go away in about a week. 
It is not good to have your shoulders bent. Keep your shoulders straight and move them forwards and backwards. Get your shoulders relaxed. 
If the pain gets worse, take one more pill of the painkiller.

 
Things to do on the first day after the Breast augmentation surgery

You can go back home 2 hours after the breast augmentation. Take a nap for two hours once you get home and move about right away. (Get help from your family members or friends)
Try eating something. You will not feel sick or throw up when you eat 3~4 hours after the surgery. 
If you feel sick, you need to eat and drink better. Take the medication (painkiller) that has been prescribed. 
Exercise by raising your arms above the head. The more you do this, the better you would feel. Try doing house chore such as washing dishes, cooking and cleaning the house.
Attention!! It is better to move about and try to do something rather than just doing nothing after the surgery. (To prevent capsular contracture)
If you feel comfortable in moving your body, take shower, wash your hair, and dry your hair with the dryer. Call your friend and meet him/her outside somewhere, get some food and go shopping.
Lie on your chest for about 15 min before going to bed. Try this every day until you feel comfortable with it. It will be difficult for you when you try getting up from the bed. Turn your body slowly, sit up, and then stand up from the bed. Get up from your bed in this order.
Take medication before going to bed.


Patients of breast augmentation need to know that they need to move about a lot purposely to recover. If you have no problems with the body before and during the breast augmentation then you would be able to do – cleaning, laundry, washing dishes, cooking, driving, shopping, showering, moving things around the house, etc – within 24 hours.

One cannot say that you will not feel any pain. Total of 500 ~ 6000 gram substance has been put into your body just about an hour ago, therefore, if you do not feel any pain, then you are not feeling normal.

However this pain should not keep you away from your daily routine and should not restrict you from economic or daily activities. The more you move, the shorter the recovery period would take, and also lower the possibility of capsular contracture or any other side effects.

This is the overall concept of “breast augmentation 24 hour recovery.”

The 24 hour recovery system of breast augmentation has been introduced by a world renowned John B. Tebbetts from US and our clinic also follows such recent guideline. Putting 피주머니 and wrapping around with bandage, getting painkilling shots, using correction bra, and massaging are all old stories now.

A good breast augmentation would lead to the patient going home 2 hours after the surgery, and having her get back to daily life.

A good breast augmentation does not need any massaging or any activity that leads to pain. The patient does not need to come back to the hospital unless it’s only for a checkup. One does not need any treatment for the wounds as well.


Inflammatory fold method leads to quick recovery, but one can also recover within 24 hours with the axillary crease surgery.
 


-       Can I get on the airplane on the same day of the breast augmentation?

Yes, of course, you can get on the airplane on the same day of the surgery.
The flight attendants (Cabin crew) with the breast augmentation can get back to work within 3 days of the surgery.

If you need to go on the business trip abroad, you can leave on the day of the surgery but should come back to the clinic for a check-up.

There are many who are concerned about the pain. 3~4 pills of the painkillers would be fine for you. The pain would go one for about 7 days but the pain would not restrict you from doing any daily routine activities. If you need to do hard labor work, then schedule it for 7 days after the breast augmentation.

Looking at the status on the same day of the breast augmentation

Today, we looked at the flight attendants (cabin crew) with breast augmentation. The same applies to those who often go on business trips abroad and those patients who come to Korea from abroad by airplanes.

Have a great day and thank you for reading.

Incision	Pros	Cons
Inflammatory fold	Most widely applied globally Applicable to any shape of the breasts Least skin damage during the surgery Least possibility of damaging important nerves and blood vessels Same location for reconstruction Applicable to all types of implants Quickest surgery time	Incision on the cosmetic part of the breast
Armpit	Incision is rarely visible Applicable on both above and below the pectoralis muscle Applicable for all types of implants but one needs to know a special know-how for anatomical implant	Directly visible when conducting the breast augmentation Need endoscope in order to see the axillary crease Can damage important nerves and blood vessels Possibility of lymph complication and bands Different incision part for reconstruction
Areola	Good visual for the augmentation Low possibility of damaging important nerves and blood vessels Applicable to all planes Applicable to all types of implants but require a large sized areola for anatomical implant	Very visible spot for the incision Possibility of tissue damage and bleeding exist Can be exposed to bacteria within the breast Not applicable to large sized implant (if areola is small) Difficult to apply if the areola color is dark
Bellybutton	Incision line is far away from the breast No important nerves of blood vessels	Directly visible to the eyes Low accuracy of desquamation, high possibility of tissue damage Only applicable for saline bag type Different incision spot for reconstruction

Implant profile in breast augmentation, KIES-U breast augmentation Korea 

Implant profile for breast augmentation (water drop type)
I have shared the below image below, let’s look at it again.




All breast augmentation implants, for example, when are all cohesive gel 300cc, i.e same volume, have different diameter (bottom length) and height (thickness). We call this profile.
 
Let’s compare 275cc implants of a low profile from Mentor, and THS high profile from PolyTech.

Mentor’s low 275 has base diameter of 13.2cm and height of 2.9cm. Polytech’s high 275 has a base of 10.5cm and a height of 4.5cm.

What would happen if you put in Polytech’s high 275? The nipple would stick outward. The cup size would increase a lot. A person with AA size would have C size. However, the breast would not look to have a large volume.

What about Mentor’s low 275? The nipple would not stick outward. The cup size would not increase much also. However, the volume would increase a lot and the breast would look wide.

How about Mentor Mid 275cc? The base diameter is 11.7 and the height is 3.5. The cup size would increase with more volume.

Breast augmentation Korea

In reality, a lot of the patients use low or mid profile when getting breast augmentation. Korean patients do not have wide enough chest to use low profile high volume implants. Also, there are many of those who want high volume compared to the past.

Therefore, in order to use a larger size, there are many who choose mid-high profile over the low ones.

Extra high is only used in special cases. For example, if you have very narrow chest but want large breasts, you need to use the extra high profile.

Let’s say that there is a patient with a breast diameter of 11cm and want large sized implants. 250cc would be appropriate for 11cm. But large size refers to 300cc. This should not be used but the patient insists.
Natrelle’s high profile 300cc implant has a diameter of 11cm and height of 4.2cm.

The diameter is appropriate so the patient can use the 300cc that she wants. (Of course, the diameter is not the answer to everything. The doctor makes the final decision by considering skin elasticity, sagginess, etc)

Such implant might be able to satisfy the patient at the current moment, however this changes over time.
The implant continuously pressurizes the original breast. The breast contracts and after a year or two, the breast becomes smaller than the original size.
This breast pressure and contraction makes people avoid using high profile implants.

Another core factor is how tight the breast skin is. If the skin is too tight, the patient cannot use high or low large sized implants. If one forces such large implant into the breast, then the contraction of the breast leads to change in shape of the ribs as well.

Following is the summary of the core points on today’s post. (Point Up!)

- The size of the implant is one-dimensionally determined by breast diameter in cm.

- If the skin of the breast is tight, then smaller size is used. If the skin is loose, then a larger sized one can be used.

- If the patient was larger volume, then +30cc can be applied.

-  If the patient has broad chest and shoulders, she needs low profile. If the patient has narrow shoulders and chest, she needs mid profile. High profile is only used during special cases.




I think this is enough explanation on the implant size for now. If you have understood the contents of this post, I think that you can say that you know much about breast augmentation. Have you all understood the contents?

This is all for today. Thank you very much.

Implants for breast augmenation [Cohesive gel breast augmentation] 

Today I would like to write up details about frequently asked questions on cohesive gel breast augmentation. First, let’s discuss about the cohesive gel implant.


1. Can I use cohesive gel for my Breast augmentation surgery? 

Currently, anyone can use the cohesive gel. Saline bag type is used when inputted through the belly button or in some special cases.

Actually, cohesive gel is a product name. It has been developed long time ago. It refers to sticky silicon type implants.

Many companies are making silicone implants that remember or memorize the shape. Mentor and McGhan in US call these implants Memory gel or Cohesive silicone gel bag. Since then, many companies in Europe and South America have made such silicone gel implants that remember and maintain the shape.

Cohesive gel implant have become famous because it is made of silicone substance that is sticky therefore does not leak out if the exterior of the implant is damaged.

The cohesive gel implant was certified in 2007 by Korea’s MFDS and has been used ever since. However, it was used 10 years prior to Korea’s certification in Europe and South America.

Breast augmentation Korea KIES-U

2) I have heard that capsular contracture is not caused and one does not need any massage if she uses textured implants. Is this true? 

Mentor and McGhan (currently known as Allergan), both have textured and smooth type implants.

It is known that if the textured implant is put in above the pectoralis major muscle, there is a less possibility of causing capsular contracture when compared to the smooth type.
The incidence rate of capsular contracture when put below the pectoralis major muscle is similar for both textured and smooth type however, this rate is lower than that of above the pectoralis major muscle.

Surface of the textured implant seen through the electron microscope.

 However if the textured type is put above the pectoralis major muscle in a person with small breast or thin skin, one can feel the implant from the outside. So if a patient has small breasts, it is recommended that the implants, whether smooth or textured, be put in under the pectoralis major muscle.

Strong massaging on the textured implant can lead to soft tissue damage, therefore, this is not recommended. Dr. Findley, a well-known breast augmentation specialist in US, stated that Biocell texture that has rough texture when applied frictional force can lead to the formation of the seroma.

Mentor calls its textured implant, Siltex and Allergan calls its product Biocell
.
3) Is Mentor the better when compared to Allergan (Natrelle)? 

It is difficult to say which is better. Whatever seems familiar with the surgeon’s hands might be the better one to use.

Products from Mentor are produced and sold in sizes of 225cc, 250cc, 275cc, 300cc, categorized by 25cc.

Allergan makes its midrange profile in sizes of 222cc, 253cc, 272cc, 290cc, 322cc, categorized by 20cc.

All are good products but there aren’t enough evidence that prove the products in Brazil, Germany, France are better that US products that are used in Korea.

There are various types of cohesive gel, ie. Sticky silicone gel products, in neighboring countries of Japan, Hong Kong, Singapore and other 7~ countries, however it is sad to know that there are very limited number of products in Korea.

Mentor 275cc round smooth moderate profile put in from the armpit

Today we looked at what a cohesive gel implant is.

Thank you.