Consumer Report : The dark side of breast surgery. Hoping for a TV program that provides the essence of the problem

I would like to share my reviews of Consumer Report on KBS that was aired on March 3rd titled ‘The dark side of breast surgery’ as a cosmetic surgeon.

The first story was about a lady named Ms. Choi who suffered from capsular contracture.


The lady got breast augmentation with saline bag type implant in 2012. Within a week, the breasts became real hard. The clinic where she got the breast augmentation, decided that it was due to capsular contracture and conducted correction. The implant then collapsed so she visited another hospital to replace the old implant. The new implant used was a cohesive gel type. However, the pain still existed and she finally decided to have the implants removed. In september, she got the implants removed, but the pain did not go away.


The Consumer Report also showed that Ms. Choi did “think about suicide” and “that one out of every 4 patients get correction. There is more behind all the sweet talks about breast enlargement”.

The program says the Ms. Choi get contracture within the first week….

This is something really difficult to happen.

Capsular contracture is formation of epidermis that becomes really thick and strong due to metabolism. It takes about three weeks for the epidermis to completely surround the implant. . Having felt something similar in 1 week seems that this is not a capsular contracture, but a mis-match of the pocket size for the implant and the implant itself.

Wouldn’t you understand better if I said that the pocket was too small for the implant to go it therefore the breast became real tight because the implant that is larger than the pocket?


If the patient’s breast skin became thinner then maybe the epidermis was removed by too much force due to the judgement that there was a capsular contracture. I think that the skin stuck on the epidermis was removed togethers. (This happens a lot when the correction is done through the armpit)

In the meanwhile, a nerve might have been damaged so that there are no senses. The patient might feel like she got burnt while bathing in a sauna - A burn can lead to contracture as well - and the 4 or 5 corrections could pull on the scar a lot, making her feel that kind of pain. I think that Ms. Choi’s case is all due to the problem of the surgeon being careless.

There was a snapshot of 2016 Reports of the side effects caused by medical equipments. I do not think it is right to show such simple data and make the viewers thinks that implants are dangerous.



This is like saying that there are 100 times more cold patients that cancer patients therefore cold is 100 times more dangerous than cancer. I think it would be better to compare medical equipments used inside the body such as dental implant, artificial valves, artificial neves, artificial joints and artificial breasts and seeing how many reports each of these equipments get.

Also, the statistics that one out of every 4 breast augmentation patients need correction looks wrong There is no such data or statistics in our country. FDA in US gathers such data. In 1993, there was a ban on silicone implants and the data then was about 20%. This was 24 years ago. That is a long time. What do you think it is like now? (This was US not Korea)

American Society of Plastic Surgeons (ASPS) gathered reports from 4990 plastic surgeons on reoperation rates of breast augmentation. This data was published in PRS 2011 October edition. .



The reoperation rates announced by ASPS was 1~5%

The second most common reason for reoperation was to change the size of the implant and the most common reason was capsular contracture.
We cannot neglect even one patient who has side effects. But because of one careless mistake, we cannot judge that these surgeries are really very dangerous. We cannot make the patients feel concerned because of this. I am also not sure whether this is something that journalism is to take account for.

The second story was about Ms. Kim who received fat transplant on the breasts. It was about getting fat transplant twice with frozen fat leading to a flare in the breast and opening up the stitch causing exudation.
The program stated that the fat stored was in a real bad condition that led to inflammation which could also lead to severe damage.




I have studied science. Science starts with rational doubt and analysis on the doubts. So I had much doubts when I was watching the program. Is this true? Can the fat of bad condition cause inflammation and infection making the patient suffer that much?

The first and the second story from the Consumer Report put much focus on the medical equipments. This is the approach that non-professionals take on some professional area. Equipments are something that are visual. Implants, fat, etc. But the specialists focus on something that are not visible, like what did the doctor do?

If the fat became bad because it was stored in the residential refrigerator and was used for transplant causing infection, why did the exudation only come out from the right side?

It was the same material. The fat with same materials was used on both breasts. Then why wasn’t there infection on both sides?

Actually, it is difficult to analyze the details with the contents provided in the program. We cannot know what caused the infection. If the nutrition from the good fat did not spread out properly into the breasts but died out, we could still have the problem of infection.



It seems like much fat was used. We need metal cannula in order to use this much fat. We cannot ignore the mechanical trauma that may have been caused.

The cannula has to move in order for the fat to enter the breasts. This may damage the cells and cause bad environment. Such could result in infection as well.



I always think like this.

All complications and side-effects are related to how careful the surgeon was.

Fat transplant on the breast is not something that is bad. The fat needs to be stored carefully, the input process should be done carefully, sterilization should be done, the patient needs to take antibiotics, there should be proper dressing for the wound, proper monitoring to lead to good result for the patient. This is all done by human.

The third story is a lot worse.

It is about a filler used on the breasts. There is no details on the safety of the breast filler in any journals published around the world.

I still think that this should not be conducted in some cases. If there is a problem with the breast regarding shape and you want to make it more contour, then we can consider the filler.
But, if you want to change the size of the breast in terms of cup size (it said 700cc in the program) then I would oppose the idea of using the filler.

There was a small detail about UK gynecology journal in the expert interview. The substance in the filler was liquid silicone which has been banned in usage for a long time. (Today hyaluron is used)

I think that what Consumer Report is trying to say was that the practice of plastic surgery for commercial reasons can be dangerous. I agree with this effort.

But, the program kind of got out of hand in sharing about the danger.

I feel kind of empty after seeing medical related programs (including dramas)
There is no essence in the program but only non-important contents.

The most important thing is whether the patient met a good doctor or not. Everything is done through the hands so one must be very careful because something that has never happened before, could happen. One should not be too greedy but be satisfied with the current status. I think that this is the essence.



My hope is that we abandon consumer targeted promotion in plastic surgery. I hope there is a medical law or regulation for this.

Thank you and have a great day.

How can we treat Poland syndrome?

[Breast surgery Korea KIES-U]

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

A. Here is the answer.

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



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

Guy's hospital in London, UK

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

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

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



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

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



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

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

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



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

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



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

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

This is all for today, thank you very much.

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

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

Breast surgery Korea KIES-U

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

There are the main factors of uneven breasts

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




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

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



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

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

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

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

Reference from an essay in Brazilian Plastic Surgery Journal

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

Reference from an essay in Brazilian Plastic Surgery Journal

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

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

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

This is all for today. Thank you for reading.

Sociology of plastic surgery

Langlois and others conducted an experiment on 3 month old babies by giving them 2 pictures and observing which they like more. Although these babies could not speak, they look at the picture of the one that the adults judged to be more attractive.

Couple of years ago, there was a TV program that tested which teacher the kindergarteners liked more, a pretty looking teacher and the ones who is not. The kids concentrated more in the class thought by the teacher who was more attractive and they thought her to be more professional.

Based on such experiments and information, we can think that the want for beauty is gained through learning and also something that is innate.



A human’s stand towards beauty is both longing and a desire, and at the same time something that is artistically wanted for.
Sophisticated, noble, smooth, attractive, lovable, enticing, etc, words such as these show how much us human being long for beauty.

In this regard, our society too is very and overly interested in plastic surgery. The plastic surgery in Korea is very famous throughout Asia.

I always think about how our country has become so famous in plastic surgery globally in its technique and culture. I would like to share about this today.

 


Plastic surgery is a behavior that is highly related to a person’s needs and wants towards beauty.

We all have our want of beauty but we are in a culture where we cannot be open about it. Things have changed a lot, but not this.
If a celebrity has a plastic surgery, this becomes a gossip but he/she and the management make it untrue or are hesitant to talk about it.
This is because many people criticize the person who look better through plastic surgery. This is especially so with mid and old aged men who are the backbone of our society.
This shows that neo-confucianism perspectives still remain as a part of our society. Such culture can bring out absolutely different perspective of plastic surgery.

These mid and old aged men set priority on the root and are trapped within the idea that “although she got pretty because of the plastic surgery, the root does not go away.” In opposite, young ladies are too concerned about looking good and they want to look good through whatever way possible.

As such, we can see two opposing views regarding plastic surgery according to social class and age.
 


We need to talk about this as well.

This happened couple of years ago. An announcer in KBS came out on TV and looked as if she gained more weight than before. The viewers criticized her by saying “how can she come out TV looking like that?” There was a lot of criticism that our country was too much focused on appearance.

Ability, skill, and experience should be more important than appearance but we are too focused only in the appearance. So there are many critics that say that our society not only judges ability but also beauty.

I had a conversation with the head of announcer academy. I asked him if he could know that the student could become an announcer just based on the looks. He answered that the student needs to be “Pretty, Being pretty is good enough. You can’t be selected if you are not.”
Beauty can be more important for visual area… but I still had some questions. This is maybe why our society is too appearance oriented.

But in overall, I don’t think that our society is that much appearance oriented. There are times that we spend much focus on the beauty but it is not the most important factor.

In Brazil, South America, it is known that 18 year old teenage girls go to the banks to get loans. They want to get cosmetic surgery on the hips and breasts. The girls here, when they become legally adults, do not go for a drink or have a date night with their boyfriends. They get money to get a cosmetic surgery.

Our country is perceived to have many who want cosmetic surgery but it is not comparable to Brazil. It is not perceived that majority of the society is focused in cosmetic surgery.

I don’t think that the problem lies because we are too centered in beauty, but the problem is because we are obsessed by it. This is highly influenced by the marketing activities of cosmetic surgery clinics as well.


There is a famous portrait named “Gangnam Beauty”. I think that many of you have seen it. There are number of ladies with same faces in this portrait.


Those from the rural areas when visiting Gangnam say one common thing, “all women in Gangnam look the same.” I don’t think that they all look the same based on my 10 year stay here in Kangnam.

There is a trend toward a standardized beauty in cosmetic surgery.

But this trend changes little by little with time.

The number of cosmetic surgery clinics in Kangnam are reduced with time as well unknowingly. People are starting to be aware that cosmetic surgery if resulting in bad outcome can lead to a loss of personality and attractiveness.

There was a TV show called Let@# that was on air until last year. It was one of the most effective means of promoting cosmetic surgery clinic of which the topic that the viewers were mostly interested in was bimaxillary surgery.

At one time, bimaxillary surgery was The Cosmetic Surgery.

The actual name for bimaxillary surgery is bimaxillary concurrent surgery. Tooth correction is carried out simultaneously therefore careful decision making is necessary. Many viewers thought that their faces could become smaller through bimaxillary surgery and invested much money just by watching the TV program.


These people have suffered from many complications after the surgery. The doctors did not ask or judge anything but just received money as they conducted the surgery. This has led to various complications and side effects resulting in legal claims and suits. There were some celebrities who came on TV crying and saying that there are at difficult times.

As people saw these things, they became to realize that cosmetic surgery is not something that can be done lightly. They also realized that bimaxillary surgery did not make their faces smaller. They also because aware that following others who look pretty and getting a cosmetic surgery is a dangerous thing to do.

In the past there was a standardized beauty, but today, consumers are aware that beauty does not come down from heaven just with money.


Complication of bimaxillary surgery… “Hospital to pay KRW 60 million”
There was a judgement that if there is not sufficient information of bimaxillary surgery then the hospital must be responsible for the complications that arise. On the 18th, Seoul district court ruled that the hospital must compensate for the complications caused through bimaxillary surgery. The ruling also included that “plastic surgery is not an emergency one, therefore the result can be different from what the patient expects, Therefore, the hospital needs to share about the treatment methods, improvements in detail to the patients”. “Also it should be noted that B did not provide enough information.” It was added that “B seemed careless and also damaged some parts by forcing this surgery.” “However, the surgery itself has some dangers therefore, B’s responsibility is limited to 60%.” “B must provide punitive damage of KRW 61 million to the patient.” A visited B’s hospital in 2007 for bimaxillary surgery but A did not see any positive effects but only got more complications that led to trial in court.



The Korean cosmetic surgery market grew with much focus on beauty. There was no individualism and personal standards. Just common beauty was required that led to much problems. But I think that today, we have different standards of beauty and there no one specific standard.

This is a time of change and I knew that this time would come soon enough.

Beauty cannot be judged instantly. Beauty at first sight only is a thing of a past. Beauty is something continuous and attractively felt. “You become more attracted to it as you see more of it” is the new perception now.

Thank you for reading. More of the related contents will be shared in the near future.
Have a great day.

Breast revision surgery - What You Should Know

#Breastaugmentationkorea KIES-U
I would like to share about things to consider in #breastrevision surgery


1. Is the revision surgery really necessary?

2. Can the problem be solved?

3. Have you done enough to prevent the recurrence from happening?.

4. Should the implant be replaced?

5. Is there enough communication between the patient and the doctor?


Let’s go into the details, one by one.

1. Is the revision surgery really necessary?

 In case of capsular contracture, the first thing you need to decide is if the capsular contracture is one that needs correction. You need to be very subjective in this case.
"Doctor, I think that my breast became hard." This is not enough to do the revision surgery.



Capsular contracture is caused when the body reacts to the outer substances by twisting and contracting. I think that we need to differentiate between the tightness and the hardness.

In the early stages after the surgery, the tightness in your breasts feels like when you are wearing a tight pair of clothes. The clothes needs to cover that fat that you have gained therefore you will feel a little tight. But if you wear that clothes for a long time, the clothes itself would stretch out. When that clothes become loose, you will feel comfortable.



The same applies for breast implant. At first, it feels tight and hard. The duration of this process differs from one person to another.
This is why the doctor’s judgement on the condition of the patient is very important.
As such we need to answer the following questions to move on further.

“Is it ok for the patient if she does not get the revision surgery”
“What would happen to her if she does not the breast revision surgery?”
“Will she get better? Or worse?”
“Will the revision surgery make her feel better?”
“What is the recurrence rate after the revision surgery?”

Such questions need to be answered with experience and subjective reasoning. This is not easy.

2. Can the problem be solved? 

If the problem is with the capsular contracture, then you should only fix the capsular contracture problem. Other problems should be 2nd or 3rd priority.

If the capsule is too thick then we need to remove it. If the patient is thin, then removing the capsule would make you feel the implant more easily when you touch the breasts and your breasts could be more exposed to outer substance.

This is what makes breast revision surgery difficult. But the core problem is to fix the main problem that led to breast revision surgery therefore, we need to be clear about this.

3. Have you done enough to prevent the recurrence from happening?

Many of those who suffer capsular contracture ask this question. “What do I do if it recurred?”

There is no doctor who can say never to this question.
Recurrence can happen. But we need to do everything we can in order to prevent recurrence from happening.

When the implant collapses, we need to know why that happened and get the breast revision surgery done. Id the damage was done while inputting the implant then we need to change the input procedure to that which is different from the first time. We need to use other equipment as well.



There are implants with higher possibility of collapse.
The thinner the skin of the implant, the higher the chance of it tearing. So it is better to replace the old implant with one that has thicker skin.
We need to do things differently in the breast revision surgery surgery compared to the first one in order to decrease the chances of recurrence.

4. Should the implant be replaced? 

One of the reasons or environmental factor for capsular contracture is the fact that the implant got exposed to the body of the patient so it is better to change the implant as well.

At times we remove the capsule but leave the implant as it is. But this is not normal. The capsule is caused due to the metabolism of the body therefore we can change the implant to same type but new or to a totally new type one.

When the implant gets damaged, the replacement would be better if it is thicker, has better recharge rate, and is smaller in size.
 

5. Is there enough communication between the patient and the doctor? 

Most of the breast revision surgery are conducted because there is a problem. The patient wanting to have this problem cared, is really concerned and worried. Today, the hospitals become really defensive as the patients can take the civil matters to court. (Today, minor problems are taken seriously as a claim)

However, there must be enough communication in this sensitive time.
There must be a conversation on the reason and origin of the problem, whether we need to solve the problem or not, whether we need to conduct breast revision surgery or not. the timing of the breast revision surgery, and what is expected after the breast revision surgery. All these are important.

If there is no communication, there would not be an understanding.
If there is no communication, then only the concerns will grow.
The patient must fully open up about the concerns and discomforts. If there is no trust from the patient that leads to hiding of the facts, the doctor and the nurses cannot provide much help.



Breast revision surgery can be a problem of medical technique or academical knowledge.

However, the most important thing is to listen to the patient, be concerned and have much conversation for better understanding.

Thank you for reading and have a great day.



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