About breast size - breast augmentation Korea 

There are many patients who do not know how the breast sizes change after the breast augmentation.

The doctors say that he/she would use 300cc or 275cc, but the patients do not know how the breasts would change along with the different sizes of the implants.

About 13~14 years ago, the internet shopping started.

At that time, people didn’t know how to buy the clothes on line just by looking at the clothes through the internet. Most people though that one must wear the clothes to buy one.

This was something unimaginable at the time, however, this internet shopping industry has grown tremendously in the past 10 years. Now, there are many who buy clothes on line. People are more comfortable with the internet shopping and they are aware of different sizes.

Internet shopping website providing explanation on sizes

There are some common sizes in shoes such as 235, 240, and 245. As for bra, there is a band size 70, 75, 80, and cup size of AA, ,A, B, C, etc.

A size is something that a person remembers as she buys things with that particular size.

But breast surgery is different from clothes in that a person would have a breast surgery just once in her life time and it is also difficult for her to know what size other people use.

I have divided the size of the implant into 3; small, medium, and large; because the patients are not aware of different cc. Below is the explanation of different sizes. (Most patients do not choose small and X-large so one can say that there are only 3 sizes)

Natrelle anatomic shape implant cannot be officially imported to Korea

　 　


This reference may help you understand the increase in size.
The difference in the cup size is difficult to estimate, as explained before.


Most of the women in their 20’s select high medium size. The next popular choice is large size followed by medium size.

This is similar with those in their 30’s as well, but there is relatively high percentage of large sized implants. The numbers are the same. (Most patients decide to get breast augmentation after giving birth and breast feeding their babies, therefore the patients tend to select large sized implants)

Most of the patients in the 40’s have re-surgeries or want to fix the sagging breasts therefore they tend to choose medium and large sized implants.

In Korea, an average patient would be 163cm tall, wears 75A bra and the diameter of the breast is about 11 ~ 11.5cm.

However, most of the patients want their breasts to be larger than small or medium sizes therefore choose high medium sized implants the most.

There aren’t many of those who have large enough breast diameter to use the large sized implants here in Korea.

I think this would kind of give you an idea of what sized implant you could use.


Today’s post was to provide a measure guide to those of you who do not know how cc is related to the size that you could have.

There is no scholastic reference for this, but I looked at many catalogues to come up with the measurement matrix to give a simple explanation that has led to positive feedback.

However, there is a downfall in this, it is a profile of the implant.





As you can see in the image above, ‘Low profile’ refers to long diameter and low height implant, ‘High profile’ refers to short diameter and high height, and there is a ‘Moderate profile’ in between the two.
People who study after breast augmentation at home through the internet do not know about this also.

Another point is that although you use the same 275cc implant, meaning although the volume is the same, the shape would not be the same once the implant goes into the body due to the different profiles.

We will explain more about this profile at a later posting.


It is already summer in Mid-May. I think one can expect how the weather would be in the next two months. Most people are already in short sleeves and pants. Are you worried about showing off your body? I am!

This is all for today. Thank you for reading.
 

Using artificial skin(alloderm) for breast re-surgery [KIES-U Korea]

We have been using the artificial skin in breast revision surgery since the early 2000’s. It was first used for the breast cancer patients but then the usage has expanded into the beauty area and is now applied on the breast surgeries.



The artificial skin is made by pig skin but has been biochemically alternated to fit into a human’s body, therefore, it is different from Alloderm that uses the skin from a corpse.
Alloderm is a brand name and the product from the brand is called Strattice.
Today, we will look into how the artificial skin is used for the breast revision surgery.





There are many causes that lead to breast revision surgery, one of which is the capsular contracture.
Also there are other causes such as the position of the implant, implant defect, leakage, hematoma / seroma.

The artificial skin(alloderm) is used when a patient’s skin becomes really thin so that the artificial skin is necessary to cover the implant.

This usage is rather an additional measure for the breast surgeries.

The position of the implant, such as going too much to the inside, lower bottom, or coming out, can be a problem, but this is caused because the pocket is too large compared to the size of the implant. So the artificial skin(alloderm) is used as a barrier for the implant to be fixed at the most appropriate position.




Capsular contracture is the main cause of breast revision surgery. Usually, we will cut off the epithelium or remove it and also change the plane of the implant, i.e. depth, during the revision surgery. Alloderm used in this case means that the implant would be covered by the product.

The artificial skin(alloderm) minimizes the possibility of the capsular contracture, and acts as a barrier between the implant and the patient’s immune system. Also, through this, the epithelium becomes really thin.

As for the reconstructive surgery, the incidence rate of the capsular contracture is decreased from 10~16% to 5% when using the artificial skin.

The sagging of the breasts is caused because the skin becomes really thin after the breast augmentation. The skin becomes thin quickly if the implant is too heavy or as the patient gets older. Normally, one would consider breast lifting is such cases but we could use the artificial skin(alloderm) so that it supports the implant therefore avoiding the sagging breast.



Rippling and wrinkling: This is normally found with patients who are thin. We use the artificial skin(alloderm) by covering the implant from the top on the part where there is refilling or wrinkling.

Many patients apply the methods mentioned above for the revision surgeries. Statistically, we have seen great improvements with the capsular contracture, and some with the sagging breasts and the wrong positioning of the implants.

However, we see many recurrences of refilling or wrinkling even after the artificial skin so we do not have much statistically significant data for such cases.




Today, we looked at how artificial skin is used on the breast re-surgeries. In summary, we can say that the artificial skin is used only when it is necessary for re-surgeries or re-constructive surgeries. Also there is a high cost for it.

Thank you for reading. Have a great day.

Bleeding after breast augmentation surgery [KIES-U Korea]

We do not call bleeding and pain as side effects. We need to know the cause of these problems.
All surgeries have bleeding. A good surgery requires how effectively you stop or minimize the bleeding. So the important thing is that the surgery be done without bleeding.

Breast augmentation Korea KIES-U Dr. Lee

What happens when there is much bleeding?

If there is much bleeding or if the bleeding is not stopped during the breast augmentation surgery, the blood builds around the implant.

The blood from the blood vessel becomes solid, i.e. hematoma.

The body can take it naturally if there isn’t much amount of hematoma, however the body cannot take in large amount of it so there will be some hematoma left. The large sized hematoma can force the implant to move into one direction causing an awkward shape and can be a cause of infection or inflammation. It also leads to pain as there is much pressure from the hematoma build-up.

If the hematoma is build up near the dissected part, then it can penetrate through the skin, finally leading to opening of the wound and worsening of the scar.

KIES-U Korea Breast augementation

What do you do when there is much bleeding?

We can diagnose if there is a problem with bleeding from 0 ~ 2 weeks of the surgery. Abnormal swelling or pain, change in skin tone, infection or inflammation can be examined. If there is not much bleeding or if the side effect is not severe, we can put pressure on it and stop the bleeding. However, if we find that there is much bleeding then we need to remove the hematoma.

If the surgery was done on the areola or on the bottom line, we use the same spot to check on the bleeding, use galvanocautery, and quickly remove the hematoma.

But if the surgery was done through armpit or the belly button, we cannot use the same spot. We would have dissect the bottom line and remove the hematoma.

Breast augmentation Korea KIES-U

If we dissected armpit in the original surgery and there is much bleeding, we can open up the armpit again, clean, and use the endoscope to stop the bleeding. If we are lucky, the surgery would be a success, if not, then we need to pull out the blood for a week and pressurize the part.

In such case, although we have saved the implant, the patient feels much pain and loses sense for a long period. Also there is a high possibility of capsular contracture.

How to avoid bleeding?

In the first two weeks of the breast surgery, one must be very aware of one particular problem, bleeding.

In order to avoid such happening;
The dissecting area should not big. The space must be appropriate for the implant size. (Minimizing dissection technique)
The implant, itself, should not be too big. (Large implant requires large pocket that leads to more damaging of skin and blood vessels)
You need to get the job done by an experienced and careful surgeon.

Bleeding in revision surgery

If the revision is necessary due to the capsular contracture, we need to remove the formed epithelium completely causing much bleeding. So we do not completely remove the epithelium but leave some that would help the new implant fit into the pocket. Removing the epithelium completely can be an another cause of the capsular contracture and also we need to change the method in order to minimize the bleeding as well.

Breast augmentation Korea KIES-U

One must be very careful about the bleeding in the breast surgery Bleeding can lead to other problems such as capsular contracture, infection, implant collapse, scar, opening of the wound, etc. The bleeding during the revision must be controlled properly as well. The result of the uncontrolled re-surgery would be obvious.

This is all for today. Thank you.

Selecting the Implant Height in Breast augmentation with anatomical Prosthesis

[KIES-U Korea]

Here in Korea, we have a short history of using tear-drop implant breast augmentation, therefore we limited know-how in various types of surgeries. In oppose to this, tear-drop implants have been used in Europe and North America for almost 20 years. Therefore, these countries have built-up knowledge and data that are important for the surgeons.
Today, we will look at a publishing by Jose Martin del Yerro, M.D from Spain and also criticize on it.




The satisfaction of breast augmentation is highly correlated with the beauty of the breasts after the surgery. This is because when you wear clothes, the upper breast can be seen easily and also the one can see the shape of the cleavage.
So this important upper breast is composed through the height of the implant, however, there isn’t much mentioning about it. The doctors do not consider this much and so does the patients.

Dr. Yerro published a paper that states that the height of the implant should be selected according to the body type.

Kretschmer and Sheldon were few of the people who divided the ‘body type’ into three. In easy terms, the types would be ‘thin’, ‘normal’, and ‘obese’.
Dr. Yerro stated that the pocket of the implant of a thin person is shaped oval vertically, round for normal person and a horizontal oval shape for those who are obese.



And through many analysis, he found that the ‘normal’ type is the majority, and the other two types of ‘thin’/’obese’ are rare. This is why there is much usage of round type implants rather than the oval shaped ones.

Dr. Yerro published his paper based on the analysis of 5123 patients that he has worked with for 13 years, starting from 1998.
This means that the thoracic perimeter has been divided by the distance between the center of the collarbone and areola to determine the height of the implant.




The result of the data can be seen in the image above. The ones with the ‘normal’ body shape were the most and the average length of the thoracic perimeter was found to be 80cm, with the average of the collarbone-areola distance being 20cm. Also, the round shaped implants were used the most.

I think that Dr. Yerro’s findings are very important in how we select the height of the implant. There aren’t many surgeons in Korea who are much experienced with using the tear-drop type implants. These surgeons only focus on the fact that they are using this type of implants and do not consider important 3 dimensional variables including the height.

 Dr. Yerro’s findings are not directly related to how we do things here in Korea, so some findings feel unrealistic. The biggest difference is that the Europeans and Koreans have different body types. My personal statistics show that the patients who want breast surgeries have average of 17.7cm in distance between the collarbone-areola, so this is much different from what Dr. Yerro has announced.

Also the thoracic perimeter is not as large as the average of 80cm. Most of these patients have very thin thorax as well. Many people with large thorax and those who are obese do not need breast surgeries.

One needs to know that most of the Korean women have short thoracic perimeter and narrow breast diameter. So, when we consider Dr. Yerro’s data, most of the patients that we have are composed of those who have ‘thin’ or ‘normal’ body type.

This means that most Korean patients need to use the vertical oval shaped implants





I will write another post to explain about how to select the appropriate height of the implant according to the various different types of the implant at a later date.
However, much of Dr. Yerro’s findings are those that have been neglected in our country, and I, personally, was glad to see such findings.
This is all for today.

Thank you.

Feeling of touch after the breast augmentation

There are three things that interest you the most when doing breast augmentation; shape, volume and feel. Today I would like to talk about this “feel”.
There are common questions that the patients ask about “feel”. Below are the questions.

1. Does smooth feel better than textured?
2. Does tear drop shape feel better than round type?
3. Does the touch (feel) get better with massage?



I sure that some of you have already realized what I am trying to say. We cannot say those 3 things above for sure.

Which implant has the best feel? 

The implant with the best sense of touch is not cohesive gel but basic silicone gel implant.


There are many who studied through the internet but do not know anything about cohesive gel.

Cohesive means cohesiveness. Cohesive refers to sticky silicone gel.

Why was it made this way?

This was made to avoid leakage of the inner substance when the exterior gets damaged.
The stickiness makes the substance stay together so that the substance does not come out easily. This helps maintain the shape of the implants and makes it more durable also.




The old type of silicone gel did not have any cohesiveness.

These products are not compact but disperse easily. Of course, these products are not manufactured any more.

But which do you think feels better? Cohesive gel or this old type gel?

I think everyone can guess the answer. The answer is the basic old type gel. Less cohesiveness, i.e. easily dispersed product leads to a softer touch and jelly like feel.
Cohesive gel cannot have a good touch feel compared to the old type. It has substance stuck together that does not disperse easily.

The first truth is that “Cohesive gel does not have good feel.” The implant with the best touch is the illegal liquid silicone.




The implants advertised on the natural feel and touch at first, but changed to focus on the safety and durability.

The conclusion is this. Why do we not use the liquid silicone or the old type? Although these feel better?

It is because these products have low safety and low durability. If the exterior is damaged, the substance inside leaks out and as a result, the shape is damaged also.

These implants have less durability so the re-surgery is necessary. This is why we hear that “the implants need to be changed every 5 years.”

The implants originally focused on the sense of touch but after the regulations set by the US FDA in the 1990’s the implants have been focused on the safety and durability. This is how the “cohesive gel” entered the market.
 


 
Differences between the round type and the tear drop type

Let’s talk about the 2nd “truth”. The implant that feels good has less gel inside it. Most of the round type implants imported to our country has less gel on the inside.
Let’s think about a balloon that is fully filled with water and the other that is less filled. Which do you think feels better? Of course, it would be the one with less water filled.




Most of the imported cohesive gel implants in our country are less filled also.
In opposite, most of the tear drop type implants imported since last year are much filled.

Allergan tear drop implant has the most cohesiveness. If you touch it, it feels hard. Polytech implant is one that is filled the most.

In conclusion, the round type implants in Korea are not fully filled and have less cohesiveness therefore; these implants feel “good”.

But the truth is that it does not matter.

There is not much difference. All cohesive gel implants are alike. The cohesive gel implants are not focused on this sense of touch.

The implants should not only focus on marketing the parts that attract the customers.

In order to feel good, dissection must be done properly and the appropriate level of epithelium must be maintained.

The sense of touch is not depended on the manufacturer.
This depends on how careful the surgeon is rather than which product has been used.





One must select an implant based on the durability, product life, possibility of getting damaged, shape stability, etc.

There are some patients who say, “I want to use the tear drop type, but I am hesitant to use it because I heard that it does not feel good.”

A patient needs to use the tear drop type if it is necessary to use it. This is not similar to shopping where a customer chooses and buys the one that she likes.

An implant, once put into the body, needs to stay in the body for a long time therefore, it is important that you have the accurate information when selecting one.

This is all for today.

Thank you for reading.

What is double bubble after breast augmentation?

Let’s look into one of the most common side effects of breast augmentation,
double -bubble

Today, I would like to share about one of the most common side effects in breast augmentation, double wrinkle ( double line, double bubble).

One must know the anatomy in order to understand this side effect, but this is difficult for a normal person, therefore, I would like to refer to an image below.

Normal structure of the breast

This is the normal structure of the breasts. There are some conflicts among the scholars, but the cause of the Inframammary fold is due to the Inframammary fold ligament.

But there are some with a clear Inframammary fold and one that is not so clear. If you are a patient with a clear Inframammary fold before the breast augmentation, then there is a high possibility that you would have double wrinkle after the breast augmentation.

The possibility is higher for those who have sagging breasts or large breasts.

Case of double bubble after breast augmentation

As shown in the image above, if the implant is positioned under the muscle, there is a high possibility of the double wrinkle due to the Inframammary fold ligament.

If the surgery is done above the muscle, this possibility is lower.

If you are the one who has read many articles in this blog, you might know that if the implant is positioned above the muscle, you will be able to feel it easily unless you have thick skin or the original breasts are large. There are much limitations to patients having under the muscle implant if the patients are thin.

That is why we need to conduct double plane correction.

Double plane correction leads to the implants not being felt easily and also preventing the double wrinkle.

How to prevent double bubble after breast augmentation

When the double plane surgery is conducted, most of the implant would be positioned under the pectoral muscle therefore one will not be able to feel the implant easily. And, by cutting off the inframammary ligament, one can prevent the double wrinkle.

However, this is not the only reason that leads to double wrinkle.

Capsular contracture can lead to double wrinkle, and also the position of the implant within the body can lead to double wrinkle as well.

Also, certain part of the body may become really thin during the course of the surgery, leading to double wrinkle.

It is difficult to think that the double wrinkle will be formed in each of these cases but there are various methods on how to remove the double wrinkles. Therefore, it is important that you consult the doctors in order to do so, especially those patients who are thin or have sagging breasts.

This is all for today, thank you for reading.

Q) Are there any bad things or side-effects of having implants that are too big? 

There are many problems. I will share them one by one.

1. Over-dissection

Measuring the width (cm) of the breast and fitting the correct width of the implant would be the first stage of selecting the volume of the implant.
 


If the volume of the implant is too big, then the width is wider as well. If a wide implant is put into a narrower pocket, then the surgeon would have to dissect the side of the ribs or dissect into the mid part of the chest.

If the side of the ribs is dissected, then there is high possibility of damaging the nerves of the blood vessel. This damage would trouble the patient continuously for a long time.

But if the inner part such as the mid point of the chest is dissected (due to the bigger size of the implant) then the two implants might touch each other (Synmastia). This side-effect, if caused, would last forever.
 

2. Implant Collapse 

If the implant is put into a pocket that is narrow, the implant might collapse and lose its shape.
No matter how large an implant is, which is made of half liquid, cohesive gel, it can be forced into the pocket that is small.

Such collapsed implant would leave some space at the folded part, and the folded part would hold onto anything that is positioned. This would cause seroma, inflammation, and hematoma.

If the implant is folded, there would be much friction caused when using the arms. This friction would damage the implant exterior causing leaks.
 

3. Original breast atrophy

Let’s say that there are two women with same sized breasts. The widths are the same and the extent to how much the skin extends is the same as well.

One patient uses 290cc implant that is appropriate for her. The other uses 340cc implant that is larger than the appropriate size.

Two years have passed after the surgery. Who do you think would have bigger breasts?
This might seem like an easy question to answer but rarely does one answer the correct one. The reasons why the answer to this question is different from common sense is that the body is not like a mannequin and the body changes through time.

Silicone is located between strong ribs and smooth skin. The ribs under the implant are strong, and the skin above the implants is smooth, therefore, the skin is pressurized.
The pressure on the skin continues 365 days a year.

Let’s say that you have a bandage on your arms for 2 years. When you open up the bandage, the arm would be thinner than the other without the bandage.

This applies to the breast with the silicone implant as well. The pressurized skin would not have blood circulating therefore becoming thinner and wrinklier.
We call this atrophy.

The 340cc implant has more pressure than the 290cc one. The patient with 340cc implant may have her breasts look bigger right after the surgery, but after 2 years, there would be atrophy that causes the breasts look like those with 290cc.

The patient with 290cc would have skin that well preserved therefore, the breasts look feel more natural than the one with 340cc.

4. Unnatural appearance and feel 

If the implant is too big, then it would pressurize the skin a lot and pull the skin as well.
Let’s say that you bought a leather jacket that fits you tightly from a shopping mall. You might not be able to close the zips easily. The implant would be much like closing the zips of the jacket.

Others might think that this is too small as well. Your jacket might look all new, but if you touch it, you will feel that the jacket feels tight and rough.

This happens to the breast. The breast would look unnatural, and it would feel rough making others recognize that there is something inside the breast.
 

5. Ugly scar  

If the pocket is too small for the implant, then there has to be much stress when putting in the implant. The tools used for this input might cause damage on the skin.
When the implant goes through the entrance, there would be much stimulation and friction on the skin.

Wherever the surgery is, this type of activity would cause less circulation of blood on the scar, causing the scar to worsen.

6. Visible margin or rippling

If the implant is too big, the margin of the breast would be formed elsewhere then the place that it is to be formed. This happens to all parts of the breast. If the margin starts from a different location then it is supposed to, the breast would look unnatural.
Also, if the implant is folded and this can be seen at places where the skin is very thin, we call this “rippling”.
 
There is not one patient who does not want a large implant, but there is a limit to this. If you ignore this limit and carry on with using larger implant than the one you are supposed to use, then there would be discomfort and side-effects. Majority of these problems cannot be fixed at later stages.


Today, we looked at what happens when you use large implant that is not appropriate for you.

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

Q. Is it better to use the round type or the tear drop type implant?

This is not a simple question to answer.
First, one must know the difference between the round type and the tear drop type.
Another important thing to know is the status of your breasts. One must know the status of the breasts/chest to decide on the type of the implant, therefore round type might be good for a particular patient and the tear drop type might be good for the other.




Round type implant has substance that is not tight, meaning it has less cohesiveness. So the round type changes share according to the environment it is in.

Tear drop type breast implants has substance that is tight therefore strong cohesiveness. So the tear drop type implant does not lose shape according to the environment that it is in.




So the round type implant does not remain round when inside the body but much of the weight of the shape is focused downwards (low stability of the shape).
However, the tear drop type maintains its shape when it is put inside the body (high stability of the shape).


But this characteristic changes according to the different manufacturers. Some manufacturers have round type implant that is tight and tear drop type that is not.



The secureness of the implant itself is important, but the skin elasticity of the patient is important as well.

- If the patient is young and has not been pregnant before, with small breasts, then the skin (that surrounds the implant) is tight and elastic.
In such case, whatever implant used, the implant would not lose its shape. If the round type is used, then the implant would look round, and if the tear drop type is used, then it would look like a tear drop. In this case, the breast would look natural with the tear drop type.


- If the patient is young and has enough volume in breasts, then the skin would not be too tight. In such case, it would look more natural if the tear drop type is used.
- If you are old, have been pregnant, and have large breasts, the skin would be lose and less elastic.
In such case, the secureness of the implant would be important. If the less secure implant (i.e. round type) is used, the breast would not look round but sagged. The upper part of the breast would look empty and the cleavage would be positioned lower. So, one must use more secure implant.


- If the patient is young with tight skin but the distance between the nipples are wide, the upper breast volume might be less. In such case, it is more appropriate to use the round type.
- If the distance between the nipples is short or narrow, then it is better to use the implant that focuses on the bottom part of the breasts. Tear drop type would be more appropriate in such case.
- If you need a breast augmentation re-surgery and would like to use a smaller implant than the previous one, it is better to use the round type. If the pocket is big then the tear drop type implant can get in easily.
- If you have dissected your breasts because of breast cancer or any other reason, and need to reconstruct your breasts, you would need to continuously press on the skin that surrounds the implant. In this case, the round type would be more appropriate.





So the type of the implant that you need to use differs case by case, and is not a simple question to answer. First, you need to know your body and the shape of the breast then know the differences of the various types of implants, and finally, know the differences of each brands.

Today, we looked at how to choose between the round type and tear drop type implants.

Thank you for reading.
Have a great day.

Solving "separated breast" deformity on thin women with composite breast augmentation

Today, I would like to introduce a thesis on the fat transplantation in between the breasts, especially for the thin patients.



The article is from a renown magazine, Plastic and reconstructive Surgery 135. April version. It is written by Francisco Bravo from Madrid, Spain. The name of the thesis is “Parasternal Infiltration Composite Breast Augmentation”. (You can think of this as solving the separated breast deformity of thin patients)



There were many others before Dr. Bravo, who conducted composite breast augmentation that requires using an implant along with fat transplantation.

The thinner you are, your breasts would look unnatural if you use larger implant than that is appropriate, and therefore, one uses fat as a covering tissue to make the breasts look natural.

But there is a limitation in such a method. It would be difficult to get sufficient amount of fat from a thin patient. Also the fat cannot be engrafted properly on to the implant therefore; the outcome is rather disappointing to many.

The characteristic of Dr. Bravo’s research is that you transplant fat between the breasts of a thin patient making the upper body look more beautiful.



This process does not require much fat and solve is judged to be helpful in providing solution to the ‘separated breast deformity’ of thin patients after their breast augmentation with the implants.

Fat transplantation cannot be a substitute of the implants but is helpful for the implant outline or the contour. This is more applicable to re-correction patients and thin patients.




The original breasts are important for the shape of the breasts with the implants.
Those thin patients with thin soft tissue on the breast bones complain about one being able to see the edges of the implants.

The patients think that their breasts have been “separated” far apart in such case.
But the fat transplantation  on the edges of the implants make the breasts look more natural and less separated apart.

We can see the improved results from the experiment done on the 2 groups; one with just implant and the other with implant + fat transplantation.



The amount of fat used was about 6-~140cc , an average of 117 cc, which is rather less that the amount that we usually use, 300~500cc. The fat is transplanted just under the skin.

The fat transplantation was done through the breastbone line.

I have used this method many times before, and there are other doctors who have used this method as well. But I believe that Dr. Bravo is the first person who announced such structured thesis.

Here is the summary.
Fat transplantation cannot solve all the problems that thin patients have with the breast augmentation. However, fat transplantation can be a solution to the separated breast deformity.

Thank you very much for reading.

Anesthesia for Breast augmentation

This is a frequently asked question. Today, I will answer this question through this post and also share some wrong information that some advertisements state about the breast surgery.


 
The difference about the breast augmentation and other surgeries is that breast augmentation requires a large substance to be put inside the body.
The important factor here is that, this large substance should not cause any discomfort on the body and that there should be no side effects also.
Therefore, it is very important that there is absolutely no problem while doing the breast augmentation.

Important factors to consider in breast surgery
1. The form of the breast must be stable for a long period
2. Implant should not have any influence on the original breast tissue
3. 24 hour recovery system, i.e. the patient must be able to recover within 24 hours (Quick recovery = Low possibility of side effects)
4. There should not be any bleeding or damage on the tissue
5.There should be semi-permanent stability / harmony of the implant and the breast tissue


I was really surprised at what I found on the internet about breast surgery. I found marketing statements as the ones listed below. Many of these surprised me. Here are a few.

Others apply general anesthesia, we apply local anesthesia
- When we refer to the textbooks of breast surgery, there is no recording that IV sedation has quicker recovery time than the general anesthesia
- Some might be quick to think that conscious sedation may lead to a quicker recovery, but this is not true. If you have breathing problems, or others that may danger your life, there is no way to solve these problems
-  An experienced surgeon can have the patient leave the hospital after 2 hours of the surgery although the surgeon has applied the general anesthesia
- Using conscious sedation as a marketing source to attract the patients is wrong and dangerous activity

Other hospitals cause 5cm incision but we only cause 3.5, therefore, the scar is very small
- An implant is pushed through a small hole and it needs to remain there for decades maintaining its form and shape. Size of the incision cannot be appealing marketing information
- The possibility of damage, breaking, contracting of the implant is higher than normal. For example if the implant is about 275cc and this goes through 11~12cm inlet. The small inlet might cause the implant to lose its shape inside the body.
- If a hospital wants to appeal that the incision size is 3.5cm or less, then it must also provide research data of MRI or ultrasound that an implant put through this small inlet has no problem for 10 years or more. Just using this advertising message is not appropriate for the patients in the long term.



We has our special technique that makes your breasts larger than 300cc
- This is absolutely false. The size of the implant is decided by the patient and also the size should not cause harm to the original breast size and shape. It is wrong to say that a surgeon will just make the breasts bigger.

I really hope that such marketing activities by the hospitals are avoided in the future.


Here are additional details about the anesthesia.

In plastic surgery, we use the general anesthesia that has muscle relaxant and other anesthesia so that the patient does not feel pain in the muscles. This is done through using anesthetic gas and oxygen put into the respiratory system.
Conscious sedation uses sedative, pain killers such as propofol. This does not relax the muscle so the patient may be able to move about during the surgery.

The reason why we use general anesthesia for the breast surgery is so that the breast muscle has no movement that may cause harm on the breast tissue or discomfort on the patient.

If you have conscious sedation, your muscles (i.e. pectoral muscle) might move without any intention causing tissue harm and inaccurate desquamation causing delay on recovery and bad outcome.

One must apply general anesthesia when doing the breast surgery.

Conscious sedation does not lead to quicker recovery but instead, a long one. Also, conscious sedation is more dangerous and has higher possibility of causing problems.

Anesthesia is very important to a surgery. Today we looked at various anesthesia methods and some problem associated.
Breast surgery cannot be corrected like eye/nose surgery.

 

I hope you will be able to get accurate information in deciding what is right for you. This is all for today.

Have a great day.

How the shape of the implant and different methods change the shape of the breasts 

An interesting report on how the breasts change according to the shape of the implants has been introduced based on various experiments conducted on 17 corpses. It was written by Dr. Antonio Jorge Forte of Yale University and Dr. Alonso of Sao Paulo, Brazil. (Plastic and reconstructive surgery, Apr, 2015. vol.135-4)




21.8% of re-correction of the breast surgery in US was done to change the size of the implants, and 8.2% was to reposition the implants.

Getting the right position to make the breasts look better is an important factor when knowing if the surgery is successful or not, however, it is not always easy to find the appropriate position for the implants.

The research team experimented on how the nipple position changes when using the tear drop implant or round type implant. One of the difficult things about such experiments is that we cannot apply various implants on the same person. It is difficult to state that tear drop implant produces one result and the round type produces the other result unless the tested bodies are of same condition.

So, it is meaningless if different implants were used on different persons with different conditions.

Therefore, using corpse to test various types of the implants makes this experiment an important one.



We call the state where the nipple sticks up front as “projection”.

Projection becomes bigger when using the tear drop implant compared to when using the round type. The nipple sticks out forward and this degree of nipple sticking out is directly associated with the cup size.

The experiment shows that 100cc leads to a projection of 0.6~0.8cm.
Implant on sub-glandular leads more projection than sub-pectoral.
Also, the distance between the lower wrinkle lines becomes wider when using the tear drop type implants. This means that the sagging breasts become higher after the surgery.

As the volume of the implant increases by 100cc, the diameter of the areola increases by 6%.

So what influences the projection of the nipples after the breast augmentation? The  research shows that the type of the implant, whether it is the tear drop type of the round type, does not matter, but the volume (cc) of the implant influences the projection. So it is common to see a patient with not too severe case of sagging breasts corrected due to the breast augmentation.

However, there is a limitation to this research.

The corpses used were 8 to 12 hours after death, so the body might have been little stiff and also the results were based on the findings of the short period after the surgery.



Summary:
1. Sub-glandular implant leads to more projection of the nipples and higher positioning of the areola. (When compared to sub-pectoral and when using the round type implant)
2. Larger implant leads to more projection.

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

Today we will talk about accessory breasts.

What is accessory breasts(polymastia)?

This is a term related to multiple breast syndrome, or additional breast tissue. The additional breast tissue is found elsewhere than the breast. When the mammals are born, mammary gland tissue is formed but this does not go away and the tissue stays due to some problem.




This can be found anywhere from the armpit down to the groin.



There are some cases where this multiple breast syndrome also has nipple and areola as well. There are cases that do not have the two.

If you have multiple breast near the armpit, you might feel pain during the pregnancy and also might have secretion coming out from it.

Revealing of the accessory breast

This is very common with the American Indians. This is also passed down from one generation to another within the same family line.
This is less common on the women. This can be found in 1~3% of men and 0.4~0.6% of women.
The ectopic breast tissue can be found anywhere in the body, but 20% of the accessory breast can be found on the armpit.


 

Symptoms of accessory breast

This can be seen during puberty, and a lot of fat and tissue are centered around the mid part of the body. Some patients come to the hospital or clinic because they do not like how it looks.

This might hurt a lot as well in the beginning stages.
It reacts according to the hormone level, therefore the pain and the side effects are greater during pregnancy, breast feeding period, etc.




Another fact that is important to know is that all things that happen on the breast can happen to the accessory breast as well. Breast cancer, and fibroadenoma can be found in the accessory breast as well, but the recurrence rate is low
If you are concerned about a tumor, then it is recommended that you get a check up on it.

Diagnosis 

There are many who are not aware of this accessory breast. Also it is difficult to get diagnosis on it. It cannot be seen easily from the outside unless there is a nipple or areola. But, if not, we cannot virtually make out if it is accessory breast or not.
It becomes bigger or smaller during period, and also cause discomfort, pain, secretion, restriction on the arm movement during pregnancy.
If you want to know if you have the accessory breast or not then you need to take X-ray, biopsy, etc.



We also do ultra sound. The accessory breast tissue look similar to those on the actual breast as well.
Some do the MRI as well but some do not if the accessory breast is too big or look too bad.

Treatment

The best treatment is to surgically remove it. You can also apply liposuction to remove it.


Today’s post was on the accessory breast. I hope the details have helped you understand it.
Thank you for reading.