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

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

When I talk to many patients, they ask,

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

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

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

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

So, I decided to draw an image.

Below is the explanation.



 


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

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




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



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



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




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

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

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

Thank you for reading. Have a great day.

Textured silicone breast implant use in primary augmentation 

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

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





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

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

Why is a contracture?

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

How does textured implant minimize the contracture?

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

What can you do if there is a contracture? 

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

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

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

Does the anatomical type lead to less contracture?

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

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

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

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

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




Some say the refilling is more common with textured type

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


Then which type shall I use? Textured or smooth?

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

I tend to use the textured implant more.

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

Today, we share a little about the textured implants.

Thank you for reading.

Q) Is there no problem with breast feeding after the breast augmentation?

The answer to this question is that there is no problem.
In addition, let’s look at some of the important facts that you need to know in breast augmentation.

Breast augmentation can be divided into two.

First is the ‘Subglandular’ – Above the pectoralis major muscle
Second is the ‘Subpectoral’ – Under the pectoralis major muscle





We call this ‘surface’.
There are surfaces above the muscle and below the muscle.
All the breast augmentations are depended on where the implant is put in.
This is why the surface is so important. Everything changes according to what surface is selected.

Then, which surface is closely located to the breast tissue that makes the breast milk.
It is the surface above the muscle.
You might think that the breast milk may not be good if the silicone touches the tissue.

But, if the implant is put in below the muscle, the implant would not interact with the breast tissue. This would have no effect on the breast milk.

If the silicone is put above the muscle, the epithelium forms after two weeks.
This epithelium completely separates the implant and the breast parenchyma.



So one can know that the silicon does not interact with the breast milk tissue.
There are many people who think that the silicone causes harm to the body. Of course, there aren’t all good things about the silicone.

However, the silicone is chemically stable substance. Also it is completely separated from the body therefore, it does not cause any harm to the body. Also there is no relation with cancer either.

The implant itself does not pollute or harm the tissue. This is a verified fact.
But, what if the surgeon is not experienced enough and causes harm to the breast tissue?

The breast tissue can recover but if the damage is severe then the amount of breast milk can be reduced and there may be limitation on it.

How can this happen?

Implant through the armpit and under the muscle does not cause any trauma to the breast tissue.
But, implant through the armpit but above the muscle can/


Incision on the areola has the highest possibility of the trauma. This happens often with the surgeon with not much experience.

Subpectoral has the lowest possibility of breast tissue trauma. The incision is visible to the eyes therefore, it is safe.
So this is the best method that does not cause any damage to the breast tissue.

This is just a principle in the breast augmentation.
But the surgery depends fully on the surgeon and his/her experience.
There are times when there is no damage to the breast tissue although the areola incision is performed.

Subpectoral is the safest method that does not damage the breast tissue.  Also is the surgeon is much experienced, there would not be any problem on the breast milk. Breast augmentation does not have any effect on the breast milk.

This is all for today,
Thank you very much for reading.

Breast Augmentation For Older Women [KIES-U Korea]

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

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

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

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




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

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




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

It is not only to make the breasts look larger.

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

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

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

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

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

Health status is more important than age

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

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

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

Is there any pain or inconvenience for the aged patients?

No, in fact, they recover with better conditions.

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

KIES-U Korea Real-Time Operation Monitoring system

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

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

Thank you for reading this post.

How to reduce pain after breast augmentation surgery

There are many who are concerned about the pain after the breast augmentation surgery and therefore do not want to get it.

There are many around who suffer from the pain so the patients get scared about the breast augmentation surgery.

There are many internet advertisements that read “no pain breast augmentation surgery” or “no pain surgery” but this will not help you relax and stop thinking about such concerns.




First, let’s find out why the pain is caused.

Pain can be felt if you irritate the pain receptor.
If there is much pain after the surgery, then this means that much of the pain receptors have been irritated during the procedure, and vice versa.

The parts of the body with much pain receptors are skin tissue, fascia, and periosteum.
You cannot feel pain in the subcutaneous fat. Also in the muscle itself and the bones. If you break and bone and it hurts a lot, the pain does not come from the bone but the skin that surrounds the bone.




When you have breast surgery, the pain is caused when the implant and the periosteum interact with one another.

So the best method of avoiding this pain is to avoid going into the periosteum area.

We need to make the pocket at the position higher than the pectoral muscle.
If we do the surgery above a certain muscle, the pain is minimized. You can move about freely as you want without any pain. Normally, if you have a surgery on the belly button, there is no pain. This is because one uses the upper layer of the muscle for the procedure.



But, why is this method, putting the implant from the upper muscle area, not used widely?

This is due to the fact that a lot of patients who want breast correction are thin.
The patients do not have much fat and the original breasts are small therefore, if you put the implant from the top, you can feel that the implant is too close to the skin.
If you touch the breast, it will feel artificial. You might be able to see the re-filling or that the implant is there.

If your original breasts are comparatively big then you would not have any problems with this method. The breasts will look more natural and larger without any pain.

But there are many problems of those in 20’s and 30’s in Korea because many of the patients are thin.



Most of the breast surgeries are done under the muscle when the implant covers the pectoral muscle.

So in such case where you cannot avoid the pain, the homework would be on how to minimize the pain.

- If the implant is relatively big compared to the body, then there is much pain. The larger the implant is, there would be more pressure on the skin.

- There will be more pain if your skin is less elastic but tight. As the implant goes in, the skin needs to stretch but those with tight skin, especially those women before pregnancy, would have skin that press against the implant causing pain.

So in order to minimize the pain, it is important that you select an appropriate size of the implant. Mid aged women after pregnancy have relatively elastic skin therefore they feel less pain.

- There is less pain with less inflammation and less bleeding. Although the surgery is same, there are some patients with more bleeding than others. Also, there is much bleeding the inflammation if the surgeon destructs more skin and fat.
There are patients with much bleeding more so than others without any reason or cause. If there is an inflammation, the breasts swell and the swelling leads to continuous pain.

- If the surgeon is more careful during the surgery, there would be less pain. If the surgeon is aggressive, there would be much pain. The aggressiveness leads to much movement therefore, the pain will be caused from the surgery tools used. So there are some patients who say that they do not feel pain because of a certain surgeon and those who fell pain because of a certain surgeon as well.

- Pain comes from sensitivity.
There are some people with developed pain receptors, and those with less developed ones. If we eat same type of food, some might find it hot or spicy, and some who do not. This is all personal sensitivity issue.


Below is the summary on how to minimize the pain with doing the surgery underneath the muscle.
1. Choose an implant with an appropriate size
2. If your skin is tight, use a smaller sized implant
3. A surgeon must be careful and minimize the bleeding

Above are important as well as,

If the surgeon is much experienced and the surgery planning is perfect, then the pain that the patient feels can be decrease by 90%.


Thank you. Have a great day.