Nipple reduction surgery

There are relatively many of those who have physical complex with their nipples and areola. Today, we will talk about the nipple reduction.

Nipples point outwards and are used for breast feeding, but they are important in terms of beauty as well. There are many nerves in the nipples and also the nipples act as a sexually sensitive area.

If you have nipples that are too thick or long, you can get a nipple reduction surgery. The explanation of this surgery is provided below with the help from the image.




As you can see in the image above, if you have long nipples, the nipples tend to sag down without much strength. If the nipples face outwards straight, your breasts look better. However, if the nipples are as those in the image, the breasts may look like the ones of the old women.





This is how we reduce the nipples. As shown in the image, we remove the tissue surrounding the nipples so there is no influence on the blood circulating to the nipples. The length becomes shorter and makes the nipples tighter and stronger.
Also, your nipples would face outwards after this surgery.

There are another method for those who have relatively thick nipples.



The method in the image above would effectively reduce the circumference of the nipples.

The core issue of this method is to not hurt the blood and the breast milk circulation and deriving the most beauty effect.

Then we can minimize the damage on the nipples and change the look into one that is very attractive.

The overall procedure takes about 20 min and most patients get local anesthesia.
However, most of this procedure is simultaneously done with breast augmentation so if you are doing the breast augmentation, you would be required to take the general anesthesia.

If you have dark nipples, then you might be able to see a white line as a scar, but if you have light colored nipples, then you may not be able to see the scar at all. You can also get medical tattoo 6 to 12 months after the surgery in order to hide the scar.

Thank you for reading the post.
Have a nice day.

Breast augmentation Korea KIES-U



I recently saw news on “Increase in number of breast surgery side effects: Damaged breast implants”. I would like to share on this topic of damaged implants.

Let’s look at an example of a tire.



A reporter took a Bridgestone tire, randomly, and used a rolling mill on it.  He rolled 5 tons on the tire. There is no puncture.
If this reporter reports that the Bridgestone tire does not puncture after this experiment, and also add that the tire only punctures by the fault of the driver, how would a typical driver feel about this report?

The news showed an implant bursting because someone put much weight on it. When a 700kg object was placed on the implant, it burst. If the news reported that the implant does not have any problem on itself and that follow-up management is the problem.
As you can imply from the example on the tire, this too is not logical.

However good the tires are, if you use the tires for 5 to 10 years and go on-road or off-road, one of the tires can be punctured. This is not because the Bridgestone tire is bad or because the driver is a bad driver.
The conclusion should be something as the following. The tires have usage life as well. You need to manage it properly but if there is a problem with the tire, you need to get it repaired or even change the tire. This is what we all know, and what we do.



Breast implants are made by men too. God did not make it. Some company has made it. Artificial heart, pace maker, artificial bones / arteries are some of man-made things that we use today but these things do not last forever. They tend to break down at some point in time. Although many pre-launch experiments had been perfect, one cannot say that the product will not break down. No one would say that you do not need to worry about this product until you die. This would be a wrong thing to say.

There was a Korean drama last year in which the main actor lived with an artificial heart.




But this character has a problem with the artificial heart so he goes to the hospital to replace the heart. The operation is successful and the character lives happily ever after.

Just like the artificial heart getting damaged, artificial breast implants can be damaged as well. The extent of damage differs according to the makers of the artificial breasts.

The products are being upgraded and are made better than ever before. However, even God given original heart or breasts get ‘damaged’ as well, and so does these products. Not all man-made products can maintain its original form after decades. This is impossible.

You must know that these artificial implants can be damaged or leak substances within. The patients must hear such facts before any surgery and know that this is a possibility.

It is wrong to say that the silicone gel withstood 700kg of weight so it would not burst or be damaged therefore I can use the implant for my breast. This is absolutely false.

There are data on the damaged implants according to different types such as saline-bag, cohesive gel bag, smooth type, textured type and even by different companies. This data can be found in US FDA.
Also the data shows that the damage differs according to the body size of the patients. The life expectancy of the implants differ from a person who uses an appropriate size to those who used much larger implant compared to what is appropriate for the body.


Tear-drop type does not change shape but maintains the shape securely. If the implant changes shape easily or is too smooth, the damage rate can be increased.

All implants have life expectancy. Some can last longer than the patient’s life. I still have not seen any of my patients with damaged implant but in theory, it is possible that the implant can be damaged within a short period of time.

A lot of the patients are curious about the life expectancy of the implants that they used. But the reality is that we do not know this for sure. First reason is that the manufacturers do not provide data on this.



All the surgeons and patients was the implants to be new and maintain its original shape for a long period.


The 5th generation silicone gel implants that are sold today are much better in quality compared to the ones that were first sold in 2007. The possibility of damage, leak, capsular contracture have decreased but still, there is a possibility that the implant can be damaged.

Also, one must know that if the cost of the breast surgery is very cheap, then one must doubt if the surgeon is using bad quality product or not. A proper breast surgery cannot be done with low cost.

A patient from China needed a re-surgery on her breasts. The implants that she used previously did not have any brand mark on it. (I had to doubt what I saw but there was absolutely nothing on the implants)

A Korean patient went to Thailand and got cohesive gel implants but she too needed re-surgery. I asked her how much did it costs to get this done in Thailand. The price was lower than what one could even think of. I could not understand why she had gotten this procedure in Thailand. The implants could be in the body forever, so I could not understand why she was less careful about the whole procedure.

I think that the 5th generation silicone gel implants are safer than ever before. If a properly trained surgeon uses such products, I believe that 99% of the cases would avoid any problems.

This is all for today. Thank you.

Breast implant placement : Under and over the muscle or Dual Plane

If you are aware about the breast implant placement, then you know just about 90% of what the breast implant that we use for the breast surgery is.

When I talk to many patients, they ask,

“How large (cc) implant do you use?”
“Do you use the round type or the tear-shaped?”
“What is the incision location?”

But rarely do they ask about the placement of the breast implant.

If someone does ask about the plane, she would not ask about the differences in the plane and why such differences exist.

I have always been wondering how to communicate this to the patients easily and clearly.

So, I decided to draw an image.

Below is the explanation.



 


As you can see above, if the breast implant is located over the muscle, you are able to feel the implant. This can be easily felt with the thin patients relatively more so than those who are not thin.

Then why do we put the implant over the muscle? There are many advantages. The implant, itself, pushes up the fat so the breast looks bigger and prettier. Also there is no pressure from the pectoralis, so the implant would not be moved to another location.




We usually put the implant under the muscle for the thin patients. You would not be able to feel the implant in this way however, the muscle tends to push on the implant. As time passes, there are few cases where the implant moves up and changes the location.



Dual plane surgery takes on the advantage of the over muscle and under muscle surgeries. We cut off the muscular fiber and put the implant at the top of bottom of it.



In doing so, this would lead to the separation of the pectoralis. Some people worry that this causes no movement of the arm.
A body builder had the same surgery. She was able to lift weights after the surgery without any problmes. You do not have to worry about the muscle functioning.




Dual plane breast augmentation causes no pushover of the implant, and you cannot feel it either.

I hope this has helped you understand what the whole process it. Dual plane breast augmentation has least number of side-effects and is a very good method.

If you know about this, then you know almost everything about breast surgery. This is the most important part of the breast augmentation surgery.

Thank you for reading. Have a great day.

Textured silicone breast implant use in primary augmentation 

Academical findings do not stay fixed but the details are changed as new findings and results come out. So the doctors pay careful attention to the new findings.
The doctors who do not study would not provide outmost result to the patients.
Also, science is something that “you might think correct, but can be mistaken”.
Medicine is a part of science.

Below is an article, released on January 2015, on “Textured silicone breast implant use in primary augmentation core data update and review"





It is stated that in 2013, there were about 290,000 breast augmentations done in US. This figure comes from American Society of Plastic Surgeons, so maybe the actual number may be greater. One of the most popular plastic surgeries around the world is breast augmentation.

The most common side-effects of breast augmentation are
Contracture, moving location, refilling, seroma, etc

Why is a contracture?

There are various reasons but the most commonly stated one is that the strain around the skin and the breast tissue comes in contact with the implant and this contaminated implant causes infection within the pocket.

How does textured implant minimize the contracture?

In theory, the texture physically breaks down the epithelium tissue, leading to the breakdown of the collagen fibers and reducing the epithelium. This is what we currently understand. 
(But using textured does not mean that you are completely free from the contracture)

What can you do if there is a contracture? 

The most effective method would be to cut off the epithelium. The epithelium incision would reduce the muscle tension so the cell that makes the epithelium would not grow and therefore not survive. 

Does the appearance of the textured implants differ according to different products?

Yes, they are different. The most widely used on is Allergan’s textured salt loss technique which leads to deeper and more textured surface.
Mentor’s textured uses imprinting technique which makes the surface little thinner and smooth. 

Does the anatomical type lead to less contracture?

Yes. The 5th generation tear-drop type implants have strong exterior with strong agglutinability on the inside therefore, it causes tension with the breast tissue and sticks together more firmly leading to lower possibility of contracture.

There are many who thinks that the tear-drop implant feels better.

Tear-drop type implant feels better because the implant / breast / epithelium all move together naturally. 

But the smooth type implant is relatively more separated from the epithelium therefore when you touch it the implant seems to be separated from the skin. 

(This comment does not apply to all patients. This applies more to those patients who gave birth) 




Some say the refilling is more common with textured type

There is still not much reference for this. We are short of data on this. 
The type of the implant do not matter, but thinner patients have higher possibility of refilling than those who are not.
Also there are some who say that more texture implants lead to more refilling than the smoother ones.


Then which type shall I use? Textured or smooth?

It is said that textured minimizes contracture and also limits rotation and movement of the implant. However, there is a higher possibility of seroma and more texture it is, there is higher chance of refilling as well.

I tend to use the textured implant more.

As a surgeon, it is more relaxing for me to use an implant that does not move or rotate easily.

Today, we share a little about the textured implants.

Thank you for reading.

Breast Augmentation For Older Women [KIES-U Korea]

Q. I am kind of old, but can I get a breast augmentation?

A. Age is not important. The health status is.

This is a commonly asked question.
There are many who are about 50 years or older, and think that they have problems with the breasts. These women think “Am I too old to have a breast augmentation?”

In our country, there are many women who want their breast size to be larger in order to show their body appeal through swimwear. So there are many in 20’s ~ 30’s who are relatively interested in the breast correction.




But in the western countries, where there is more number of those having breast augmentation, the main patients are those aged 35 ~ 50 years old.

Most of them want the breasts to look prettier after pregnancy or diets. Also, there are some who think of the breast augmentation as antiaging surgery.




There are very few of those in our country who think that the breast augmentation is an antiaging one. The most important objective of the breast augmentation is that the implant goes into the breast in order to improve the shape of the breasts to make them more elastic and look younger.

It is not only to make the breasts look larger.

The oldest patient that I had was 65 years old.
She needed a revision surgery because the saline bag implant that she had from her previous surgery needed replacement.

She asked me whether it was better to remove the implant or replace it. My answer to her was that the old implant was fine before, there would not be much problem replacing the old ones.

So this patient replaced the old ones with the cohesive gel implants with the concern of the breasts collapsing without the implants.

Is age important? If a patient who is older than 65 years old wants breast augmentation, we must first check if she has any problems with her body.
She might have diabetes, heart problems, cancer, lung disease, etc. In such case, it would be difficult to have the breast augmentation

But, if the woman does not have any illness and wants the breast correction, she will not be able to give it up.

Health status is more important than age

If a woman in her 30’s has a severe illness, then I would recommend her to rethink about the breast augmentation. If she is in her 60’s but is healthy, then I would recommend the breast augmentation.

Most of the aged patients who come to our clinic have problems with the previous surgery (most come due to the implant rupture).

If there are not problems with the tests prior to the correction and the general anesthesia, then we go ahead with the replacement surgery. Also, the result of this is similarly good to that of those patients who are younger.

Is there any pain or inconvenience for the aged patients?

No, in fact, they recover with better conditions.

The younger you are, the tighter the skin and the tissue are therefore the implant is compressed and there is much friction. However, those who are older have loose skin and tissue.

KIES-U Korea Real-Time Operation Monitoring system

So, there is not compression on the implant.
The patients recover comfortably.

There are many aged patients who do revision surgeries, and there are many who have the first surgeries as well. Also most of the surgeries are inferior breast crease.

Thank you for reading this post.

Q. Should Breast implants be replaced every 10 years? 

A.



Before the FDA approval of cohesive gel in 2006, there was a time when we only used saline solution bag. The various rumors at that time are still on-line today.
What I am surprised at is that there are many surgeons who do not have sufficient knowledge about the breast implants but communicate some common sense knowledge to the patients.

Although many of these surgeons received license from the country, the surgeons, especially those who conduct breast surgery, should have updated knowledge at all times and study the respective field.

The statement that cohesive gel breast implant needs to be changed every 5 or 10 years is not true but there are those patients who ask this question saying that such statement would not have come out if it was completely false.

Rumors without any evidence tend to capture more attentions. The person who tries to communicate the accurate message may be judged falsely by the others. Today, I would like to share the FDA announcement.





In June 2011, FDA announced “FDA update on the safety of silicone gel filled breast implants”. Here are the details. (Source;http://www.fda.gov/downloads/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/UCM260090.pdf)



[VII. Summary of Key Findings]

1. Based on the totality of the evidence, the FDA believes that silicone gel-filled breast implants have a reasonable assurance of safety and effectiveness when used as labeled. Despite frequent local complications and adverse outcomes, the benefits and risks of breast implants are sufficiently well understood for women to make informed decisions about their use.

2. The longer a woman has breast implants, the more likely she is to experience local complications or adverse outcomes. Women with breast implants will need to monitor their breasts for local complications for the rest of their lives.


3. The most frequent complications and adverse outcomes experienced by breast implant patients include capsular contracture, reoperation, and implant removal (with or without replacement). Other frequent complications include implant rupture, wrinkling, asymmetry, scarring, pain, and infection, among others. These observations are consistent with the local complications and adverse outcomes that were known at the time of approval.

4. Women with breast implants may have a very small but  increased likelihood of being diagnosed with anaplastic large cell lymphoma.

5. In the post-approval Core studies, between 20 ~ 40 percent of augmentation patients and 40 to 70 percent of reconstruction patients had reoperations during the first 8 to 10 years after they received  their implants. Although  routine replacement is not necessary, many women will  need additional surgery to modify, remove, or replace their implants.

6. There is no apparent association between silicone gel-filled breast implants and connective tissue disease, breast cancer, or reproductive problems. Associations that are very rare or that take many years to manifest may not be detected using currently available data.

7. MRI continues to be the most effective method of detecting silent (asymptomatic) rupture of silicone gel-filled breast implants.

8. Interpretation of the data from  the silicone gel-filled  breast implant post-approval studies may be limited  by low  follow-up rates.




As you can read in the 5th statement, there is no recommendation about changing the cohesive gel implant regularly


The rumor that one need to change the implant every 5 to 10 years comes from the time when the clinics used to use the saline solution bag implants and is still lasting today.

Also, this rumor is used as a marketing means in the clinics that recommend filler or fat transplantation for breast surgeries.




A scientific and accurate information is not “the information that I want” or “the information that I want to hear”. An objective information with numerical data that can be accepted by anyone would be the information that I need.

Thank you for reading the post. Have a great day.

Breast Augmentation Surgery To Know List 3.
What types of breast implant are there?

I would like to present a simple description of the different types of implant for the breast augmentation surgery. There are many of those who are curious about this but it is not easy to distinguish the different types because there are too many.

First, we can divide into two types of saline solution type and cohesive gel.
This can be further divided into smooth type and textured type.
There is a smooth / textured in saline solution type, and smooth /textured in cohesive gel type. Also, we divide the cohesive type to round type and water drop type.

Types of Saline-filled Breast Implants

Types of Cohesive gel Breast Implants

The water drop type cohesive gel breast implants does not have smooth type, it consists only of the textured type. (Saline solution has water drop type as well but we do not import that in Korea)

Saline-filled breast implants is used primarily for re-surgery therefore it is not used in the usual 1st breast augmentation surgery that has the objective of beauty. So we will discuss about the cohesive breast implant today.

Cohesive gel Breast Implants

Therefore, we will talk about 3 types; Round smooth type, Round textured type, and finally Water drop type implant.

1. Round smooth type breast implant

Cohesive gel breast implant is made by filling the gel into the smooth surfaced layer. This type of implant is soft and is bendable.
Many say that the smooth type implant feels better than the textured implant but this is because the smooth type has a thin layer. Also, if the implant goes into the body, it is difficult to feel the difference between the smooth type and the textured type.

Round smooth type Breast Implant

The smooth type feels very thin and weak so many think that the implant might tear when put into the body. The biggest problem with the smooth type breast implant is that there is not friction between the layer and the body so we do not know where the implant would locate itself.
The layer is rather slippery so if the implant is not exactly placed in the room provided for it, the implant may shift to another location.

2. Round textured type Breast implant

Smooth type lead to different forms after the surgery, and so in order to prevent this, textured type implant was developed. The skin would grow into the textured implant therefore limiting the thickness in the epithelium however this was a failure. Different forms were made with the textured implant as well. Also, there was no difference in possibility of having different forms for both smooth and textured type if the implant was placed under the muscle.

Round Textured type Breast Implant

Then why do we use the textured type? It is used to stop the misplacement or the shifting of the implant to another location. Smooth type has smooth layers making it easy to move about to another location and also leading to deformation of the implant.
However, the textured type has rougher surface so it does not move about easily. I usually recommend the textured breast implant. There is no assurance that the implant will stay at the location that I intended.

3. Water drop type Breast implant

All water drop type breast implant have textured surface / layer.
Water drop type was made so that it would look natural on the body.
There are many of those who do not know about this properly but the water drop shaped cohesive gel breast implant was produced and sold at the same time as the round type cohesive gel breast implant. It is false that the water drop type is an improvement over the round type.

Water drop type Breast implant

The origin of water drop type breast implant is Natrelle Style 410. It was first sold in 1993 and was the first product of its kind.
This is the strongest of its kind as a cohesive implant, meaning that it is very safe. This is both the advantage and disadvantage of Style 410. It is very strong so it does not lose its form. Also it can fill up the volume properly.

On the other hand, since this is the strongest of its kind, it is very difficult to place it into the body. Also, the final feeling is not as good on a thin person. Recently there have been side effects of seroma and double capsule in the Natrelle product reported by the doctors.





So Natrelle develops a lower model Soft Touch in Style 410 lineup.
There is higher level of cohesiveness, and so it became easier to put in the implant. However, the safety level decreased as much as well.

The tight gel leads to longer formation of the breast and also improves on the sagging breast by uplifting it properly. But those who are young may feel dissatisfied with using this type as it feels less smooth.

There is no right answer in how you choose the implant. There are pros and cons according to different situations.





If you want satisfaction right now, you might want a soft breast implant, however, if you are looking long term, you might want to have a stronger breast implant.

However, there are many doctors and patients who say that Style 410 is too strong.
So other companies such as Mentor, Silimed, Nagor, Arion, Polytech, Sebine decide to make a softer implant than Style 410 and a tighter one compared to other round cohesive gel products.




If we compare the tightness and the softness of the imported implants, we could rank them as, Polytech being the softness, Silimed, Sebin, and Mentor at a similar level, and style 410 being the strongest.


I will prepare another post on the differences between the brands. Today, we differentiated various types of implants into three types and talked about the basics.

There is no absolute correct answer on how to choose the appropriate breast implant. This depends on the body, preference, age, financial status, and the doctor as well. One cannot say which implant is better than another.

Thank you for reading.

Have a great day.

Situation where you need Breast Revision surgery
by Dr. Lee Joo Hyuk (KIES-U Plastic clinic in Korea)

You made a big decision to have a breast surgery, however, you might have a make another rather difficult decision for a revision surgery due to some problems such as capsular contracture, change in location, and severe asymmetric shape.

A situation as such would not be welcoming if you were to have a Breast Revision surgery.





Today’s post is on the Breast Revision surgery.

According to US FDA PMA Study, about 20% of all breast surgeries need a revision surgery. The study includes all the requested cases to the surgeons including the cases with saline breast implant, textured implant, and smooth implant.  (It could be assumed that the 20% figure could include rupturing of the saline bag as well)

However, the rate of re-surgery varies a lot from a surgeon to another. Some rate is about 1% and there are some that are much higher so a percentage figure might not have much meaning.

There is no reliable study that shows the percentage of revision surgery here in Korea.
Therefore, this post will be written according to my experience. I will include the details of those revision surgeries that I have completed, or I have been requested to do by other surgeons, foreign country cases and those that I have heard from other surgeons as well.

Majority of the breast revision surgeries are due to Capsular contracture.

Breast Implants

Judging whether a breast is pretty or not, depends on visual and tactile senses. This visual and tactile senses are negatively influenced due to capsular contracture.

There are at times when a person misjudges the capsular contracture. This is not when the breast becomes hard or stiff, or the implants becomes hard, but it is when the scar tissue capsule becomes hard.

So the surgery that is caused by the capsular contracture would include procedures that would get rid of the scar tissue capsule partially or completely.

Then the question would be ‘why does the scar tissue capsule become hard?’. There is no one who knows the answer to this question. When the breast implant and the skin meet, there is no interaction and this may have caused the stiffness.





The first thing that we do in the breast revision surgery due to the capsular contracture is to change the environment and conditions that lead to the aftereffects.

The breast implant can be changed if requested as well and also the pocket size determined in the 1st surgery can be changed as well. If the capsular contracture is rather severe, we can change the breast implant surface.

Usually, I do not remove all the scar tissue capsule around the implant. I think that the tightening of the capsule is due to the trauma that is caused on the skin to make room for the implant. So, by removing the scar tissue capsule completely, may cause a larger trauma on the skin.

Therefore it is important to minimize the trauma during the revision surgery, and remove only the necessary part of the scar tissue capsule, or chip small parts or the skin.

If the case is severe that the scar tissue capsule must be removed completely, it is advised to set a new surface for the room to input the breast implant.

It is important to have the techniques to minimize the trauma and to minimize the bleeding for the breast revision surgery caused by the capsular contracture.

I think that the less harm on the skin would lead to lower possibility of the recurrence.
Also, it is important not to have any blood clots after the breast revision surgery.
The surgery should not be performed so that the blood clot is necessary.

When the patients come in for revision surgery due to the capsular contracture, they are psychologically and emotionally unstable. They are at a desperate stage.

Can I trust that this would not happen again after the breast revision surgery?
Maybe I should have not had such as surgery before? Maybe this isn’t for me.
Why do I have to go through this difficult procedure again?
Many patients ask these sorts of questions in their minds.

My experience is that a lot of such patients go back home happily after they have the breast revision surgery due to capsular contracture.
There are those who feel more secure and happy about the result compared to the initial breast augmentation surgery.



Of course, it is not necessary that all the capsular contracture need a breast revision surgery.
First it is important to make decision on whether the breast revision surgery is necessary or not, if there is another problem other than the capsular contracture, or if there is some misjudgment on the result.

The serial photos can be a lot of help. If the photos show that the location or the shape of the implant change continuously, it is advised to get a revision surgery.

I usually have good results after the breast revision surgery. There might be recurrence of the capsular contracture but this was very low with about 0.1% in my experience.

The breast revision surgery must start from the lower line of the breast. We will talk more about this next time.

Today, we looked at the overall picture of the breast revision surgery caused by capsular contracture. Next time, we will look more about the situations where you might need breast revision surgery due to other problems.

Thank you for reading. Have a great day.