Criteria for selecting anatomical vs. round type implant

Many of the patients ask this question so I have shared various postings on it and provided much explanation but there is still some confusion.

Breast augmentation Korea KIES-U Plastic surgery clinic

So I have prepared an algorithm today for your understanding.

I have tried to make it crystal clear, but I am not sure if it is effective enough.


I have used terms such as loose and tight skin for easy understanding but this actually refers to the breast envelope. This involves all the parts that include the fat under the skin layer, epidermis, muscle, etc.

Young women have tight skin, and older women have loose skin.

Also, thin person with small original breasts also have tight skin. A person with larger size breasts has loose skin.

Another case is that if the patient gives birth, the skin becomes loose as well.

So this is the first thing that we need to consider. Choosing anatomical or round type is not like choosing a typical product when shopping. We need to consider the status of the original breasts, and the body of the patient.

If you are young and have tight breasts but apply large sized implants, your skin would put much pressure on the implant causing the shape to deform.

In such case, I would recommend anatomical type implant. If the implant can be seen from the outside, it is better to use the anatomical because it is more natural looking.

But things become different if the patient wants small volume. Although the skin may be tight, the implant volume itself is not large therefore there is not much tension inside the pocket. The implant is half-liquid because it is consisted of gel therefore it gets shaped down once inserted and so the upper part of the implant looks little empty.

This makes the new breasts look natural.



So even though you have tight skin but prefer more natural looking breasts and you are not that interested in large volume, round type implant may be the best choice.

Then how about those with loose skin, or aged patients, and those who gave birth and have sagging breasts?

The goal of breast augmentation for such patients may be enlargement, but there is also another goal of removing the wrinkles, making the skin more elastic and filling up the upper breasts to make them look better.

If small volume implants are used in such cases, there would not be much effect in filling up the upper volume or making the skin elastic. If the volume is too large, then the sagging effect could result quicker therefore one must choose an appropriate sized implant.

Also, such implants need to be stabled and maintain its shape although the skin may not be elastic.

Although the original breast shape becomes out of shape, the implants should able to support and maintain the new shape formed in order to lead to positive result in the long term. This is what we call shape stable implant.


The most representative shape stable implant was firm implant such as Style 410 in the past, but now there are too many products with many spectrums that have differences in level of stability.

Most of the anatomical implants introduced in our country are stable in shape but most of the round type implants at our country are not.

So the type, whether it is the anatomical type or the round type, is not important, but the stability is.



Lastly, there are patients who have appropriate size, shape, volume, feel, ratio, etc in the original breasts. Such patients can use all types / volume implants. Both round type and anatomical can make the breasts look beautiful....

The implants were initially used to enlarge your breasts therefore the original breasts are important. If your original breasts look great then the implants would not have much influence in making them look better.

So if there aren’t any complications after the breast augmentation, the patient would be greatly satisfied.

Today, I shared a diagram that could be simple for you to understand the differences of the implants that I have shared much in the past.

There are too many implants imported today and it is difficult to decide between the round type and the anatomical type. The answer can be found above.
Thank you for reading.

Things to consider for breast augmentation

[KIES-U Plastic surgery Korea]



There are three ways to select the implant size.

First method is to select a size without any measurements. 

This depends largely on the preference of the patient and the doctor. Plastic surgery is referred to both art and engineering but this method is solely based on art as there are no measurements involved and the selection is done through visual method based on preference.

Breast augmentation Korea KIES-U

Second is the dimensional analysis system method;
The patient and the doctor deliberate on the wanted results and then measure accordingly. This method is to measure the breasts so that we derive the wanted implant size and the shape.

Third method is the tissue based planning; 
This is not based on the preference of the doctor, or the requirement of the patients. We select the appropriate size range through experiments and plan the augmentation accordingly. The doctor recommends the implant size according to the width of the patient breasts, skin elasticity, distance between the nipple and lower line of the breast, etc.

Plastic surgery Korea KIES-U

The current trend is with the tissue based planning.

According to the journals published, we observe that the highest satisfaction is gained from tissue based planning. After taking the measurements, the doctor introduces the appropriate implant size range to the patient. The patient can get a fitting test before the augmentation to see what type of final result can be derived.

The patient can choose the size from the size range provided to get the most satisfying result possible.

Just like any other plastic surgeries, breast augmentation is also an art and engineering, but it needs to be scientific as well.

Scientific decisions should not be made based on how you feel. In reality, art itself is not structural enough, and it cannot be said that it is craftsmanship like.

The selection should be made through statistical data measurements, but I think that there should be a little art too it as well.

This is one fact that everyone accepts in cosmetic surgery. The difference between the cosmetic surgery and others is that cosmetic surgery starts off with the patient’s hope that we need to respect. There are many methods that can be applied in order to respect such hope therefore, the doctor’s preference in the method and experiences are also important.

There is no one correct answer. The answer depends on the wants of the patient and the preference of the doctor.



There are many patients who ask why all the hospitals are different in their methods. The difference arises because we want to satisfy the cosmetic wants of the patients and set direction in such way. We do not focus differentiation for marketing purposes.

I have used tissue based planning from the very beginning but I think that one needs to be flexible in decision making when considering cosmetic surgeries as we center our decisions on patient needs. But there are some things that we cannot be flexible about.

Therefore, I need to invest much time in such area to make the patients understand the things that I cannot be flexible about.

Today, I shared contents with reference on Plastic and reconstructive surgery 2016 Nov publishment by Dr. William Adams from Dallas.

Thank you for reading.

Q. I was found to have Fibroadenoma in my medical examination. Can I get breast augmentation? Do I need to remove the lymph first and then get the augmentation?

A. Here is the pathological explanation on Fibroadenoma
Fibroadenoma is a benign lump that perimenopause women suffer from. It can move about easily,  is strong and smooth, but there is no pain from it.



Fibroadenoma can degrade by itself and there is a very low chance of it developing into a cancer.

Then why does it happen? We do not know the origin and there are many scholars trying to find it out. However the development and the enlargement is perceived to be caused by the female hormone.
It gets bigger during pregnancy and breastfeeding period. It also gets bigger when you receive hormone treatment and get smaller after menopause.


Is incidence rate for fibroadenoma high if I take birth control pills or get hormone treatment? The answer is no. Female hormone does not cause it and there is no heredity factor as well.

- What is the incidence rate of Fibroadenoma?
In breast biopsy, about 50% of the cases are found to have Fibroadenoma. (75% for those who are 20 or less). Also, it is higher for those who have some type of social status. (I think this is because there are more women working in countries like US so those with low social status have difficulties in getting a check-up..)



There are some abnormal historical findings on Fibroadenoma. One should be more careful in such cases so that it does not get any worse.
- Does Fibroadenoma recur after its removal?
There is a chance of recurrence. If we find one or two and remover it, there is a chance that another one or two regenerate in the future.
- Does Fibroadenoma must be removed?
There is no one answer to this question. We cannot say yes or no. If we remove the big ones, there there would be large empty space that could change the shape of the breast. Fibroadenoma can contract in size or disappear if your let it me and at times, we recommend doing nothing.

- Can breast cancer be misdiagnosed for Fibroadenoma?
It is reported that the chances of misdiagnosis is 1/700 when conducting physical examination, ultrasound test, and fine-needle aspiration biopsy. The change become greater as the patient gets older.



- How do we treat Fibroadenoma?
Many medical institutions have different treating standards for Fibroadenoma. This applies to other countries as well as Korea.
A malignant tumor is life threatening therefore one must follow the proper protocol for treatment but there is no concern that Fibroadenoma gets any worse therefore the decision on the treating method is depended on the doctor and also can be not treated at all.
If you are 35 years old or older and diagnosed with Fibroadenoma, it is good to do a follow up check once every 6 months. 
If the Fibroadenoma contracts by itself naturally, one should monitor the status until it is completely disappeared.
If there is not change until you are 35 years old, then physical removal may be necessary.
If Fibroadenoma gets any bigger while it is being monitored, one must remove it definitely. If the patient’s family has a history of breast cancer or if Fibroadenoma looks abnormal, removal is recommended as well.
- Then, should we remove Fibroadenoma before or after the breast augmentation?

Fibroadenoma is formed on the breast tissue and implant insertion in done below the pectoralis muscle so the two do not interfere with one another.



So if you are removing one or two Fibroadenoma lumps, you can get the #breastaugmentation within a week or two after the removal.
If you already had breast augmentation, then you would have to wait 2~3 months for the breast skin and tissue to become stable, and then remove the Fibroadenoma.

But if you need to remove a giant fibroadenoma or many of those, then you would need to talk to your doctor on the time of the removal surgery.

Today, I shared some contents on #Fibroadenoma. I hope that the contents have helped you out.

Thank you very much. KIES-U Plastic surgery Breast augmentation Korea

☏ KIES-U what's app +82-10-2687-4790

Q&A on breast augmentation | Plastic surgery Korea

Should you use anatomical implant or the round implant?
The answer to this differs from a doctor to a doctor and even the hospitals.
There is no 100% correct answer, so the patients think the implants are chosen based on preference.



I have used anatomical implant for the past 5 years, and used round type and saline type from earlier period. I cannot exactly say that anatomical and the round type lead to differently shaped breasts, but I can say that there is a certain situation when the anatomical type must be used.

This has been agreed by many doctors.



1. When the patient wants a natural look (and if she likes anatomical type a lot)

Dr. Bronze took x-rays of anatomical and round type implants placed above the pectoralis muscle and showed them to many doctors. The doctors who saw the photos could not find any differences between the two.

This means that the doctors cannot distinguish the anatomical implant from round implant. This is the same for me as well. I cannot know whether the patient used anatomical or not even though I conducted the procedure
At times I think that it would be better to use anatomical implants on those patients who have small orginal breasts and used round type implants for breast augmentation. The augmented breasts look unnatural.

Anyways, in most of the time, the patient gets to decide on what type of implant she wants to use. If she prefers to use the anatomical type implant, we do not necessary feel that we try to change her mind.

2. Constricted breasts ; 

I have shared on this in the past. Constricted breasts are usually when the area from the nipple to the bottom of the breast is very tightly close together.
In order to put volume onto such breasts, there must be much tension on the bottom part so that the skin in that area can stretch out easily. For this to happen, anatomical implant would be useful.


You can refer to more information on this by clicking on the link below.
http://drleebreast.blogspot.kr/2016/11/breast-augmentation-for-constricted.html

3. Thorax hypoplasty

If there is no proper or clear ratio of the upper body, and if your original breasts are not shaped right, anatomical implants would be recommended.
If you have a Poland syndrome where one side of the thorax looks lower than the other, anatomical implant with larger size can be inserted to the lower side.

4. Breast ptosis or sagging

In case of sagging of the mammary glands, what is the best implant to use when wanting to avoid Mastopexy (lifting)? An implant with stability would be good. An implant that does not collapse and maintain its form would lead to high level of satisfaction. Anatomical is more stable compared to round type, so there are many who prefer the anatomical implant. Also, if we select tall anatomical implant, it would help add more volume on the upper breast as well.



Current trend is that there is no one appropriate implant for all causes. Different implants are used for different situations. Therefore, it is wrong to say that anatomical implant is good for everything. But I have shared cases where anatomical could be more effective in usage.

Thank you for reading and have a great day.

Breast augmentation methods

Everyone dislikes scars. Many patients expect small incision but large implants for breast augmentation.


But logically, you would need a large incision spot to insert large implant. We need to have an incision spot of 4cm to insert most widely used implant size of 280~290cc.

If you are to use low to mid 300cc implant, the incision spot needs to be about 4.5~5.5cm long.



There was a patient who really could not stand any scar on her body. As her request, I made an incision about 3.5cm long to insert 300cc implant on the axillary fold.

I completed the operation but the scar was large enough to be noticed so I doubted if small incision was really beneficial or not.



If the incision is small, it gets in the way of the equipment used during the operation. Therefore, the equipment will keep on touching the skin leading to more traumas on the skin.

When we design the axillary fold incision, we tend to start at the deepest spot in the armpit. When we look at that area again after the recovery, the skin in that particular area is different from the other parts and therefore, more visible to the eyes.

The better solution would be to make the incision larger so that the equipments used such as endoscope, retractor, gauze can move about without hurting the incision spot. Also this large incision line would look more naturally like the original axillary fold therefore it would be less visible to the eyes.



This is what operation is all about. You do not need to make it big with necessary changes, but also you do not need to put much effort in minimizing the incision to make the patient feel more comfortable which could lead to worse outcome that you did not prepare for....


Let’s say that you built a building. You might think that the construction building is not too big so you don’t need to use a large safety shade and minimize the number of danger signs used. The construction could take a shorter time than average projects. But this is a dangerous thought. There are safety issues also with small construction projects.



No matter how minor the operation is, we need to carefully check on all the safety measures and equip all the safety related equipments before conducting the surgery. We should not try to minimize anything, including the incision length.

There is a pre-axillary line on your body. We start from behind the pre-axillary line and move to a deep spot found when you lift up your arm. You can find a spot where there are wrinkles and straight line. This is the incision spot.

Today, we shared on the spot and length of the incision area.
Thank you for reading.