Patients are from Mars, and doctors are from Venus [Plastic surgery Korea KIES-U]

The Importance of a Consultation before Breast Surgery

A doctor’s concerning points about breast surgery


I think that this area is more confusing and difficult as I talk to more patients.

I feel hopeless when.....
the patient’s response is completely the opposite of what I am trying to get across.

Plastic surgery Korea KIES-U

This is a communication problem. It is not easy to get an agreement with a person trying to convey one thing to another.

There are some patients who catch on what I am trying to say accurately and understand it well but this is not always the case. Sometimes, both sides are talking about different things.

I thought about why this happens.

There are many reasons but I think that one important one is the pre-information that the patient has before visiting a doctor.

A patient has a need for plastic surgery (including breast augmentation) and asks things to those around and also searches information on line.

In this stage, she catches both right and wrong information. There are some information that oppose one another.

Breast surgery Korea KIES-U

There is some wrong information from non-experts that they get.
The fundamental behind a medical activity is to provide a treatment to an ill patient.

But breast augmentation is not for illness but for those who want to improve on some beauty related problem and therefore this is much related to product sales and advertising.

I think there is a big problem here. I think that the miscommunication between a doctor and a patient starts at this very point.

Plastic Surgery Korea KIES-U

Commercialized hospitals or non-experts spend much money to advertise on 000 surgery,  000 methods, to cover up a surgical method and communicate on a product.

This would lead to differentiation. For example, if you are advertising on an energy drink, you will talk about different substances in it and say that is why the drink is more superior than the competitor products.

But this type of thinking cannot be applied on to the surgery method or any other medical activity that requires dissection.
All patients have different problems and characteristics.

A surgery should be applied according to the patient. A certain '000 surgical method' should not be mentioned as the most outstanding one and advertised as the best one for everyone.

Breast augmentation Korea KIES-U

A patient needs to quickly forget or disregard any information on the internet that says you will have an uniform effect if you use '000 surgical method' or '000 implant', etc.
A medical activity is different from a bag shopping.

In the first meeting between the doctor and a patient, the doctor analyzes on the patient’s body and any special characteristics.

And needs to look at
1) What is necessary to improve on and what can be improved on
2) What is necessary to improve on but cannot be improved
3) What does not need an improvement

A doctor needs to differentiate the things above and communicate them to the patients. One should not say that he can improve on something that he cannot.

Breast surgery Korea KIES-U

Everyone can buy the same bag with a certain amount of money, but this is not the same for a medical activity, especially in a surgery. If there are 1000 patients, all 1000 patients have different problems and after a surgery, all of them would have different results.

This is the part that the patients do not understand and this is why the communication gets difficult. I spend the most time explaining on the problem that the patient has in the very first interviews.

It is difficult for a person to have a rational thought about one’s body. However, this is necessary prior to any surgeries.

I have small breasts

There are many with small breasts. But it is important to think about what are my special characteristics, and what is different about me comparing to others.

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Is there asymmetry? Why is this caused?
Are the nipples in the correct position when comparing to the shoulder bone and the belly button? What caused this wrong position?
Is the width and the under-band diameter appropriate compared to the body shape?
Are both axillary creases symmetric or not?
How is the extensibility or the elasticity of the skin? Too weak or too strong? Why?
Is the tissue close to one another or not? How is this caused?
Is there something that you can feel on the breast? Does the patient have past records? Is this related to breast augmentation?
How big is the areola? How is the costal cartilage?
Are the ribs or spine bent? Or shaped differently than normal?
Are the breastbones shaped evenly?
And finally, do I hope for mentally normal and appropriate results? Or am I expecting unrealistic results?

All these things are important during the communication stage. If you disregards these things, then the interview with the patient might not be worthwhile.
It would just be like any simple talk on beauty surgery.

Breast augmentation Korea KIES-U

But surprisingly many patients….

When I talk to the patients about the body and breast, they cut me off and say things like “I have heard that 00 brand smooth round type implant is good. I want it.”

This is similar to when you are buying a house.
You are busily talking about school district, house size, price, location, distance from public transportation, noise level, accessibility, but then all of a sudden you say that you like a certain lighting system in a particular house and decide to buy it.

If you look at the patients who want beauty surgery with a perception of marketing, the suppliers would explain things with the purpose of selling any good that they make. This is not a consultation, this is sales.

Consumers would just talk about what they want and try to get discounts, whereas, the suppliers will try to promote and sell the products that they have. The communication would be centered about these points and nothing more.

The problem is that there are too many people who are like this. The hospitals too, try to what the patients want and are not focused or interested on how the patients would be in 10 or 20 years.

Breast surgery Korea KIES-U

Looking at those who want breast augmentation to solve a problem as a patient and looking at them as just another consumer who wants a product are different.

The hospital should to observe and analyze the patient, communicate on the problems and have the patients realize what the problem is.
Then provide information on how the problem can be solved with what limitations, and finally decide on whether to have the surgery or not.

But in today’s capital oriented society, the hospitals, whether they like it or not, have characteristics of a salesperson.

But a surgery that uses knife for dissection needs to remove such sales thinking, and strive to communicate on how to solve the problem that a patient has.

This would lead to great mental and physical satisfaction of the patient with minimized dissatisfaction, surgical accidents, side effects, or any other problems.

This is all for today, thank you for reading.

Have a great day.

Teenagers need “cosmetic (plastic) surgery” education
KIES-U Plastic surgery Korea

If I recall correctly, I think that I received sex education in 9th grade.
My teacher played a video in the AV room at our school and the teacher explained on the difference between a man’s and woman’s body, how the hormone secretion takes place, secondary sex character, differences in the body, genitals. It wasn’t so bad talking to our teacher about those lower parts that we as boys used to giggle about. I think this education was rather meaningful.




I am aware that this sex education has become more advanced with growing interest and I am also aware that there are many programs related. The society knows that hiding this would only hurt it therefore, people are opening up more towards this education even at schools.

I think that these teenagers definitely need sex education

My reasoning is that the teenagers, especially those girls in middle school, are at an alarming stage regarding their perception on beauty, and plastic surgery. Also, this perception can have great influence on the rest of their lives.
 
 

1. Our children’s perception on cosmetic/plastic surgery

Middle schools talk about this area a lot and already are much aware of it so that their parents cannot even say a word about it. Some middle school girls come with their friends to talk about the plastic surgery and I have recognized that those who are 14 to 16 years old already talk much about plastic surgery with their friends.

This might be too early for them. They are at a stage where they cannot objectively talk about plastic surgery and that is why they easily say “I do not look good here so I need a plastic surgery on this part.”

But it is not right to conclude that “kids today have a lot of problems.” Our society such as the TV and other mass medias have made our kids think in such way. Our society is too much focused on the outer looks and this has been communicated without any means to the teenagers.
 
 
The perception of our children on cosmetic / plastic surgery starts as they go online looking at all the pretty looking male and female celebrities and comparing themselves with these celebrities.

All dramas or movies have an ending where a pretty main actress has an happy ending.

- I am not good looking
- Things get bad if you don’t look pretty
- So bad things happen to me

This is the result.
 
And so this conclusion naturally moves on to the next.

- I get look pretty if I get a plastic surgery
- I will be happy if I look pretty
- So, I must get a plastic surgery

The reason why our children’s perception is serious is,
They do not know about their attractive points and characteristics but also think about their negative points and are focused in trying to fix those negative points.

They need to those that their outer look is just one small part of what their identity is.

- I have certain positive points
- Those with positive points are loved by others
- Therefore, I can be loved by others

If our kids can think in such a way, they will have more rational perception on cosmetic surgery.

They will realize that the outer look is just a small part of “me”, and not everything.

If you have too much expectation on cosmetic/plastic surgery, you will rely on it even more. Such a teenager when grows up to be an adult, would have more dependence on the outer looks and also suffer from outer look complex.

2. The right perception of your looks 

The way, attitude of how you look and perceive yourself is very important. You need to have a balanced perception of your looks and should be able to judge the looks in such a way.

When you have this mature perception, you will be able to talk and think about cosmetic surgery.

I believe that each individual woman has her own appealing points.
But most women do not know what it is.

The more surprising fact is that the more beautiful a person is, she does not know what her appealing points are and what her weak points are.

Those who are not confident about their looks are not confident talking about it as well.
They just hope that they could look pretty, and do not know where the real problem is.

It is concerning that many women get an expensive plastic surgery by looking at falsely made advertisement on plastic surgery in such situation.

Cosmetic surgery only makes one of many problems that I have, better.

Therefore, one must know what my positives and negatives are by taking a step backward and observing oneself. Once you have this rational attitude, you will be “ready” to get a cosmetuc surgery.

I look so bad, I need to get everything fixed.
Why do you think that our kids think in this way?

There are three things in our society’s outer look centralism that influenced our children.

Parents criticizing the looks of the children since when they are small.
Things about the outer looks that their friends tease about such as “You, pig”.
Outer look centralism in the mass media such as TV or internet.



Just like any education, the right education needs to start at home.

"My baby, you are so cute and lovely "
This might be a start, but,

"Your eyes look so pretty, I used to like people with similar eyes ever since I was young."
"Your smile makes those who see you happy." If you say such detailed word repeatedly, your children will know that you mean it.

I think these expressions are more necessary during the maturing stage. Then your children would have more confidence about their looks and those appealing points.



"Then what can I tell my kids about plastic surgery?" This is a question that you might have.

It is difficult for the parents to be the main source information on plastic surgery to the middle school girls. It’s because the parents do not know about the plastic surgery well enough. The information that the kids get from the internet is very much comparable to what the parents have.

It is necessary that the mothers get on line and start studying about beauty surgery as well. This will help maintain subjects to talk about with the kids.

Sense of one’s identity needs to be formed,
And one should know her own appealing points,
Then, she needs to have self confidence,

in order to have an accurate, balanced, objective thinking about one’s outer looks. I think that the responsibility of the parents is the most important factor.

Today, I talked about why the teenagers need cosmetic surgery education. This is something that I felt strong about as I consulted many middle school girls these days. I hope that my thinking has been agreed by most of you, readers.

Thank you very much. Have a nice day.

[Breast augmentation Korea]
Wound/Scar after breast augmentation

There are certain things that patients worry about on breast augmentation in such order,
First, do I really need to do this? How much does it cost?

When the above questions are answered, the patients look for how long the recovery period is.

Finally, they worry about the scar that is caused by the breast augmentation.

Today, I look like to review on the scars that are caused near the inflammatory fold and axillary crease when performing breast augmentation with water drop type implants.
As you have visited my blog and have noticed, the contents here are those that you cannot find on any advertising contents online. I like to blog in order to correct the wrong information that the patients have and ask when they visit the hospitals and also to be a communicating bridge between the surgeon and the patient.

First the scar near the axillary crease disappears after 6 to 12 months.

Breast augmentation Korea KIES-U

This is a photo of the breast augmentation on the axillary crease after 8 months. The wound is becoming lighter without any problems. Maybe the doctors would not realize that a surgery was done on it if they look at it.

Breast augmentation Korea KIES-U

 This is a rare case. This is called hypertropic scar. (It is different from keloid). A hyertropic scar was formed about a year and a half after the surgery. It is difficult to forecast if such a scar would be formed or not in advance.

Breast augmentation Korea KIES-U

This is a picture of the scar after the scar removing injection. The scar is getting lighter but this injection is needed again in the future. I have only seen one of such cases until now.


For your information, there aren’t many who can differentiate hypertropic scar and keloid. Keloid does not have any limitation on the location that it can be formed and it is formed largely without any control. Hypertropic scar can lead to swelling but stays at one position.

A scar from the breast augmentation is rarely a keloid and I have never seen one as of now.

Let’s look at a scar on the inferior breast crease. This scar is different from the one on the armpit in that the scar can be formed on the breast, therefore, this is rather scary. But let’s see if this scar is indeed scary or not.

Capsular contracture Level 3, revision surgery patient Photo after the revision surgery KIES-U

This patient changed the saline type implant and then faced capsular contracture. In the past, the saline type was put through the armpit but the reconstruction was done on the inferior breast crease. As you can see, the incision line is very clear on the inferior breast crease.

6 month after revision surgery It is difficult to find or see any scar from the front view.

Let’s look at another patient’s photo.

Breast augmentation Korea KIES-U

The above and below photos are those of a foreign patient. She did not like the size of the implants and therefore wanted to change then. This is a phots taken after 6 months, and as you can see, there are no scars that you can see from the front view.

Breast augmentation Korea KIES-U

Scars cannot be seen easily from the side view as well.

Breast augmentation Korea KIES-U

 The scars can only be seen if the patient cups her breasts to make the scars be shown easily.
(Normally, one would not be able to see the scars....)

This is a photo taken 4 months after the surgery. I think that the scars will completely disappear in a year or two.

Inferior breast crease scar is more advantageous when you go swimming. It is a place that the swimming suit always covers. In fact, the armpit would be more suspicious to others if you go swimming.

If you are the one who likes public bath, then you might be worried about the inferior breast crease. But you would have to lie down on the ground for anyone to see and notice the scar.

A scar cannot be a decision making factor. The surgeons agree that the major claims after the surgery are shape, symmetry, and volume. There are very rare number of patients who are unsatisfied with the scar.

Today we looked at the scar formed from the best method, inferior breast crease incision, with the help of different photos..
Have a nice day. Thank you.

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