Incidence rate of capsular contracture

 


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


Capsular contracture depends on


Here exists the core problem.

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

Here is the summary.

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

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

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

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

What can I do if I have a capsular contracture?

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


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


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

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

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



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

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

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

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

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


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

Side effects of breast augmentation -What is capsular contracture?

Many people around the globe are interested about breast augmentation and breast augmentation is one area that a lot of people are researching on in the medical field.

So there are fast developments in this area and the doctors seem difficult to catch up with all the new information and research if they are not interested.

In US, there are about 400,000 implants used in a year. This is comparably different from Korea where we use about 50,000 implants a year.
Also most of the data on the side effects come from US. Today, I would like to use this data to share some information. (There aren’t much data in Korea)

Patient with breast augmentation side effect (Source: MBC)

 
This might be out of line, but let’s compared the airplane accident rate to breast augmentation side effect rate.

According to IATA, the accident rate of planes manufacture in the western countries was 0.71%. This means that there was 1 accident in every 1.4 million flights. Those people who died on flights are 685 (Yunhap News)  

 
A plane with 0.71% of accident rate, is it safe to ride on it?
This depends on each individual who knows about this rate. I usually use the planes, but there must be some who do not use the planes because they think that it is not safe.

I will ride the plane. I will not. As you know about the safety and decide on whether you would ride the plane or not, one must be aware of the incidence rate of capsular contracture, implant collapse, etc related to breast augmentation and decide on whether you would need breast augmentation or not.

Breast surgery Korea KIES-U

 
MFDS has data that says that there were about 98 cases of capsular contracture last year. But this number does not have any meaning to the patients and even the doctors.

Epidermis is formed naturally on anyone, but the real problem is when this squeezes. We are interested about what number of capsular contracture leads to reconstruction, what type of implant was used, how many implants were used, and what manufacturers made these implants. However, these type of data do not exist right now.

What is capsular contracture?

This is a term that many patients know and one that a lot of doctors use as well. However, capsular contracture is not an appropriate term to use.

An exact expression would be epithelium contracture. If an outer substance enters our body, our metabolism system forms a wall around this substance. We call this wall, capsule.

The capsule takes a few weeks to be formed. The wall is formed and grown, squeezing the substance but this is different from one person to another.

If it is tightly squeezed, much pressure is formed on the implant making the implant as strong as a stone or it can even change the shape of the implant casing discomfort.
We call this capsular contracture. Capsular contracture is similar to healing of a wound. All mammals including human have scar when there is a wound. This scar can be big or small on a person. As for a scar from a surgery, the scar would depend on how the doctor performs on the surgery.

Capsule formation is normal on the body, ‘but the problem exists when there is much pressure on it.  However, this cannot be known before the surgery.
If the capsule becomes very tight at the bottom of the breasts, the implants would be pushed upwards and the upper breasts would stick outwards.
 

Breast surgery Korea KIES-U

If the capsule is very tight on the insider, the implant would be pushed outwards and the breasts would look far apart.

If the capsule is tight from all sides, the implant would become as hard as a stone. If the tightness comes all around the breast, and changes the shape of the implant, we call this capsular contracture. The 98 cases announced from the MFDS can and cannot be this type of capsular contracture.


In the next posting I will continue writing about the 'incidence rate of capsular contracture'.
Thank you

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

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

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

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


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

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




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

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





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

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

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

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

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



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

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




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

This is all for today. Thank you.

What happens to my breasts that I have cosmetic surgery on, after pregnancy or after I give birth? Which looks better? Before the pregnancy? Or after it?

This is a common question. The answer to this question is that the surgically done breasts become similar to the non-surgical breasts.

Breast augmentation requires putting in the implants and enlarging the skin. The skin tissue suffers much tension and weight load and also, the skin ages over time.




All the skin tissue suffers from aging whether you had breast augmentation or not.
The skin and the related tissues suffer change from pregnancy and birth whether you had breast augmentation or not.

Also, if you had a sudden gain or loss in weight, there would be changes in the skin tissue whether you had breast augmentation or not.

After breast augmentation Korea KIES-U

The sad news is that all these changes that a person faces are not positive ones.
As you age, there are many changes such as wrinkles, sagging skin, loss of hair, fat moving downwards, weakening of your bones and joints, weakening of your organs, etc, and these changes are not positive changes to you in terms of beauty. (This is why people do not like to age)

The tissues surrounding the breasts suffer the same changes as well. Whether there is an implant or not, one cannot avoid many changes that take place after the pregnancy or birth.

The only difference is to what degree each different person suffers these changes.

Breast augmentation Korea KIES-U

In the old days, some companies used to manufacture stickers for the surgeons to use on the implants so that the implants do not sag down along with the breasts when the patient gets older.

However, the result was not good. The implants did not move from its original position but the skin sagged with time, and it looked like that there is a bump on the breasts. The sticker product has vanished from the market since.

Unless you use such an implant, any implant would move its location according to the sagging breasts. Implants do not prevent the changes due to aging or pregnancy – giving birth.




But, there is something that gives some sort of minimum help to all these negative changes.

Implant needs to fill up the upper breast volume when there isn’t much volume due to the sagging breast. An implant needs to improve on the shape and maintain the shape as much as possible through all these changes for the breast augmentation to be successful.

If you are a person who is looking to be pregnant or planning to give birth soon, you need to consider this change for the long term as you think about getting a breast augmentation. Also it is important to think about how the breasts would look like as you age or give birth.

Some patients ask which of the two, breast augmentation before giving birth or after it, is better.

This question is a little meaningless, because no one knows when this giving birth would end. One might have a child but have another one unexpectedly. Also it is common to see a person get pregnant in her 40’s.

There are other various changes after pregnancy-giving birth. The body goes through a lot of changes from birth until death and so does the skin tissue.

If you ask about the right timing for the implant surgery, there isn’t one settled timing that a person can answer. This is the same as getting Botox or wrinkle free surgery.

We are trying to find improvement methods that could be applied to all these changes that a person goes through.

We are just trying to find the best solution in all these situations.
And we do this be estimating what kind of mid to long term changes you would face after the breast augmentation.


Today we looked at how the augmented breasts change before and after giving birth, along with when is the best time to get the augmentation.
Thank you for reading.





p.s. I missed out a point. There is no medically known proof that breast feeding leads to quicker sagging of the breasts. Breast feeding is important for the baby so it is not right to stop the breast feeding because one is concerned about the sagging breasts.

Q. What is the name of the surgery that I am getting? Is it called breast augmentation or breast cosmetic surgery?

In truth, this is one question that I hope to be asked by my patients.
I think that this question carries the most important message for a breast surgery.
In medical terms, we call the breast surgery, ‘Augmentation mammoplasty’. This means breast enlargement cosmetic surgery.

The following definition can be found on the internet.

Definition about 'Breast augmentation' in Naver Korea

I do not like this explanation.
If I had to define this term, I would do it as the following.


"A cosmetic surgical method the makes beautiful looking and appropriate sized breasts, with an objective of setting the right beauty proportion, balance of the two breasts, and harmony with the upper body."


Proportion, Balance, Harmony

The three matters above are important to any cosmetic surgeries and the same applies to breast surgery as well.

When people consult about the breast augmentation, there is a lot of emphasis on the implants. Implants are used for the proportion and balance.

An implant is used for the beauty of the breast and not much more.
Volume is necessary for the beauty. Not the other way around.

One must know that this breast augmentation is not just to makes the sized bigger (cup siz bigger).

Let’s look at the two images below.

Breast augmentation surgery Korea

The above picture shows a patient who is about 170cm tall using 375cc round type implant.
The patient blow is about 167cm and she uses 270cc water drop type implant.

Breast augmentation Korea

Some patients think that the breasts are covered by the bra and others cannot know the difference exactly so they just want large size. But this is not a good decision. As you age, breast feed, get pregnant, the shape of breast changes. Therefore, in the long term, this would not be a good decision.

Golden ration of the breast

As you can see in the image above, the part above the nipple is the upper breast and the part below the nipple is the lower breast.

The upper and the lower parts need to have different shapes. The upper part needs to have a natural shape (beaker) and the lower part needs to have semi-circle shape. You can see the differences in the shape from the two pictures.

If you look at the image below, you would be able to recognize the golden ratio that I would like to refer to. The golden ration is known to be 1:1.618 and amazingly, this applies to breasts as well.

Breast augmentation Korea

It is not breast enlargement or breast cosmetic surgery. I think the right answer is “breast enlargement for beauty.”

The main message for today is that this is NOT "a surgery to make the breasts bigger”.


Thank you very much.