Microthane implant – is it safe to use in the long term?

Today I would like to share about a writing from Dr. Pompei from Rome, Italy, who is a World known specialist in microthane implant augmentation. As you read this post, you will be able to understand the characteristics of microthane implant better.



Ashley first adopted breast augmentation with polyurethane implant between 1970~1972. This is about 50 years ago, a very long time ago. Since then, there has been much advancement and improvement in the technique.

The first implants introduced were hard and had no elasticity. Glue was used to stick the polyurethane on the gel bag. This was not safe. The first generation implant with time would change shape, foam would fall off and also the silicone gel would be separated. This could result in silicone leakage.

Loss of foam in 1st generation polyurethane implant would make the shell become similar to smooth type implant. Some believed that this would increase the possibility of capsular contracture.

But this is not an accurate hypothesis. Capsular contracture is not formed due to the smooth shell but because of the silicone leakage, i.e. implant collapse.

1st generation polyurethance implant was made by BMS (Brystol-Myers-Squibb). I shared about this in my post of 30 year experiment on polyurethane implants used in breast augmentation.

Recently, Dr. Pompei announced his result on 10 year monitoring of more modern product, Polytech’s microthane implant. The essay was published on 2016 Aesthetic surgery journal  (Oxford Press).

131 patients (255 implants) received breast augmentation with microthane implants between 2000~2012 in Sandro Pertini Hospital, Rome. Most patients used round type polyurethane implants with dual plane or above the pectoralis method.

After an average of 110 month follow-up survey, there were 4 cases of malpositioning, 4 cases of rippling, 2 cases of capsular contracture after hematoma, 2 cases of collapse, and one contracture. There were total of 19 complications. Bottoming out effect due to malpositioning was found only on one patient but the cause is unclear.

But when we consider the characteristics of microthane implants, it is unusual that there were 4 cases of malpositioning.

Once the microthane implant is inserted into the body, it immediately sticks to the surrounding tissue therefore the implant does not move about although the patient takes some aggressive actions.

It could be assumed that the surgeon was not careful with the implant insertion during the surgery. The surgeon could have placed the implant in the wrong spot and the implant remained there. If the microthane implant was inserted into the accurate location, it does not move around.

Microthane was larger barrier between the polyurethane foam and silicone gel compared to the predecessor. Also the sticking process was largely improved. The possibility of gel leakage due to the separation of shell and foam greatly decreased.
This is why many expect that the chances of having capsular contracture also greatly decreased for microthane implants.
Of course, we need data that has been gathered for more than 10 years.



Capsular contracture was found in total of 3 breasts. 2 breasts had capsular contracture after hematoma. There was much bleeding during the augmentation that led to the forming of hematoma. The hematoma interferes with the polyurethane foam sticking to the skin tissue. The capsular contracture was formed within a very short period of time (less than 1 year).

The result of this experiment showed that the incidence rate of capsular contracture during 14.6 years is 2.3%. According to MD Spear, an expert in breast augmentation, the 10 year incidence of capsular contracture with textured silicone gel implant is 17.2%, and smooth silicone gel with 19.9%. But microthane implant had incidence rate that is about 1/8 ~1/9 of silicone gel implant.

The structure of micraothane implant is very active and strong. It is very difficult and time consuming to remove the microthane implant after the breast augmentation. The implant holds on to the skin tissue cell tightly.

If you remove the microthane implant from the breast after a few years, you would be able to fine urethane foam tangles with the epidermis. You would see the rest on the implant exterior. We cannot remove this tangled part with scissors or any other equipment.



The information that removing microthane implant harming the patient or that it is impossible to remove the microthane implant is not true. It is difficult to be removed right after the breast augmentation but after some time, it can be removed rather easily.

MD Pompei shows much confidence on his microthane implant research after performing many breast augmentation surgeries. There are some doctors who use microthane implants on capsular contracture patients, but it can be used in the 1st breast augmentation surgery with good results.

Today, we share about polyurethane foam coated implant, i.e. microthane implant and the research from Italy.

This is all for today. Thank you very much.



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

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
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.

The science of plastic surgery is rapidly changing. The changes are so fast-paced that I started comparing today’s trends to last month’s, not last year’s. Things that were thought impossible before are becoming reality before our eyes. In such a volatile environment, we are pushing on without knowing where we are going. However, we still need to prepare for the future and that starts with reviewing the past. Dr. Joo-hyuck Lee of KIES-U Plastic Surgery Korea leads a new series on the present and future of plastic surgery.

What is behind the recent popularity of microtextured implants?

I am seeing more and more patients asking about microtextured implants for breast augmentation. Sebbin or BellaGel products are some of the most popular. Many doctors may still be unfamiliar with the term ‘microtextured implants.’ In the past, Allergan’s Biocell was categorized as macrotextured implants and Mentor’s Siltex as microtextured implants [Derby, Brian M.; Textured Silicone Breast Implant Use in Primary Augmentation: Core Data Update and Review, PRS Jan2015;135(1), 113-124]. However, such categorization was used within the academia and was not widely used by the public.

The current popularity of the term microtexture does not accurately reflect the scientific concepts and is being rampantly used as a marketing keyword by distributors and even some plastic surgeons.

The microtextured implants of Sebbin, a French manufacturer, have become very popular in Korea. Advertisements claiming they offer a natural texture with a lower risk of capsular contracture have successfully won over the public. And naturally, Sebbin’s implants have become very hard to come by in Korea. Catching on to this new trend, BNS Med quickly developed a microtextured implant line called BellaGel and entered the Korean market.

These microtextured implants have micro bumps on the surface that are only 30-40 micrometers wide. This creates a very smooth surface. What is the reason for designing the bumps to be that small?

Sebbin’s product catalog does not mention “natural feeling” anywhere to describe their microtextured implants. 

1. Ease of insertion and less friction on the tissues.
2. Minimizing the rate of capsular contracture.

It does, however, explain that the implants are “textured and are not prone to capsular contracture. The microtextured surface makes it easy to insert them.” However, there is no clinical or scientific data supporting this claim. It is surprising that many people have accepted as a fact that microtextured implants are safe from capsular contracture due to aggressive marketing.

 Any surgeon specializing breast augmentation would know that the resistance of textured implants to capsular contracture is irrelevant in Korean patients who mostly go through submuscular placement. When McGhan first developed the textured shell, the primary goal was to promote tissue ingrowth and prevent capsular contracture. However, there is a growing consensus that they failed in achieving this goal. 

Early on, Tebbetts already explained that the textured shell is not effective in preventing capsular contracture.¹ He found that some plastic surgeons mistakenly think that tissue adherence of the textured shell is important for preventing capsular contracture. However, FDA’s PMA study (comparing textured and smooth saline implants) already found there is no difference in the incidence of capsular contracture between the two types. 

Image 1. Source: S. Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

Image 2. Source: S. Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

Image 3.

Image 4. Source: S.Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

Image 5.

Table 1. The 14 point plan for preventing capsular contracture. It cannot be said that all surgeons agree with this but various peer reviews have mentioned similar measures for preventing capsular contracture in the past few years (Source: William P. Adams, Jr., Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination Around the Device: Experience in 42,000 Implants., Plast. Reconstr. Surg. 140:427,2017).

Possibility of breast implant rupture vs MRI, is it necessary?

KIES-U Breast augmentation Korea

The US FDA approved silicone gel implant sales in 2006 for the purpose of breast correction and augmentation. It also provided guideline that there should be MRI test once every 2 years starting from the third year of breast augmentation.


There is no change to this guideline.
Of course such is necessary, if there is a damage to the implant and the patient needs some treatment. but there are those who oppose this.



Today, I would like to introduce a data of an experiment that Teresa Wang M.D and other from Sloan-Kettering Cancer center in NY conducted with 383 patients.

There was a tracking study in this hospital for 10 years starting from 1999 on the patients with correction surgery. MRI was tested and data was gathered to see if the implants have been ruptured or not. 963 MRI were conducted over 53 months (4 years and 5 months).

The result showed that the damage rate was 1.9% through MRI and the false positive rate is 8.4%.

The statistical findings showed that the rupture rate of implant within the 3~5 years was 0% and 2.3% for 7 years. 15.1% for within 10 years.

The rupture rate of the implants is very low therefore all the high costs and time needed by the patients for MRI test (in the first 5~6 years) are a burden. Therefore, the authors conclude with a question of whether the MRI inspection is really necessary.


There are opinions that MRI is unnecessary for those patients without any complications for 7 years after breast augmentation.

Since the first day that the cohesive gel has been imported until now, I have never seen a patient taking a MRI test because she was worried about the implant rupture.



It is not saying that these patients are not interested in their bodies. It is just that they did not have any problems or discomforts therefore this expensive MRI (MRI is not reimbursed and costs about $500 or more) is not tested by many.

Also there are other findings, that the silicone when leaked from the implant, does not get dissolved within the body and it does not cause any complication or illness.
Is this guideline of getting tests once every 2 years really meaningful?

FDA should remove or edit this guideline not only because of this finding from Teresa Wang.

I think that it is more realistic to consult with the doctor 10 years after the breast augmentation. If there is any problem, then one can use ultrasonic test that is less costly to find out the problem. I think this is more realistic and better scientifically for the patient compared to the MRI.



Thank you for reading. Have a great day.




Breast augmentation Korea KIES-U | www.kiesu.com | +82-2-3452-0202 
 

Criteria for selecting anatomical vs. round type implant

Many of the patients ask this question so I have shared various postings on it and provided much explanation but there is still some confusion.

Breast augmentation Korea KIES-U Plastic surgery clinic

So I have prepared an algorithm today for your understanding.

I have tried to make it crystal clear, but I am not sure if it is effective enough.


I have used terms such as loose and tight skin for easy understanding but this actually refers to the breast envelope. This involves all the parts that include the fat under the skin layer, epidermis, muscle, etc.

Young women have tight skin, and older women have loose skin.

Also, thin person with small original breasts also have tight skin. A person with larger size breasts has loose skin.

Another case is that if the patient gives birth, the skin becomes loose as well.

So this is the first thing that we need to consider. Choosing anatomical or round type is not like choosing a typical product when shopping. We need to consider the status of the original breasts, and the body of the patient.

If you are young and have tight breasts but apply large sized implants, your skin would put much pressure on the implant causing the shape to deform.

In such case, I would recommend anatomical type implant. If the implant can be seen from the outside, it is better to use the anatomical because it is more natural looking.

But things become different if the patient wants small volume. Although the skin may be tight, the implant volume itself is not large therefore there is not much tension inside the pocket. The implant is half-liquid because it is consisted of gel therefore it gets shaped down once inserted and so the upper part of the implant looks little empty.

This makes the new breasts look natural.



So even though you have tight skin but prefer more natural looking breasts and you are not that interested in large volume, round type implant may be the best choice.

Then how about those with loose skin, or aged patients, and those who gave birth and have sagging breasts?

The goal of breast augmentation for such patients may be enlargement, but there is also another goal of removing the wrinkles, making the skin more elastic and filling up the upper breasts to make them look better.

If small volume implants are used in such cases, there would not be much effect in filling up the upper volume or making the skin elastic. If the volume is too large, then the sagging effect could result quicker therefore one must choose an appropriate sized implant.

Also, such implants need to be stabled and maintain its shape although the skin may not be elastic.

Although the original breast shape becomes out of shape, the implants should able to support and maintain the new shape formed in order to lead to positive result in the long term. This is what we call shape stable implant.


The most representative shape stable implant was firm implant such as Style 410 in the past, but now there are too many products with many spectrums that have differences in level of stability.

Most of the anatomical implants introduced in our country are stable in shape but most of the round type implants at our country are not.

So the type, whether it is the anatomical type or the round type, is not important, but the stability is.



Lastly, there are patients who have appropriate size, shape, volume, feel, ratio, etc in the original breasts. Such patients can use all types / volume implants. Both round type and anatomical can make the breasts look beautiful....

The implants were initially used to enlarge your breasts therefore the original breasts are important. If your original breasts look great then the implants would not have much influence in making them look better.

So if there aren’t any complications after the breast augmentation, the patient would be greatly satisfied.

Today, I shared a diagram that could be simple for you to understand the differences of the implants that I have shared much in the past.

There are too many implants imported today and it is difficult to decide between the round type and the anatomical type. The answer can be found above.
Thank you for reading.

Breast augmentation Korea

Today, I would like to share about the relationship between breast cancer and breast augmentation.



Here are some of the general questions;
1. I already had a breast augmentation. What happens to the implants if I suffer from breast cancer in the future?
2. If the implants are removed because of the breast cancer, can I get reconstruction again with other implants?
3. What is the cost of using implants for breast reconstruction?



Let’s answer these questions one by one.

But, before I answer them I think that I need to share about the various treating methods of breast cancer.

If the tumors become clear and are separated without the lymph nodes spreading (early stages of breast cancer), we can just remove the tumors
In such situation, we do not need to remove the implant and recover it.



But in the more severe case of breast cancer, we need to remove the polluted area and also the implant. We need to conduct a surgery to remove the breast cancer and start on the reconstruction right away (stage 1). There are times when we assign another date after a few months to conduct second surgery (stage 2).

Whether it is stage 1 or stage 2, the reconstruction is done with the implant or the patient fat can be used (rectus abdominis muscle or latissimus dorsi muscle flap surgery) or even both. Anyways, the breast cancer reconstruction can be conducted with implants.



However, there are some differences in this compared to the 1st breast augmentation surgery. If the penetration rate of the tumor is high, then we cannot reuse the original implants. We need to use new ones.

Also, the size of the implant must be smaller. When we remove the cancer tumors, we need to remove the surrounding tissue and skin as well, therefore if we use a large sized implant, we will not be able to close the skin with less tissue.

We can also apply the radiation treatment but we cannot use the implants at this point in time because there is a high change of skin necrosis.

So in answering the above questions with such knowledge,

1. I already had a breast augmentation. What happens to the implants if I suffer from breast cancer in the future?

We can maintain the breast augmentation effects if we find the cancer in the early stages. But if the cancer is any worse, we need to remove the implant along with the cancer tumor.

2. If the implants are removed because of the breast cancer, can I get correction again with the implants? 

As explained above, we can reconstruct with the implants. But this all depends on how elastic the skin is.
If the incision area is large and if there needs to be much skin removed, then reconstruction with implants becomes difficult.



Also if you are planned for radiation treatment after the surgery, then the implant cannot be used also.



If you are unclear about something, we can conduct rectus abdominis muscle or latissimus dorsi muscle flap surgery with the implants as well but small sized implants would be used.

If the patient wants implant no matter what but has less tissue cells and less elastic skin, then we could use the saline gab first to expand the skin and then apply the cohesive gel implant.


We use the saline bag first and close out the incision. Then we increase the amount of saline fluid over time to expand on the size. After a few months, the breast skin would expand and we will be able to see some improvement.

After this expansion is complete, we would conduct the reconstruction by removing the saline bag and replacing it with cohesive gel implant.



3. All the global companies that produce good quality implants provide warranties on their products. The implants used to replace the original ones during the breast cancer surgery or reconstruction can get warranty as well.



Also the reconstruction surgery after the breast cancer surgery can be reimbursed from the National Health Insurance in Korea. So, one can perceive that she has removed some burden on the cost.

However, this compensation from the National Health Insurance is very low and it cannot even cover the cost of the implants. I am not sure whether the patient would able to pay the cost of reconstruction surgery although she gets support from the National Health Insurance.

Today, we looked at the relationship between breast augmentation reconstruction after breast cancer surgery and the implants.

Thank you.

Breast augmentation - About illegal breast implants

I have found few Chinese made cohesive gel implants when I conducted revision surgeries abroad.

I thought that China is a great country, because, it can make such fake products. There was a logo ‘Shanghai’ at the back of this fake Chinese implant.




It is not wrong to say that all the medical devices and the products that we used are all from the western countries. All the breast implants are from either Europe or US.
But, Chinese people do not consider western products good enough. They have such pride that their technical ability is not bad compared to those of the western countries. They are the followers compared to US or Russia in satellites or rocket physics but they still have good technical skills.




However, one can question Chinese techniques except for a few areas in the medical industry. The biggest problem is that the land is too large with great population so the political powers can only reach so much. It is difficult to know who is making what in that large country. This is why the Chinese people also do not rely on their Made in China products although they have much pride in them.

For the same reasons, I as a doctor, do not trust Chinese medical related product. There is no national restriction or certification on these medical products. This is a big problem.







Anyway, I was curious about this Chinese implant so I kept on touching it and compared it with other implants from US / Europe. There is not much difference in the products if you look at it vaguely, however, there are many problems that you can recognize.

First, the appearance of the exterior texture is not stable.
If you look at Mentor’s product, the texture is smooth and slippery. Allergan’s texture is a little bumpier but is smooth also.

However, this Shanghai implant is not uniform in appearance (similar to hair that you have not combed).

Also, it seems that there is shortage of gel in the implant. There needs to be enough gel within the product in order to maintain the shape. There are some doctors who think that there should be excess amount of gel. The Chinese product looks alright from the outside, but there is not enough gel on the inside.



As I conducted the revision and took out the implant, I have observed that there was much sticky liquid in the implant pocket. I think that the cohesive gel might have leaked out from the implant and this is why there weren’t enough gel in the product.

I do not want to judge this Shanghai product badly without any evidence. Also one cannot think that China is far behind Europe.
But, if the doctors in China are still using their local products today, they need to report their evaluation on the implants. There is not one report on this Shanghai implant. Nothing about collapse rate, capsular contracture rate, revision rate, etc….

Such implants without any data cannot be used in the actual cosmetic surgery.
Currently there are 4 products; Polytech from Germany, Mentor and Allergan from US, and Sebbin from France; imported to our country. All have been evaluated and used by many doctors.

KIES-U Mongolia Surgery room

Today, I posted on how I felt about the Chinese implant.
I don’t think that there is any doctor who uses this uncertified product in Korea but there are many news on it so I do not know what to say about it.


This is all for today.
Thank you very much.