How can we treat Poland syndrome?

[Breast surgery Korea KIES-U]

Q. I have Poland syndrome. What can I do about it? Can there be any more problems in my body?

A. Here is the answer.

Poland syndrome was discovered by an English doctor, Patrick Clarkson in 1962. He had observed patients with abnormality on hands and hypoplasia on the breasts.



Clarkson found out that he saw was discovered about 100 years earlier by Alfred Poland. Poland reported it as just one of some cases and did not think that it was a symptom of some other illness. So it is correct to say that Patrick Clarkson was the one who found this Poland syndrome.

Guy's hospital in London, UK

As you can see from this background information, Poland Syndrome is not something that is common. Poland syndrome involves hypoplasia of pectoralis muscle and symmelia of your fingers.

It is a state where you are missing an big muscle between brachial and breastbone. There are at times where more muscle is lost near the breastbone making the shoulders look deform.

Also the ribs can be shorter than usual and the subcutaneous fat may be thin. You can find abnormalities in the areola and the nipple. You might not have any hair or too much hair in the armpit.



In most cases, we do not bring about the problems that may happen on the chest.Poland syndrome commonly happens on the right side and it is more common with women than men.

There is no accurate cause of Poland Syndrome but there are opinions that it is caused because there is a blockage in the subclavian artery blood flow during prenatal life. Subclavian artery is known to be somewhat involved in the growing of the hand under the chest during the prenatal stage.



There are many types of treatments (but we are only going to cover about the breasts)

We put implant in the greater pectoral muscle where there is a loss of volume due to the missing muscle. There is no Ready-made silicone implant for the greater pectoral muscle therefore we need to make CAD designed implant.
These implants are not made of cohesive gel but by silicone elastomer that feels similar to rubber and acts well like a strong muscle.
At times, we use TRAM flap or LD flap where we use the fat from abdominis muscle or latissimus muscle to fill up the pectoral space.

Axillary hyperhidrosis is cut in order to put in the implant. For women, we not only need to fill up the pectoral muscle but also provide more volume therefore second surgery might be necessary. The 2nd surgery could require cohesive gel implant or fat transplant.



It has been reported that women suffer Poland syndrome three times more than men and it happens on the left side twice as much than the right. The incidence rate of this illness is one out of every 7,000~10,000 newborns.

There is no limitation to daily chores for those with Poland syndrome. Fernando Alonso, F1 racing driver, suffers from this as well. He does not have right pectoral greater muscle. There are famous Olympic boxer and PGA golfer with this as well.



You cannot be differentiated as a disabled because you have a Poland syndrome. The surgery is done just to make the appearance better. It is for the balance of your body. (Your hands might require more microsurgery)
 

Female patients with Poland syndrome might require latissimus dorsi muscle flap surgery or pectoral implant surgery. If you want to fill up the less generated breasts, then we can use the cohesive gel implant on one or both your breasts and conduct breast augmentation. If you have a lot of fat, then we can also consider fat transplant.

This is all for today, thank you very much.

Uneven breasts; how to correct them
There are patients who have a complex with uneven breasts as much as those who do with small or sagging breasts. Today I would like to share about the uneven breasts.

People think of uneven breasts as breasts with different volume size but there is a lot more to this. Let’s look at them one by one.

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1. Uneven thorax
2. Different location or inframammary fold or nipples
3. Different degree of sagging
4. Different original shapes of two breasts
5. Uneven breasts caused by breast cancer surgery or other treatments
6. Uneven breasts caused by breast augmentation, contraction, correction

There are the main factors of uneven breasts

1. If you have two sides uneven thorax then you have uneven breasts by default. This is because left and right sides of your body are uneven naturally.
You need to understand this properly. All human being and all living things do not have perfectly even two sides of the body. Only the mannequins and dolls have perfect even two sides of the body. Your face, hands, and legs are all uneven.




As you can see in the image above, the left and right lungs look differently. The heart is not in the middle but is little closed to the left. The main artery and the main vein are also positioned towards one side.
 
This is why the ribs that protect the inner parts of the body look differently as well. The left ribs that protect the heart usually stick outwards more that the right ones.
This is why about 90% of the people think that their left chest sticks out more than the right. But there is not that much difference to say that both sides are uneven. However, we tend to use different size implants in order to make the two volumes the same.

From my experience in consulting with the patients, about half of them know that they have uneven breasts and the other half does not.



2. There are very rare amount of people who have the two inframammary folds lined up in a straight line. This means that one inframammary fold tends to be positioned higher than the other. Therefore, the nipples are located at different level of position as well.

From my experience,  the distance between the nipple and the inframammary fold is about 1 cm or less. We can say that this much distance is within the error range therefore, we do not need to focus on the cosmetic beauty regarding it. But if the distance is greater, then you might have to consider getting a correction done.
You can consider areola movement and implant surgery simultaneously. We can correct the location of both areola and nipples and make the inframammary folds line up straight as well.
 
3. It is common to see different degree of sagging as well. One breast may sag when you are going through puberty, but this usually happens after breast feeding as mothers cannot balance out the breast feeding evenly on both sides.
It is natural for the bigger breast to sag more after giving birth. The loss of volume is noticeable as well. Using implants on both the breasts cannot solve this problem. The sagging needs to be corrected so they are even therefore we need to conduct breast augmentation on the more sagging breast simultaneously with correction.
Many think that breast augmentation just involves putting in of the implant. But they do not know how the sagging breasts are corrected. We can design the correction in a shape of concentric circle and move the location of the areola and the nipple. We can gather or pull up the derma from the bottom part of the breast to correct the sagging. There are many techniques as such.
We can also apply different level of lifting to make the breasts even. At times only one implant is used for a particular side and we conduct correction on the other.

 
4. Two sides with different shapes mean that one side is conical and the other is sagging. Or one side might have the areola and the nipple located away to the left of right side of your breast, and the other in the middle of the other breast. This happens because you are born with uneven thorax.

We can move the location of areola and the nipple more towards the middle of the breast or we can make the implant pocket size different on each breast or even use different types of implants. We can apply dual plane on one side and under/above pectoralis muscle method on the other.

Reference from an essay in Brazilian Plastic Surgery Journal

5. We must consider many methods for uncorrected breast after breast cancer surgery or one that needs correction for unevenness. We can change the skin flap, or can use implant by estimating how much fat can be regenerated. We could also add fat transplant.

Reference from an essay in Brazilian Plastic Surgery Journal

 
6. There are times when you get uneven breast because of some cosmetic surgery or your uneven breast may look worse after the surgery. You need to compare your breasts before and after the surgery properly so that you can know the cause of the unevenness and find exactly what needs to be done to correct this.

You might need to have different planes on each sides for the implants. You have might to consider relocating the position of the areola and the nipple. You could consider fat transplant or you might even have to replace the old implants. You need to think about all these addtional alternatives.

Lastly, uneven breasts is a problem that most women have therefore you should not think that only you have this particular problem. Every person has uneven two sides of the body. You breasts are to look good with cosmetic surgery and not to look even on both sides.

This is all for today. Thank you for reading.

Breast surgery Korea KIES-U plastic surgery

The least pretty looking breast is the sagging breast.
One of the scariest concern that the women around the world have is having sagging breasts and their body turning “old”.




Men then to lose interest on those women with loss in breast volume. A lot of women after pregnancy come and ask about what to do with their breasts.
Your breasts sag more and more as your get older, give more births, and as you gain and lose weight.

Your sagging breasts have a critical point.
There is a standard such as
 - The breast is sagging but it still has certain formability
 - The breast is now completely sagging


There is a cooper’s ligament in your breast. It is a diaphragm formed from a fascia that makes many different rooms and maintains the shape. When this cooper’s ligament loses elasticity, the breast itself loses the strength to hold the cell tissue therefore, the breast starts to sag.

If the skin itself loses elasticity simultaneously, then you would have old looking breasts. There can be wrinkles on the nipple and the part surrounding it.
It is difficult to know where the border line is because each patient has different locations of the original breast and combination of nipple and areola.
However, in average, the critical stage is examined through following standards.





- When white skin under the lower part of the areola cannot be seen
- When the composite body of the areola and the nipple is lower than the inframammary fold.

When this happens, we know that there is a problem, and so recommend the patient to get the Mastopexy, a breast lifting technique.


If you can see the white skin below the lower part of the areola, and if the nipple and the areola complex is above the inframammary fold, then you would not need the Mastopexy but can get the dual plane implant surgery.




But there are some uncertainties.
One might think that the current stage is past the critical point or not.
The breast might be sagging but not completely.
One might not be able to decide between the dual plane implant surgery and Mastopexy.
In such case, we can conduct the implant surgery while changing the location of the areola.




In such case, the breast is not pushed upwards but on the areola is relocated to upper area. The name of this procedure would be areola relocating + breast augmentation.


Today, I posted on the conditions of sagging breasts. In reality, there are various cases of sagging breasts, and the patients feel differently about the sagging breasts. There are many ways to improve on what the patient feels and there are also some concerns with the costs therefore it is important that you visit a hospital to get proper knowledge.
This is all for today, thanks for reading. Have a good day.

Can you see the implant in the x-ray after the breast augmentation? 

There are many of those who ask if one can see the silicone implant through the x-ray after the breast implantation.

The answer to this is, “Yes”. You can also see the saline bag type implant as well.

X-ray is a line that penetrates through the body, and the amount of penetrability determines the shade or shadow that comes out finally as the x-ray film.




Doctors are well aware of how the x-ray penetrates through a normal person’s body.
If there is a substance in the body, the shade looks different therefore, one can know that there is something different than that of a normal body.




But having a silicone implant in the body does not mean that there is something wrong with the body itself.

X-ray specialists receive training on how to look and examine the x-ray of those women’s chest that has implants.



It is very rare that they misjudge heart or lung disease, or trauma such as a break on the one because the implant covers those certain parts.

In case of CT, one discovers the implant coincidently as he/she looks for heart or lung illness, or clinical stage of the lung cancer.



One cannot get detailed information of the implant through the CT.

If you find that there is an implant rupture through the CT, then you would not need to get a MRI.

However, although you get positive result from CT, this does not mean that the implant is at a normal status.

If you want an accurate examination of your implant, MRI is the one that you need to take.





Many women are concerned about implants getting damaged due to the mammogram (i.e. x-ray) pressing against the chest as they get an examination for breast cancer.

The answer to this is that there is no actual problem in this. Such pressure has 0% chance of rupturing the implants. You do not need to worry about this and so you can go on and take the mammogram.

There are those who are concerned about one’s privacy being scrutinized as the implants may show up during the mammogram or ultrasound test.





But this is something that you need to compromise.

The reason is that there is nothing more important than health to any human.
One should not try to hide that there is a substance in the body from a doctor who needs to examine, find, and treat an illness.

If is necessary for you to let the doctor know that you have implants in your breasts whether you are being examined or treated by the doctor.

Also, there are many women who had breast augmentation with implants therefore, it is rather not awkward for the doctors to treat or examine a woman with implants.

This is all for today. Thank you for reading. Have a good night.

Recent finding on the risk factors of capsular contracture (breast augmentation) 

There was an announcement regarding a finding on the capsular contracture risk factors by Dr. Grant Stevens and 34 others and so I would like to post on that.

When there is a medical finding and announcement, there must be a reasonable number of samples to derive statistics. Also, there should be an appropriate time period that the experiment was conducted.

Therefore, major announcement such as this one, does not come out easily. There are many experts who debate on this finding, showing how important this journal article is.



There were 34 doctors and 2560 breast augmentation patients involved in this research. The data was gathered over a period of 5 years.

Only one type of implant, Sientra (known as SiliMed in Korea) was used, and the main objective was to find out the difference in the capsular contracture incidence rate between the textured type and the smooth type.

The incidence rate of these 2560 patients over 5 years was 7.6%. Some doctors experienced the incidence rate of less than 2% and some over 17% therefore the deviation was rather large.

The risk factors that lead to capsular contracture found from this experiment are

Surface of the implant; Smooth type has higher incidence rate

Incision part; Breast aureole has higher incidence rate than the inframammary fold

Plane; Subglandular has higher incidence rate than subpectoral

Hermatoma and seroma formation leads to higher possibility of capsular contracture

There are other minor ones such as massage, correction bra, size, etc.



Former findings showed that subpectoral had similar incidence rate whether the implant is textured or smooth, but higher incidence rate for subglandular breast augmentation.
But, the current experiments showed that whether it is subpectoral or subglandular, the textured type leads to lower possibility of capsular contracture.
Also, there was a statistical finding that the subpectoral leads to lower possibility as well.



Another finding was that massaging after the breast augmentation causes more cases of capsular contracture.

Massaging was popular in 1970’s and it was perceived that massaging minimizes the possibility of capsular contracture but there weren’t any findings that massaging influences capsular contracture in any way.

Massaging leading to lower possibility of capsular contracture is something of old and should be completely removed today.

The summary of the report is that in order to reduce the capsular contracture, one should use the textured implant, place it under the pectoralis muscle, and conduct inframammary fold incision.

There aren’t convincing contents about the implant size and the usage of the correction bra. Also, the experiment only used the Sientra (SiliMed) implants therefore, there needs to be more supplementary findings or data.




This is all for today.
Thank you for reading.

[Breast Surgery Korea KIES-U]

Breast augmentation is the most popular beauty surgery in the world today.
In 2010, there were 318,000 cases of breast augmentation in US alone.



Image that shows the possibility of capsular contracture according to different incision areas. Reference: 2012 Aesthetic surgery journal vol. 32, Doctor Jacobson


The most concerning side effect after the breast augmentation is the capsular contracture. There is no confirmed reason as to why this capsular contracture is caused or formed but there are many doctors who perceive that the exterior pollutant that penetrates into the body is the cause.




Prof. Jeffrey M Jacobson, Prof. Scott Spear and others from Georgetown University in D.C. has studied results from experimenting 197 samples from 2003 to 2009.
Prof. Jacobson and his team built a hypothesis that staphylococcus on the human skin leads to high possibility of capsular contracture.

They perceived that the staphylococcus that lives in sweating parts of the body such as the armpit touches the implant as it is put into the breast leading to higher possibility of the capsular contracture. They also believed that staphylococcus infected the implant in the same way when the incision is done on the areola.

After many comparisons and analysis, the incidence rate of capsular contracture due to armpit incision was found to be the highest at 6.4%, followed by breast aureole at 2.4% and inframammary fold at 0.5%.



This result was found to be statistically significant by Prof. Jacobson’s team.

The finding was that the possibility of capsular contracture by armpit incision is 13 times more likely than the inframammary fold incision. 

Capsular contracture is not as simple as to be only explained by germs polluting the implant. How the patient desquamates the implant pocket, how severe is the bleeding, is the implant textured, etc are all variables that may lead to capsular contracture.

However, I think that this finding, inframammary fold incision leading to least possibility of capsular contracture, is a meaningful one.

Toda, we looked at the findings by Georgetown University research team regarding the different incision parts and the incidence rate of the capsular contracture.

Have a great weekend. Thank you.

Choosing your implant for water drop breast augmentation 

It is not easy to make a normal person who is not professionally knowledgeable in medical field to understand what a doctor wants to communicate. I get quite surprised that my patients do not understand me.

Today I look like to share something that the patients have most difficulty understanding, making it easier for you to understand. It is about selecting a water drop implant.

Water drop implant is 3 dimensional, so you can select the implant according to 3 stages.


There are those who are quick to ask “are you not going to decide on the volume (cc)?” If you think about the three stated above, you will be able to know the volume instantly.

You will be able to know what a diameter / height / thickness are with the help of the image below.





You only need 2 parameters for the round type implant because the diameter and the height is always the same.

But you need to decide on the diameter, height, and thickness for the water drop type.

First, the diameter refers to the width of the implant. The diameter of the implant should be selected first. It cannot exceed the diameter of the breast. If the diameter of the breast is 10.5cm, the diameter of the implant should be equal or less than 10.5cm. From the 3 parameters of diameter / height / thickness, the diameter should be chosen first.

Second, the height of the implant is related to the type of the implant. The one with short height would be the ‘short type’, mid height would be ‘Normal type’, and the long length would be ‘tall type’. So one would measure the upper body and if it seems long, you would select the tall type, or if it seems small, you would select the short type. The normal type is the most common one. You will be able to understand this more easily with the help of the images below.







Third, we refer to the thickness as ‘profile’. Low profile refer to the one that is really thin, Moderate profile for normal sized one, and the high profile for something that is thick. The volume of the implant depends on the thickness.

So, if you want a large sized implant with increased cup size, you would select the high profile.

If you aren’t too greedy about the up size and want something that is more natural, you can select the moderate profile. Low profile is used if you have asymmetric breasts or sagging ones.

But, there are some who are not satisfied with the new volume although they use the high profile. So there are some manufacturers who make Extra high profile, i.e. very thick implants. Extra high profile cannot be used without much thinking. It is used for those who have thick skin tissue and want large volume.



The sizing of the water drop type implant is selected according to the following order.

1. Measure the diameter of the breast then select on the diameter of the implant

2. Measure the distance from the collarbone to the nipple and the distance between one nipple to another. Decide if the upper body shape is wide or long in height. Then decide on the height of the implant

3. Ask the wanted cup size of the patient and then decide on the implant profile

This is how we select which implant to use.

Let’s try going through the three phases for an example.

Before Breast augmentation Surgery

Let’s analyze this patient.

First, the diameter of the breast is 11cm. We can use any implant with diameter of 11cm or less.

Second, the distance from the collarbone to the nipple is 17cm. if we draw a triangle, we can see a tall isosceles triangle. This means that we can use a round base type or the tall type implant.

Third, the patient does not want to increase the cup size much. The patient did not like to have big breasts originally, but as she gave birth and breast fed her child, her breasts sagged. Therefore she wanted the upper breasts to look bigger. In such case, the moderate profile would be appropriate.

This is it. We can select an implant that is 11cm in diameter, tall type and a moderate profile.

Polytech 260cc implant has a height of 12.2cm and a thickness of 3.7cm.
Natrelle 235cc implant has a height of 11.5cm and a thickness of 4cm.
SiliMed 275cc implant has a height of 12cm and a thickness of 4.2cm.
Servin 285cc implant has a height of 11.cm and a thickness of 4.6cm.

You can select one from any of the four above. But a patient should put each of the implant inside her clothes to see the volume and check on the size.
So it is better to see the actual size in person and then decide on the volume and the size. This patient liked the 260cc after the size test.

The implant has been selected and the result of the breast augmentation is as below.

Before and after Breast augmentation Korea KIES-U

The patient has a rather long chest but this is due to the sagging breast after giving birth. You can see that the upper part of the breasts have been filled up. The patient wanted more of a natural look so she was very satisfied with the result.
In summary, you need to measure the width of the breast and decide on whether to use the oval type or the round type and finally select the thickness profile according to the volume that you want.

In reality, the selection is not as simple because there are many patients with asymmetric breasts, and the tightness of the skin was to be known. There are other variables as well.

Therefore, the experience of the doctor is very important as well.

This is all for today, have a great weekend. Thank you.

The types and differences of breast implants II 

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Which implant looks and feels the most natural? This is a frequently asked question. My answer is always the same. There aren’t many differences in the 5th generation cohesive gel implants.

If you put a smooth type and a texture type implants on top of the table and touch them, you would feel a lot of differences. Also if there is less substance in the implant, it would be feel softer and better.

Some consultants train the nurses in such aspect and say that the smooth type feels better.

	If there is less gel in the implant, it may cause a rippling effect

 But the result of the breast augmentation is different from what you think.

The Allergan type that is perceived to the hardest one becomes soft once put inside the body. Therefore, it is difficult to make out if the implant feels good or bad by touching it from the outside.

I cannot know that implant had been used on the patient unless I look at the patient’s chart.

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The softness of the breast is not depended on the type of the implant that you use, but by the skin that covers the implant. Although you use jelly like implant, but you have a hard skin covering the implant, you would feel that the breast feels hard.

So it is wrong to say that you need to use the smooth type for better sense of touch.

The answer to the good feeling breast is not to choose a soft implant, but to conduct a smooth surgery so that there is no bleeding or no trauma on the body. This would lead lower possibility of stronger epidermis.

The sense of touch is not depended on the manufacture but how the doctor performs the surgery and how the patient’s body reacts to the surgery.

Problem of durability

Which implant has the best durability?

There is no answer to this question as of yet. One can estimate it but there is no statistics to prove it. We can compare the implant not collapsing easily and lasting longer to that of a bicycle tire.

If you are riding a cycle on a road with a lot of substance on it, and you have a high pressure tire on the cycle, the small sized substances bounce off easily having less possibility of the tire being punctured. In opposite, if you have a low pressure tire, it would step on the substances directly leading to a higher possibility of a puncture.
If the implant is filled up with silicone gel there wouldn’t be any folds leading to no friction therefore leading to no breakage. But if the implant is not filled up, there would be many folds leading to more friction and higher possibility of breakage.

Breast augmentation Korea KIES-U

Also the gel has strong agglutinability therefore if the implant maintains its shape there would be no folds whatsoever avoiding any damage. But if there is less agglutinability meaning that the implant cannot maintain its shape, many folds are made leading to damage on the implant.

The implant with the most agglutinability is Allergan’s water drop type implant. I cannot say for sure but I can estimate that it as a good durability. SiliMed from Brazil has high agglutinability but not as much as the Allergan’s. The other implants are much alike.

Sadly, all the round type implants that are imported to Korea do not have high agglutinability.


In all cases, the water drop type (ones that are imported to our country) have stronger durability than the round type implants. 

Which implant leads to better shaped breast?

This is the part that bothers me the most. All the water drop type implants imported to Korea have the same level of durability, sense of touch, and side effect incidence rate. The biggest problem would be which implants is the most appropriate one according to the body type.

KIES-U Plastic surgery Korea

There isn’t much to think about when considering the round type. They are all the same. Whatever the manufacturer is, the shape and the volume are all the same. But the water drop type is made 3 dimensionally therefore there are a lot of differences.

There are two types of patients who want breast augmentation that requires implants.

First are those who want to look good and thin.
Second are those who want to fix the sagging breasts after giving birth.

For both the groups, it is better to use long height implants.
The think patients usually have long torso.
Therefore, it is more appropriate to use implants that are thin and long.

Also sagging breasts have empty upper part therefore it is good to use oval type implant that fills up the upper part of the breast. If you look at the breast, you would know that the breast is not shaped in perfect round shape. It is closer to long oval shape.

Germany’s Polytech oval shaped implants are long shaped that are fitting to the Korean women. Brazil’s Silimed water drop type has a good shape but does not export oval water drop type to Korea. If all the products from Silimed are imported to our country, I think that there would be a good market response to all the products.

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Sebbin from France has strongly filled implant that is round and thick. So the patients who have thin breast and cannot use wide implant but want to increase the cup size can use this implant.

The cancer causing agent from PIP in France that was reported early last year is not related to Sebbin implants.

Allergan implants have best stability and durability but have wide width when concerning the profile. The patients in Korea have narrow upper body, so they need to use rather small volume implants.

Conclusion

In conclusion, there has been many implants in the market, but there isn’t one that is 100% fitting. Also, one cannot say one manufacturer product is better than the other therefore it is important to find an implant that is most appropriate to your body.

Also, whatever implant you select, the skill of the surgeon is the most important factor.

We looked at the type of implants imported to our country and their differences. Has the post helped? Thank you.
Have a nice day.

Incidence rate of capsular contracture

 


The implants in Tebbetts’ article were textured water drop type saline implants and the implants tested by the manufacturers were mostly smooth type saline implants. Also the writer is an advocate of 24 hour recovery system, and he enforces that the surgery must be performed without any bleeding and no damage to the tissue.


Capsular contracture depends on


Here exists the core problem.

How can you avoid the revision surgery due to the capsular contracture?

Here is the summary.

-  The surgeon needs to take care of the implant and not damage it when inputting it.

-  Do not use less than full filled implant, use filled and secured implant. (Water drop, textured, silicone gel bag implant)

- An experienced surgeon should not damage the tissue and not cause any bleeding during the surgery. (24 hour recovery system)

- Double plane surgery or sub-pectoral surgery has lower incidence rate than sub-glandular surgery.

What can I do if I have a capsular contracture?

An internet popular “Baker method” has 4 types. But, this is something that is decades old. I do not think that this is necessary now.
The bottom table is useful.


Cases when you need reconstruction when there is a capsular contracture
- Very hard breast
- Awkwardly shaped breast, or implant moving to a different position
- When one can notice that the breast looks awkward when wearing everyday clothes
- Capsular contracture caused when there is an infection


You should not have a revision surgery because you have a capsular contracture. There is no guarantee that you will have a good result after the revision surgery. In conclusion, it is best to try and prevent the capsular contracture.

I would like to share something obvious before I finish off.

What can you do in order to minimize the possibility of a side effect?



- Get a surgery from a doctor who is well educated on the breast augmentation (beauty surgeon). (Be careful of similar titles such as International beauty surgery specialist, Beauty surgery specialist, etc)

- Go to a hospital that has a quick recovery system.   A recovery must take place within 24 hours with pain and bleeding so that you can get back to your everyday life. This will minimize any possibility of implant collapse, and capsular contracture.

- Go to a surgeon who can explain properly about the side effect. An experienced surgeon would have experienced many side effects as well. Those who say that there is no side effects is not an experienced surgeon.

-  Go to a hospital that charges an appropriate amount of surgery cost. Breast augmentation cost includes implant cost, surgery facility and personnel cost, testing expense, material expense, anesthesia, recovery and monitoring expense, surgery expense, unexpected cost, VAT, etc.

Very cheap surgery would leave out one thing from the above list. This means that you will not be guaranteed on what would happen to your body and would not be able to solve any problem you’re your body might get into.


This is all for today. Capsular contracture is the most important side effect, and there needs to be more explanation on it but I will have to end for now.
Thank you for reading.

Does the textured implant have more rippling effect than the smooth type?

Rippling is similar to waviness. For those of you who are searched on the internet a lot, most will think that rippling is caused on the saline bag type and also on the textured type.

Today I would like to share on the two side effects of rippling and feeling on the implant on the outside.

Why is rippling caused? Let’s look at the cause first.
The first cause is because there are much substance around the implant.
The second reason is because the skin does not completely cover the implant.


Rippling cause by less fill is caused when the saline or cohesive gel is not filled up to the actual volume. Liquid is filled up in the saline bag type therefore many causes can lead to incomplete filling. But cohesive gel is made in a plant, so why is it that the cohesive gel is not filled to the maximum level?

A person walks straight forward. So the implant does not lie on the body but it stands up.




The standing up implant would have more balance at the lower level. This bottom level would have more silicone gel centered on it and the upper part would have less silicone gel. This causes the under-fill effect.

This under filled part would have wrinkling effect as well and this is the cause of the rippling. There are many types of cohesive gel implant that are under filled.
Textured water drop type silicone gel implant standing up in the body would be the most secured type with less under filled parts.





Under filled rippling can be prevented by filling up the volume more. If the saline type is 250cc, it can be filled up to 260cc.
 
If you want to avoid rippling on a cohesive gel type, you need to select one that is well secured like the one in the photo above.

If you feel that you have a rippling effect on the saline bag type, then you need to fill up the implant more. Or you can change it to a cohesive gel type.

Second reason that causes rippling is not how much the volume is filled up but whatever the type of implant it is, the surrounding skin needs to cover up the implant completely.
Therefore, rippling is caused easily on those with thin breast skin, or small breasts, or those with very thin subcutaneous tissue.
The skin that covers the implant is very thin therefore the weight of the implant pulls down the epithelium causing wrinkles and rippling effect.

One needs to plan out the procedure properly so that the skin covers the implant completely in order to prevent such a problem.
More padding under the muscle would help out such patients as well. Double plane would be good also. Subglandular would be lead to rippling.

There are those who say that rippling is caused more easily on the textured type compared to the smooth type. But there is no evidence to this according to 2002 Mentor and McCann PMA report to FDA. Textured having more rippling compared to smooth type is a wrong information.



Also, rippling is a problem if you can see it when standing up. It is not a problem when you can feel it in a certain position.

A specific part might feel wavy after the breast surgery but one cannot say that this is a side effect. However, if you can visually see that the breast is not looking proper due to rippling, then you can say that there is a side effect.




One last word.
It is wrong to think that the side effects are caused by bad implants and that one can avoid side effects when using good implants. This all depends on whether the surgeon has accurate knowledge and performs on the patient. Whatever surgery it is, the outcome is depended on the surgeon.

This is all for today. Thank you.

Q. When do you need to have a breast revision surgery?

There are few reasons for the breast revision surgery

First, when the breasts become hard due to the capsular contracture.
Second, when the breasts look awkward because the location or the position of the implant changes.
Third, when there is a damage on the implant (this is common on the saline type)
Fourth, when there is inflammation, bleeding, etc.

Breast revision surgery Korea KIES-U

The most common question is on the capsular contracture. I will talk about breast revision surgery considering the capsular contracture.

The reason why the patients are scared of the capsular contracture is that the breasts look “artificial or surgically repaired.” The implants are out of the original position, the breasts become hard, and the two breasts look different from one another.

The upper part sticks outwards or the implant is pushed away from the breast. Also there is much pain or at times there may not be any pain. The two breasts do not face the same type of capsular contracture, each faces different types.

Before & after Breast revision surgery Korea KIES-U

The above image is not the worst case of the capsular contracture, but the breasts have become hard and the implant is pushed upwards.

The patient received breast augmentation through the armpit using the smooth type implants. The breasts started becoming hard after 3 months and there has been a severe upper block.

The patient received a breast revision surgery after 7 months from the first one. The original implant was takes out from the sub-pectoral part and put into sub-glandular location.

The lucky part is that the patient had some volume on the breasts even before the first surgery, so the sub-glandular part could be used for the re-surgery.

If there is not much volume in the original breasts, the implant pocket cannot be formed on the sub-glandular part therefore, we need to form double layer for the revision surgery.

The patient had sagging breasts, therefore, we selected water drop type without any hesitation, and used oval shaped 290cc implant. The patient is now satisfied.

In the next posting I will talk about 'Why is the capsular contracture formed?'
This is all for today, thank you.

Ultrasound imaging for breast surgery


Today I would like to share about the Ultrasonography after the breast augmentatioin surgery.

Although there aren’t any problems after the breast augmentation, one might be curious about if the implant is at the appropriate position and think about if there is no problem inside the breast where one cannot see.

Breast augmentation Korea KIES-U

Or, the breasts might seem thicker or there might be pain or even difference in the shape. All these changes might lead to concerns.

Ultrasonography would be very useful for such cases. There is no penetration with this test. One just uses the probe to rub on the skin and see the inside of the body and check the inside.

We refer to penetration as poking with the needle or opening up the skin but this is not something that one can do at any time. Ultrasound test is one that the patient would not feel any pain and is also a cost saving measure.

Below is a brief summary of different tests that you can do on the breasts.

 

Breast surgery Korea KIES-U

The cancer test of Mammogram, is one of the most common one that the patients take. A machine would press on the breast and takes a X-ray. Mammogram is one of the cheapest basic tests that you can take and is also one of the most effective means of detecting cancer. If there is a problem found from the mammogram, one could take the higher level test such as the MRI.


MRI is the most sensitive and accurate test that one can take. You can find the symptoms of the breast cancer at an early state and one can also differentiate the worst case from others as well. It also provides the most accurate results related to the damaging of the implants. US FDA recommends taking the MRI every 2 ~ 3 years as it gives certification of the implants.

However, this test is very expensive so there aren’t many patients who take MRI after the breast augmentation.
 

Ultrasonography is taken a lot for the breast cancer as well.
It has high sensitivity and high accurateness in finding something without any pain.
It is also cheaper than MRI. Ultrasonography also helps check problems of the patients with silicone implants / saline implants.

I usually recommend ultrasound to the patients who want re-surgeries.
Re-surgeries are usually done without knowing how the breast shape has changes after the first surgery or not know how the process has been changed. If a doctor wants to explain the current status and talk about the future plan, he/she needs to know the current status accurately. This could be done with the help of the ultrasound test.

Breast augmentation Korea KIES-U

Above is an image of a patient with a revision surgery. If you look at the right breast, you might be able to know that there is something wrong with the implant. The same result came up through the Ultrasonography.






When I first saw the image above, I through that the implant was damaged. The white color shows the surface of the implant and this white line is broken in the middle. We conducted the re-surgery to find that the implant was not damaged but flipped upside-down.

This is the bottom of the implant (what we refer to as a belly button) where the brand name was printed on.

The patient thought that the skin became really dense and though that there was a capsular contracture so she massaged the breast often.

The implant was small compared to the large pocket it was in, therefore the massaging has led to the flopping of the implant.




The above image is from the ultrasound test of a patient with a damaged implant. Usually the gel inside the implant would look black but there is a lot of density with tattered surface so I suspected damage on the implant.

I found out that there was a lot of blood around the implant from the re-surgery. The patient had an auto accident after the initial surgery and it seemed that the blood from the accident stayed around the implant.

 



The above image is the result of a seroma. Seroma can be caused by different problems including the water formed from the breaking of the tissue, or bleeding, etc. The water left over that has not been absorbed causes the seroma along with other trauma, infection, etc.

Water can exist at the earlier stages after the breast augmentation but if there is liquid after 6 months, we call this a ‘Late seroma’ or ‘Late fluid collection’. We solve this problem according to the different cause of the problem.

We do not treat the problem because there is a seroma. If there is an additional problem such as an infection from the seroma, we would do the treatment to remove any problems.

But if there is a lot of blood, then we would need to find out where the blood came out from at an earlier stage.

These kind of problems can be helped out through the ultrasound test.

If there is a capsular contracture, the membrane surrounding the implant becomes very white and thick. This can be seen through the ultrasound test as well.
However, capsular contracture can be recognized by touching the breast therefore, ultrasound is not used as to tell if there is a capsular contracture or not.
The ultrasound test is used to find out additional information on how to solve the capsular contracture.




The above image is to check whether the implant is in the right position or flipped upside-down. There is a white spot in the image and this is connected from the midpoint of the implant up until the 6 o’clock location. One can find out whether the midline of the implant is through this image. Finding out this kind of a problem is one of the biggest advantages of the ultrasound test.

Today, we looked at the various results that ultrasound tests can show before and after the breast augmentation. Has this helped?

Have a great day.