I have collected my own data for three years regarding breast augmentation and not I would like to share some statistical findings on the width of the breast comparing with the size of the implant here in Korea.

When we decide on what size implant to use, we need to measure the width of the patient’s breast and the width of the implant. If the width of the patient’s breast is 12cm, then the width of the implant should not be larger that that. Of course there is a problem with extensibility (but this applies more to those who give birth) but the main issue would be that the size of the implant should not affect the thickness of the outer breast layer and should not lead to complications.



Anyway, the easiest measurement would be according to the size of the width. In my past 3 years of experience, they average width size for those who wished to get breast augmentation was 11cm. Also, if I look at the data of the 3 implants brands that I have used, the average volume is 284cc and the width of the implant is 11.4cm. The data is a little different according to the brands and the yearly distribution is also a little different but we can see that the width of the implant is little larger than the width of the breast.



There is difference between the implants used in Seoul and other cities as well. Some prefer round type, others prefer anatomical type. The preferred sizes are different also so we cannot say everything with just the average numbers. Those who come to Gangnam are prefer large sized implants. Those in the rural areas are very conservative on the implant size (both doctors and patients). The younger the patient is, she prefers larger sized implant for visibility reasons. The older the patient is, the requirement is different. In the past (2011~2013), those who preferred anatomical wanted large sized implant but this is not the same any more.

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There are patients who have same width size in both their breasts but are asymmetric and the two breast volumes are different because of the bone structure. In such case, we might have to use large implant for the small volume breast and smaller implant for the large volume breast. This would decrease the overall average of the implant size.

When I interview the patients I find out that those who want large breasts want their breasts as large as they can get without any severe complications. Those at the opposite request so that the augmented breasts are not too large. The size of the implant decides on the breast volume nowadays. I am currently in Kangnam so I feel that there are many young women who want large sized implants. Whenever such requirement is made, I tend to talk a lot with the patients. In overall, Korean women do not require a large sized implant, but those who come to Kangnam require large sized ones. I hope that they can step back a little and be less greedy.

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Today, we looked at the data of the implants used and the characteristics of different patients in finding out if the appropriate sizes of implants have been used.
Thanks and have a great day.

 

Science does not allow us to talk about something that is not proven. The difference between science with myth or religion is that science only talks about things that have been confirmed. Medical sector is a part of science therefore, the doctor should only communicate about scientific truth as well.



However, the medical field has a lot of technical and professional terminologies that cannot be understood without any basic knowledge. Therefore, it is important to change these terms to what the patients can understand. We need to use some daily life words or terminologies when we treat the patients.

In the internet, we see contents that both professionals and nonprofessionals have written. We do not know what is scientific or not, and we do not know what is for marketing purpose or not. I think that as a doctor, it is important to let the patients know what contents are reliable or not.

This applies to fat / stem cell transplant as well.

In this era of capitalism, people are excited and concentrate on new products and want to purchase these products. The professionals need to provide evidence that these products are effective and safe to use. The patients should listen to these evidence and make decision on the purchase. However, there are millions of false information on the internet with marketing purposes.



Fat transplant in exact terminology is called ‘Free fat graft operation by injection’. As soon as the fat is removed from the donor site, the supply of oxygen/nutrition is stopped. The core question then would be how long this fat can last without oxygen/nutrition until it is transplanted to a new site.

If we conduct the surgery in a quite, stable and ready environment, there would be less trauma on the patient and the overall transplant process would be quick with high success rate. The fat that has been transplanted does not grow its vessels but gets oxygen/nutrition from the surrounding areas. So engrafting large amount of fat would not be meaningful. Small amount of fat transplanted in a large area would lead to better success rate.




But if this is applied, there would be many complaints from patients. They would think that there is no effect with the given cost. In order to satisfy the patients, the hospital now puts much more fat than necessary and also provide 2nd, 3rd, and 4th revision if necessary.

There still is a problem with the graft success rate. In order to improve on this, stem cell transplant has been carried out simultaneously. We also provide an explanation to the patients that this simultaneous activity increases the success rate.

In 2013 during the US Plastic Surgery Association Meeting, it was notified that stem cell transplant is still not reliable as there are not enough related data, findings and complications that may arise. Also it was notified that stem cell transplant should not be used as a marketing tool to gather the patients. However, not much has changed since.



The studies on the stem cell transplant are still under say and there is no concrete finding that we can share. We only presume that something would happen with a few concrete facts. We derive preadipocyte and enrich it to put into an area such as your wrinkles on the face. The preadipocyte are young compared to other cells therefore one can presume that they can last longer and result in higher success rate. It is still believed that minimum of 5 to 10 years are required for us to find if the stem cell transplant is safe and has no complications.



I do not recommend stem cell transplant unless it is really necessary (for example, when you need a revision, have a severe scar, or if there are no other choices). I hope that the patients too ,would give much thought into fat and stem cell transplant.

This is all for today. Thank you.

Surgical procedure such as a “temporary boob job” is very popular in NY and other parts of the world. we do not know exactly how many people get this does. We are just talking about it with our basic perception that this is very popular.

Breast augmentation can be perceived as the most applied surgery in the world (in US, there were 300,000 cases in 2013). This led to a cosmetic surgeon in NY to develop InstaBreast concept that she tested on herself, which can estimate the size of the breast after the breast augmentation. This InstaBreast is actually applied in a different way now. People today, look for it when they want to temporarily make their breasts bigger for a dress or a bikini.



InstaBreast is really simple. First, you can rub it on the breast, then inject saline liquid (0.9% salt water) into the breast…. It is durable for 24 hours. The body intakes the saline water in time and this saline water is discharged through urine.

There might be a bruise but it does not last long. It costs about $2500~3500 in NY, so this is not something that is cheap. Of course, breast augmentation would cost a lot more.

You can do a simulation for InstaBreast. The simulation result is much more effective than that 3D computer simulation of T-shirt Test. So I think that this is the best method today to estimate how your breasts would be before the breast augmentation.



Once the surgery starts, the patient will be on anesthesia The patient would not be able to communicate with the doctor until the implantation and stitching are complete. The dissatisfaction with the size of the breast can arise as the patient cannot communicate with the doctor during the procedure. If you are one who is really worried about the final result, you could try out the InstaBreast to estimate the outcome. But, I really wonder if the cost is good enough for the people to try it out.

The cost could really be a big problem if you are the one (maybe if you are afraid to put implant in your breasts) who wants to use the InstaBreast temporarily for a party or a summer vacation.



I think that many methods are brought up in US because it is such a huge country. People think a lot, and there are many things advancing there compared to our country.
I would like to introduce Macrolane, a large capacity filler for breast enlargement. It is hyaluronic acid that was used a lot in Europe but became restricted in UK from 2012. It was restricted because one could not identify the difference between the bundles that the filler made with the cancer tumor through the mammogram. This Macrolane could not get FDA approval as well and it is not imported to our country as well.

There are some patients who ask me if I recommend InstaBreast to the patients. I think that InstaBreast can be applied in limited terms. If you are really resistant to implant and want temporary enlargement of the breasts, do not know how your breasts would end up, then you should consider InstaBreast.

Currently, it is not too expensive to get a breast augmentation, and the recovery is really quick without much pain. So, I do not think that InstraBreast is something that I should recommend aggressively.

Thank you for reading. Have a good day.

Plastic surgery Korea KIES-U

We call augmented breast that is too large, an overaugmented breast. Today, I would like to share about using a large implant that is too big for the body of its owner.
Most of you know that the implant is made of silicone. But, why is the silicone used? I have not seen any patient ask me about this. The implants used on the breast augmentation, whatever the brand or type it is, are all made of silicone. I would have been amazed if there was a patient who asked me about the procedure of the implantation.



This is the core activity of the whole process. The brand or the type of the implant is not important. There are various reasons for using the silicone and here are a few;

1. The form does not change with time (It is semipermanent)
2. It is cheap and is easy to purchase
3. It has that soft feeling similar to the skin
4. It can be formed / processed into different shapes

These are some important factors, but you should be more interested in no. 1.
Silicone does not change its form. However, the long the implant stays in the body, the silicone does not change its location or the shape. We stated before that the skin is similar to clothes with spandex and the pressure goes against the silicone. The silicone can resist this pressure.



365 days a year, the outer layer of the breast pressures the implant, but the silicone can withstand this pressure leading to the outer layer extending. The collagen fiber restructures making the skin extend. Other outer layer that cover ligament, fascia, etc of the breast all extend. Also the rib cone and periost start to erode. The bones get dug out.

The restructuring of the collagen and the eroding of the bones do not happen severely if the implant is not too large.



But, what if there is a too large sized implant that goes into the pocket with much pressure? The skin and other parts of the breast would extend a lot. This is natural for adaptation to the surrounding environment. Also, there would be a sever case of erosion and the bones will be dugged out. a lot.

The biggest problem in using a very large sized implant is the extension of the outer tissue. The breast would not be able to withstand the weight of the implant and the breast would fall downwards. The breast would sag and the overall shape would be worse.

If you have breast augmentation before marriage, your shape would not be affected because you would have good enough skin elasticity. However, this is not the same once you get married and start to breastfeed. Another problem that may arise is the contraction of the breast. As the implant pushes up the breast, much pressure is caused on the breast making it thinner. The implant blocks the blood circulation leading to shortage of oxygen and nutrition, making the tissue amount less. We call this breast contraction.



Let’s say that a person with A cup size uses 400c implant and makes her breast size C cup size. The volume of the breast would be original size + the volume of the implant. As time passes, this volume changes. As the implant pressed against the breast, the original volume decreases. So if you measure the size after 2~3 years, the cup size changes from C to B. This change is not from the silicone implant but the change takes place with the original breast. So, such person would have an effect similar to that of another with 300cc implant in a few years time.

The problem does not end here. There are other complications related to using a large sized implant.

Due to the contraction of the skin and its thin layer, one can feel the implant easily, which leads to big dissatisfaction. If you give birth at this point in time, there might be a yoyo syndrome that makes the breasts sag or contract. This is an even worse case.

Two problems that can arise due to usage of large sized implant are
(1) Outer skin extending, low skin elasticity, misshaped breasts
(2) Breast contraction. There may be more problems generated from these two such as rippling, being able to feel the implant, being able to see the implant and breast boundary, low durability of the implant, etc.



So if you are the one who thinks that 400cc is necessary because others used 300cc, you need to change your mind. You might feel good about driving high displacement car but this does not apply to something that goes into your body. You also need to trust the doctor’s experience.

Today, we share about the problems that may arise in using too large sized implant. Did the details help?

Thank you and have a good day.

Plastic surgery Korea KIES-U

First, I would like to share about constricted breasts. (Today’s topic is a little difficult to understand. Please ask me any questions after reading the contents)

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Constricted breasts happen inherently. There are different cases. In one case, your breast might look like it only has a root. In another, you might see a breast that is shaped upwards only. I think that the connective tissues (collagen fiber / bundle) have some influence on the structure and formation. The tissue that shapes the breast become tight and pulls the breast making it look constricted or conical.

There are other terms such as tubular breast, snoopy breast, and conical breast. We also call this subformation of the bottom tissue of the breast.

Most of the patients with constricted breasts do not know the exact characteristics and think that it is caused due to subformation.

Common characteristics are wide and swollen looking areola, widened separated breasts, small breast tissue, high inframammary fold, small area at the bottom of the breast. Severe case can hinder breastfeeding as well. But there is no influence on pregnancy and giving birth.

Those with constricted breasts have short distance between the nipple and the inframammary fold. The skin on this part is tight as well. This is why the bottom part of the breast cannot be visible and one cannot look glamorous.

The solution for constricted breast is breast implant. Implant can be used to disperse the tightness of the breast.

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If you skip this stage and just use the implant, the tissue at the bottom part of the breast do not get improved. Therefore, this results in worsening the constricted breasts.

The surgeon needs to hold onto the bottom part of the breast, cut off enough fiber and other tissue so that the breast can intake the implant with enough extendibility. This requires dual plane augmentation.

If the implant is located under the pectoralis muscle, there cannot be enough gravity or pressure on the bottom part of the breast, therefore the dual plane procedure is necessary.

Also, the sagging breast can be corrected as well. As I have stated in other posts earlier, dual plane makes the pectoralis muscle lift up improving on the sagging breast.

This was a brief summary on the constricted + sagging breast. I hope the contents are clear.

This is all for today. Thank you.




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