Hi. I'm Dr. Lee.

Today I'll write about the details of the topic, 'how to choose the breast implant size for augmentation mammaplasty'.



Last time I mentioned breast width has supreme importance for choosing the size.
But another important factor is the breast envelope.

For some patients, it is not difficult, nor problematic, but for some patients, it is very difficult and problematic.

Let me compare it to space of a house.
The actual area of a house fits for just 4 persons to live in.
But if its space was applicated very well, there could be room for additional persons. 6 or 7.
These ideas have parallels in breast augmentation surgery - the extensibility of breast envelope.




If one's breast envelope is stretched very well, then a big size implant can be inserted easily, and the shape must be natural enough.

If one's breast envelope is very tight and tense, then a big size implant will not be available even for a big-built woman, and the shape must be unnatural.

What is breast envelope?

It is the covering tissue of the mammary tissue.
That is, skin, subcutaneous fat, muscle (pectoralis major), and fascia.

These tissues cover the underlying implant.

Breast envelope goes looser with age, less tight, more stretchy.

Other factors related to the stretchy breast envelope are  as follows ;

Number of delivery.
Massive weight loss (10~20 kg)
Big breast

Breast feeding is not yet established as the culprit of the saggy breast but could be considered as that of stretchy breast envelope.

If a breast augmentation surgery candidate is very young and has no history of delivery, the breast envelope  must be very tight.

It does not stretched well. The surgeon has to struggle to insert something under it.

If a candidate is aged or, has many children, with saggy breast then generally the implant volume could be very big. The envelope would be well stretched and the insertion process might be easy.

In these cases scar would be vague because, a bad scar is made when there is strong  tension between the opposite side of the wound.




But the size should be adequate even for these people because, if the implant is very very big, the weight of the implant must be very heavy and it can stretch the envelope too much. That condition could result in a saggier breast.


Big-built woman (wide breast width)  with  loose breast envelope, can have very big implant.

Small-built woman (narrow breast width) with tight breast envelope, should have smaller implant for natural - looking breast.

If a candidate for the surgery is small build but the breast envelope stretches well, then she can use bigger implant than expected.




That's it for today.

Thanks for reading and have a great day.

So many people are asking this question. today's posting is the answer,
When can I golf after the breast augmentation surgery?

Let's think about the muscle contraction during the golf swing.
For a right handed golfer, right triceps muscle, trapezius, and various forearm muscles would contract during the back swing. Left arm would just follow, this side muscles would not contract strongly.

Both pectoralis muscles - the directly related muscles with implants - would not contract during back swing.

During down-swing, left triceps and forearm muscles would contract and right pectoralis contract but not strongly.



Unless the golfer is a beginner, both pectoralis will never contract strongly.

So, the possibility of implant rupture by the muscle contractile power during golf swing looks slender.

But golf is not just strength.  The stretch of body can affect the postoperative breasts -  during the swinging movement, the golfer's shoulders and arms can push the implant here and there.



Thinking about it, during back-swing, the left side implant could be squashed by the left upper arm.

After the impact, during follow-thru, right side implant could be squashed by the right upper arm.

But, the pressure is not severe. The pressure severity of golf swing on the implants would not enough to affect the position of them.

One exception is saline implants which already have leakage. A lady pro golfer had taken re-operation surgery 7 years ago because of the ruptured saline bag.



I do not think the swinging power brought the intact saline bag to rupture, but the swing could allow the leakage - by other causes - just faster.

Saline bags are not as sturdy as the cohesive silicone gel bags. If  a pin-point hole on the surface had arisen, then saline would leak out, and the leakage would not stop until it is completely deflated.

But it is nearly impossible for a golf swing movement or muscle contraction for it to break nor move the cohesive gel silicone implant.


Human body makes a barrier against the silicone implant right after the operation.

The barrier is called capsule. And it takes just a few weeks for the capsule to cover all around the implant. Once the capsule completely surrounds the implant toughly, then it is very difficult to move the implant out of the original position. So you can golf roughly 1 month after the operation.

But it is different from case by case. I recommend you to return to your swing step by step.
One day half swing, and next day more than half swing, ....... and at last, if you think can do that, then full -  swing!
Don't overdo yourself, take your time.

That's it for today, Thanks for reading.
Have a great day.

Question ; I want breast augmentation with anatomical implant through the armpit. is it possible?

Answer ; It is possible. But not for every patient, not by every surgeon. It can be done for selected patients and done by qualified surgeons.




The anatomical implants are designed  to have orientation and direction. The lower part is thick and upper part is thin. That nature makes it easy to insert them through the lower part of the breast, but difficult to insert through the upper part. 




I think we had better review the  pros and cons with the incision approaches.


The operation time is delayed when the incision is armpit because, it has no visual and the endoscopy is always needed.

Both surgeons and patients are worried about the rotation problem with the anatomical implant inserted through the  armpit.

Anatomical implants have embossing on its center part, so the surgeons can just see that to confirm the position when the approach was areola or under breast line.
But when it is armpit, surgeons cannot see that.
So they just grope for the embossing of the anatomical implants.

There is no way to 'confirm' that it is not rotated.
And we don't have enough data for the rate of rotation of tear drop implants after the armpit breast augmentation surgery. (on the other hand, numerous data are available for under breast line approach surgery and the rate of rotation.)

If the breast shape is normal, not ptotic, not constricted, and no other bad condition, a qualified surgeon can do it (armpit surgery) very successfully.

So armpit anatomical implant insertion technique is possilbe, but the first choice is, under breast line incision.

That's it for today.

Thanks for reading, have a nice day.

Delivery, aging, and massive weight loss generally  changes the breasts.
They are going saggy.




This posting is a talking about the saggy breasts. What means saggy breast? and How can we improve it?

The first step is the downward movement of the breast parenchyma,
Meanwhile the lower breast envelope is stretched.

And the upper volume of the breast is shrank.

These changes, relatively early phase of the breast ptosis, is said 'Glandular Ptosis'.

The glandular ptosis is somewhat different from the 'real ptosis'.

In real ptosis cases, even the upper part of the breast envelope is stretched, and the nipple-areola will drop. So that is the Difference, the distance from the clavicle to the nipple is very long in real ptosis, and not that long in glandular ptosis.





And nothing is seen between the nipple and the lower margin of the breasts.

Another point is, the level of the under breast line.

If the nipple level is lower than the under breast line, then it is real ptosis.
If the nipple level is not lower than that, it is glandular ptosis.

Real ptotic breast needs lifting operation.
We call it 'mastopexy'.

Glandular ptotic breast usually do not need mastopexy. Generally they just need augmentation.




But the augmentation surgery for the ptotic persons are different from that of usual augmentation.

The surgeon has to have a good, detailed idea and knowledge about the augmentation surgery for the glandular ptotic breast patients.

The photographs of each surgery is as belows.





That's it for today. Thank you for reading and have a nide day.

This is the most frequent question I get from my clients.



Many talkings with my clients go by as belows.

client ; "I do not want too big size. I want natural and optimal one for my body."

doctor ; "Then you want cup B?"

clinet ; "........ at least C or D."

doctor ; "Haven't you told me you want natural look?"

client ; "Yes, I hope natural one. But  I'm afraid I would not be satisfied with cup B after the operation."




Because the name of this surgery is 'augmentation', generally the bigger, the better.

But as long as it does not exceed the acceptable limit of one's body.

If the implant is too big to look natural, then we would not call it 'successful'.


1) Weird shape

If the implant is too big, it could exceed the acceptability of the breast envelope.
The skin - breast envelope expand here and there, to the maximal tension.
That tensile power makes the breast shape not good.
The breast might have  upper fullness, and it makes big but not beautiful shape.

2) implant durability

If the space is narrow but something big is inserted anyway, then the contents should be collapsed or folded. With time goes by, the folded portion of implant get frictional forces repeatedly and finally it can have crack or rupture.

3) tissue atrophy

A big implant present expanding power on the skin envelope. It makes the breast envelope thinner. With more time, skin must be even thinner.

Ultimately the implant can be palpable and visible through the paper thin skin at the margin. We call this, 'tissue atrophy of the breast envelope'.

If a big implant put enormous pressure on the bottom of the chest cage for a long time, then the rib bone can be dug. (bone erosion)




Breast augmentaion surgery is, a technique that inserts a foreign material  into human body.
The point of this surgery is, How well the material does match the patient's body.

Once the operation performed, then the implant will dwell in the patient's pocket permanently, so it is very important for the patient how well it fits for the body. The volume, the height, width, thickness, every parameter is important.



Firstly the surgeon measures the width of the patient's breast. And it is the first considerable factor for decision making.

The second factor is the skin tightness. If the breast envelope is tight, then the pocket space would not be enough for the implants. And the skin envelope will get too much tension.
For large volume implant, the skin envelope has to be loose.


These 2 factors are the most important points for decision making processes of the implant volume.

Breast width and the skin tightness.

A surgeon has to measure them objectively and make a rational and discreet decision.



So that's it for today. Thanks for reading and have a nice day.

Hi, I'm doctor Lee.

24 hours recovery of breast augmentation surgery is not a marketing - promotion term, but one of essential points of this surgery.

Surgeons has to perfect himself in 24 hours recovery to minimize the complications and postoperative problems.


It means, morning operaiton and evening going out for dinner.

The patients who have recovered fast had fewer and minimal complications  than who have not.

In Seoul, many overseas clients come and return to their country in only 3~4 days, Russia, Mongolia, China, Hongkong, and USA.  Although more time is desired for the surgery for them, but under 24 hour recovery system, the time is not lacking.

"The same decision process and surgical techniques that deliver 24 hour recovery also deliver optimal long term outcomes with low complication and reoperation rate."
(John B. Tebbetts, AUGMENTATION MAMMAPLASTY, Redefining the patient and surgeon experience, Mosby, 2010, Elsevier Inc. pp.377~385)

But How?

How a surgeon can let the patient recover that fast?

It requires plenty of experiences and accumulated know-hows.

I have conducted survey about the 24 hour recovery after operation of my patients for 1 year.



The questionnaires were sent thru the phone message s and 172 patients responded. And the results are as follows.




90.1% of the responders answered positively. Who answered 'not recovered in 24 hours' was 9.9%.

Although the majority of patients answered "I recovered very fast. I didn't have much discomfort." . but some did not, so I have thought about the reasons of the delayed recovery.

And I can present a few factors for that.

1) Too big size implant compared to the patient's chest size.

2) Tight skin (breast envelope) which make it difficult to adapt to the expanded body surfaces.

3) The patient's bad condition on the operation day.

If the  size of  the implant is very big, then the surgeon has to dissect very wide space, then the possibility of bleeding or tissue trauma increases. And it is concluded to a delayed recovery.

And If the skin envelope is tight, or the original breast tissue is scant, small, then the skin will put pressure on the implant and the underlying periosteum. And it brings pain and the delayed recovery.




Fast recovery means there was little trauma on the patient's body.
And the tissue which has only minor injury can heal fast,
As a result, we can have optimistic view of the complications of the surgery including capsular contracture. They can be minimized.

Today my posting was about 24 hours recovery of breast augmentation.

Thanks for reading, have a great day.

HI, I'm Dr. Lee.

Today I'm going to write about the dual plane breast augmentation.

The frequent questions about the augmentation surgery are, what implant is good for me?, How big ? and where should we put it through.

The above 3 questions are very important but, the supreme importance is, what plane should the implants be.


There are 4 planes for the breast implants.

Above the muscle, under the muscle, under the fascia, and dual plane.

It means, the depth of the implant position.

Belows are my hand paintings for explanations.

1) Above muscle

Implants are between the pectoralis muscle and the breast parenchyma.

With this method, the implants make the breast shape directly so the aesthetic effect is nice and the breasts look big enough.
And the surgery is easy and not painful at all.

The shortcoming is that the thin breast envelope cannot cover the implant sufficiently. Thus the margin could be visible.   And the occurrence of  the capsular contracture is relatively high.  Below are the hand paintings about that.






2) Below muscle

So if the implant is located below the pectoralis muscle then it would have thicker coverage.
Therefore, looks more natural especially for thin patients  and the risk of the contracture, rippling, palpability will be lower.

But the shortcoming is, the muscle contracts and releases and put pressure on the implant. So the position of the implant could be unstable, and there is higher risk of double fold formation.












It makes up the shortcomings of above 2 techniques. The upper part of the implant is under the muscle and, the lower part is above the muscle.

The merits are
staunch coverage of the implant, (thus lower risk of palpability and unnatural feeling)  
Margin of the implant will not be visible.
The implant is stable in its position and has low risk of displacement.
The contracture risk is low.
The risk of double fold line is lowered.

To sum up, the dual plane technique is the most reasonable, stable, low risk procedure ever known. The surgeons must find his feet at the dual plane surgery.

That's it for today. Thanks a lot and have a nice day.

Hi, this is Dr. Lee.

Today my posting is about the textured breast implants versus smooth breast implants.

There are numerous informations about this topic through the internet but it is very difficult for non professional persons to find out an accurate and precise knowledge about that.

This blog is for correcting this informations, and bringing some detailed knowledge about the type of cohesive gel breast implants.

1) Question ; Is the textured implants absolutely contracture-free ?
(an Answer from one of the breast surgery forums) ;  Textured implant's surface prevents capsular contracture, and it 'adhere' to the surface of the human tissue........

(an Answer from a news paper) ; There is tissue ingrowth into the textured implants surface therefore it makes the capsule contracture-free status. 

Good answers but the mentions above have to be corrected.

Scientists presented the Electron microsope photos proving that there are no 'true' human tissue ingrowth into the surface of textured implants.

It just 'look like ' adhered with surroundings because it is rough.

The point is, the weak degree of adherence with textured implants and human tissue cannot prevent the formation of a single linear, hard capsule and cannot prevent the capsular contracture. 

It is hard to say we are using textured implants to prevent the contracture, but we are using it to control the position of the implant by the surface friction.

Briefly, it is relatively predictable and consistent. that is why we use the textured.


2) Then what is the textured implant?



In fact, textured implants existed very long time - from 1993~1994.

At first, the implant company made the textured surfaces to reduce the contracture rate.

But the effect of contracture reduction was disappointing, because any silicone surface implants cannot avoid formation of the linear, hard capsule.

On the other hand, the Polyurethane covered implants (made by Silimed, Polytech) have been very successful to prevent capsular contracture.

If you have decided what kind of implant to use, then you would be thinking where to incise.

A majority of the papers and literatures about breast augmentation worldwide mentions the under breast line approach is the excellent way for this surgery.

Despite the relatively inconspicuous appearance of the other resulting scars, many surgeons find the inframammary fold approach to be the most attractive optioin when comparing operative exposure with scar quality and its location. (Surgery of the Breast, Scott L. Spear, 2006. Lippincott Williams@ Wilkins)

Reasons for popularity of the inframammary approach include  direct vision for optimal control, minimal tissue trauma, and minimal bleeding. As a result, inframammary approach sets a standard based on logic that is currently unmatched by any other incision approach.
(Augmentation mammaplasty, John B. Tebbetts, 2010, Elsevier Inc.) 


In addition to these mentions from the breast surgery experts, the under breast line approach technique is getting more and more important because we are using the anatomic shaped implants after the FDA approval.

The anatomic implants should be inserted through the under breast lines for most cases.

But in Korea, many surgeons are not familiar with the under breast approach technique because, many Korean young ladies have been preferred the arm pit technique.

Today I'm posting about the under breast approach technique.

Below is a simple chart for comparing each of the approach techniques.



1) arm pit approach

This is recommendable for the people who mind the scar because the incision is located far off the breast. But the field of vision is very limited so it needs endoscopy - the op time could be delayed -.

And who takes this surgery has to keep in mind that it can make some tissue trauma along the long pathway from the entrance to the breast under line.
And the insertion is difficult for the form stable anatomic implants thru the armpit and,  the surgeons need more data about the chance of rotation after the operation with this approach because it is difficult to correct the position of the implant thru the armpit.



3) Under line approach

The visual field is always essential for every kind of operations.
Breast under line technique presents the best direct visual  field among the whole approach techniques.
So it is the safest and, makes the least trauma. So it has the minimal invasiveness.

If a surgeon is blind and operates with just the perceivablity and the experiences, then the result of the operation would be fluctuated. This technique has the best consistency.

The form stable anatomic implants can be inserted easily with the under line approach.
The scar of this skill could be covered up by the impending breast tissues and it would be inconspicuous except some special cases.



4) navel approach

The scar is very far off the breast with this technique, and the pain is minimal.
But it is impossible to insert cohesive gel silicone implant, so is the anatomic shaped silicone implants. And this technique just allows the subglandular placement for most cases. Dual plane placement of the implant is almost impossible.