[KIES-U Breast augmentation Korea]
This applies to all foreign substances that are put into the human body, but it is very important to know that the breast implant used in breast augmentation matches well with the body or not.

The success of breast augmentation depends on the implant therefore; the implant must match the body.

The implant makes my body look better and this means that the implant must be fitting for a certain individual. Therefore, stating that the implant matches the body is very important, and we call this implant – tissue structure dynamics.



There are 2 concepts to breast augmentation

Making the breasts larger + Filling up the breast volume appropriately

Breast augmentation requires filling up the volume to make the cup size bigger and this is not everything.

We need to consider the tissue structure and conduct the surgery appropriately. In doing so, we would be able to avoid any complications and maintain the beautiful shape for a long period of time.

We tend to think about many things when we put on our clothes. We choose the clothes that are fitting to our body. But, we also want our body to fit into the clothes that we like. We use correcting inner wear or even lose some weight in order to wear such clothes.

We need to consider the breast tissue structure and conduct the breast augmentation accordingly, but at times, in order to get the result that we want, we force a change in the tissue structure.

If your original breasts have ideal shape but not much volume, there is no reason to put on much stress on the tissue structure. The shapes does not need to change therefore just inserting the implant would be good enough for the volume.

We wouldn’t need to consider many things in such case. This case would be similar for a woman with great body shape wearing a dress, pants or anything.

But this is not the case all the time. There are cases such as asymmetric breasts, contour or bird chest, sagging breasts, etc where you need breast correction to solve the problems.

This would be similar to wearing clothes that have some attractive points that would cover up certain parts of the body.



Let’s say that you have one breast that is sagging a lot and the other is normal. What implant would be good for you?

It is not right to think that an implant that is currently the most widely used would be fitting for you. Breast augmentation is not as simple as you think.

Sagging breasts means that there is no upper filling in the breasts but there is much volume in the bottom part of the breast. If the breast status is the opposite, then you would need to fill up the bottom part.

We would need to apply dual plane for the sagging breast and insert the implant filling the upper volume. The implant must hold up the upper breast shape properly therefore the implant must be a form stable one. You would not need such implant if you already have much upper volume in the original breast. You would need to use an implant that stretches downwards.

The type of the implant, size, and other factors must be considered in order to select an implant that matches your body. Also we would need to know what happens when the implant and the tissue cells come together.

Selecting the size of the implant

Everyone would think cautiously about the size of the implant.
We need to think about this with some common sense.

If you use a very big implant, it would look awkward and it would be recognizable as well.
In opposite, if you use a small one, then there would be no reason for you to get the breast augmentation done.



Most people think that “the more is better”. Those with small original breasts would be more interested in the size. This is like a little chubby person wanting to wear tight clothes.

Although the expected outcome of the surgery is good, we should avoid it if we know that the skin tissue could be damaged or something that cannot be fixed could happen.
Selecting the implant size just through subjective reasoning of the patient and the doctor could lead to a harming situation.

Large implant puts on much pressure on the skin tissue and the bone that the implant is positioned on and this could lead to some unexpected negative results.

- Breast skin layer becomes thin and the breast tissue cells contract
- This results in small volume in few years
- The implant line becomes visible
- Clavicle erodes making the bones sink

If such activity takes place, there is no way we can correct it therefore it is important that we try to avoid such situation from the beginning.

Then what is an appropriate size of the implant that would not damage the tissue cells and end up with the best shape possible.
This is the main focus point.



If your body is big enough, you can use large sized implant.
If your body is small, then you need to use small sized implant.

Everyone can know this.

But, how can we judge if our body is small or big?
There are women who are 170cm tall but have narrow shoulders and thorax.
Such patients cannot use large sized implants.

There are those who are small in height but have wide shoulders and large thorax. Such patients would need to use large sized implants.

The size of the implant would match with the size of the body in such cases.
We do not stick the implant on the outside, but insert it into the body.

Therefore, it is important to know how much the skin surrounding and covering the implant can stretch out.

If you are wearing a dress that does not stretch much then you would need to wear bigger size. But if you wear something that stretches very well then you might be able to wear a smaller sized dress.

If your skin stretches easily then you can use large sized implant. But if your skin is the opposite, then you will not be able to use a large sized implant.


In conclusion, there are two factors that determine the volume of the implant.

- Diameter of the breast
- Expansibility of the breast skin

Height, weight and other physical structure are not important.
Putting in something big to make the breast bigger is not important. The implant needs to fill up the volume properly and improve the look of the breasts. The weakness that you have in your breasts must be corrected and possibilities of any complications must be minimized simultaneously. These are all factors that we need to consider when we say that the implant matches well with the tissue cells. This is the key point.

We will share more on this topic in the future. Thank you for reading.


[KIES-U Breast augmentation Korea]
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
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How are breast implants inserted during breast augmentation?

There are many patients who ask how the implant in insert in during the breast augmentation.

Today, I would like to briefly share about this process.

If someone judges just by looking at the breast augmentation, then he/she might think that the overall process was quick. But as always, what you see from the outside is not so important as to what is happening on the inside.
If the implant is to be put in properly without any contamination, there must be some principles that the surgeon must follow.

The first is a principle on trauma.



If the surgeon gets too tough during the breast augmentation and hurts the tissue cells, the skin and the tissue cells at the entrance point do not regenerate.

The incision part must be very clean and the skin tissue, epithelium, muscle and other parts must cared for with minimum damage for the cells to regenerate at the point of entry. This will lead to normal state of inputting the implant.

If there is much damage to the skin and entry point along with bleeding, we will not be able to open the entry point properly making it difficult to put in the implant.
Careful desquamation, non-damaging surgery, and clean insertion of the implant are mandatory in breast augmentation.

Second, we need to conduct desquamation accurately in size and direction. 

If we approach from the areola then we need to desquamate between the gland and the skin layer. The desquamation must be precise and enough. This makes a tunnel for the implant to come out.

If we approach from the axillary fold, then we need to make a path above or below the pectoralis muscle. This path must be big enough as well. The tunnel that the implant passes through to get to the pocket must be accurate and big enough.

This applies the same on inframammary fold as well. This is really basic stuff but if the desquamation is not accurate or big enough, we may face hard time putting in the implant which could also lead to implant damage, skin damage, scar and failure in putting in the implant. In the long term, all this could lead to implant collapse or capsular contracture.



Third is the no-touch technique.

The most concerning part about putting in the implant is the contamination. Implant is a foreign substance to the body therefore if pathogenic virus infects the implant that stays within the body for a long time; this could lead to bad results.

One of the worst complications is the capsular contracture. Then where does this infection source come from? It can come from the surgeon’s hygiene gloves, or the blood that gets on the implant as the implants goes into the pocket from the entrance, or the surgical equipment used or even from antiseptics. Also, the implant from the manufacturing plant might not be hygienic enough.

The source of infection cannot be seen by the human eyes. There is no way if there is any infection caused during the surgery therefore it is best that the surgeons be careful during the surgery and take preventive care.



No-touch technique means that we do not touch the implant with our hands. We use funnel-like equipment for insertion and squeeze out the implant. Nowadays we do not use the funnel that much, but use latex gloves called insertion sleeve.

Also, the implant must be unwrapped just when the desquamation is complete and when the preparation for the insertion is complete. We need to minimize the time that the implant gets exposed to the air. We also need to minimize the number of touches we make on the implant once it is inserted.

All the 3 factors of minimizing trauma, accurate desquamation, and no-touch technique are all applied by the surgeons in all clinics. These must be carried out in order to minimize the possibility of implant collapsing, getting infected, rotating, or leading to capsular contracture.

This is all for today, thank you very much.

Inflammation and infection are two main adversaries of breast augmentation

Hello everyone. Today I would like to share about one of the most common theme in cosmetic surgery, the inflammation and infection with their results and further complications.

In science, we always ask “is that true?” and go through various stages in order to find out the opposite. Some people suffer because of what we try to change at present, but we cannot avoid these moments in order to find out the truth. The same applies to the medical field.

There are many surgeries that require implants. I am sure that there will be many products made in the future that could be used in the human body. Artificial tooth, ie. Implant (titanium), artificial knee, joint, artificial veins, pacemaker, etc are all these type of products. Silicone, artificial skin or ligaments and implants used to enlarge the breasts and buttocks are some common implants used today.



The reasons for using these implants are that the surgery can be quick, and we use already made products with perfect shape and features that make the overall result dramatic. It is much cheaper (due to mass production) than bone graft or cartilage transplant.

But an implant is a foreign substance. It is not made inside the body but in a manufacturing plant. People get suspicious about complications in using these products. Many complications do take place in reality.

The biggest problem in breast augmentation is the capsular contracture. We use implants for volume fulfillment but if they become hard and not smooth, there would be no meaning to using them. This is why all the doctors have been studying why capsular contracture is formed from the moment the implants are inserted.



Many studies show that the capsular contracture has been formed through contamination by germs. A lot of animal testing and clinical testing show such results.

Implants come with packaging with sterilization however we cannot say for certain that they are 100% hygienic. We also sterilize all the tools and equipment that we used during the surgery but can we say for certain that we killed all the germs? The surgeons use hygienic gloves and sterilize the operation room but there are always germs, bacteria in the air and there is no place around the world without them (except sterilization laboratory and immunity deterioration room). Therefore, there is a possibility that these germs get into and contaminate the implants and the pockets during the surgery.



If you have normal level of immunity then you can win certain level of germs that are acceptable and also recover properly. The same applies for breast augmentation patients. The human body makes the immune system active to kill and clean off the germs.

However, an implant is a foreign substance therefore it does not have the immune system. If the implant gets contaminated and there are much germs or if the surgery is too destructive and the tissue cells cannot have proper immune system, the germs will not disappear but live among the implant. These germs do not go away but make a wall for protection that leads to a thin film like structure around the implant.

We call this biofilm and this biofilm is resistant to sterilization and protects the germs therefore the germs can live for a long time causing worse level of inflammation on the body. Such inflammation works together fiboblast leading to severe case of capsular contracture. This is one of the most accepted theory.

Usually the patients cannot differentiate infection and inflammation. Infection refers to the allowing of outside germs to penetrate to the body and inflammation refers to the body reaction towards the germs.

If there is bad infection during the breast augmentation, you will have fever and also swelling on the breasts. When we say you have ‘inflammation’, it usually means that you are infected. Capsulation contracture is not a form of severe inflammation but a weak one. It is caused when there is minor inflammation that cannot be visually noticed that makes the body react with thick capsule leading to hard feeling breasts.

So what can we do to prevent such situations? Below is the 14 point plan that world known cosmetic surgeons around the world accept as capsular contracture preventing methods. I would like to clarify that massaging and taking prescription are not one of these.

1) Insert antibiotics during anesthesia
2) Avoid areola incision
3) Cover up the nipple during surgery
4) Be careful not to cause too much damage during the surgery
5) Careful hemostasis
6) Apply dual plane or form subfascial pockets
7) Use antibiotics or antiseptic solution to clean the pocket
8) Use sleeve (funnel, to avoid skin contact) to insert the implant
9) Change hygienic gloves before touching the implant
10) Reduce the time that the implant gets exposed (Unpack just before insertion)
11) Do not touch the implant a lot in order for proper placement
12) Stitch up layer upon layer
13) Avoid using drain tube (can be the cause of contamination)
14) Use antibiotics if additional surgeries are necessary
(There are some doctors who question No. 2, Avoid areola incision)

The conclusion is that the surgeon must conduct the breast augmentation properly. If there is severe case of capsular contracture after the breast augmentation, there is no reason for you to spend much money getting massages and taking medicine.



No matter how careful the experienced doctor is, he/she cannot completely avoid all the germs getting through. If the patient is unlucky, she might suffer from minor case (Grade 1~2) of capsular contracture. Such contracture does not require breast augmentation revision surgery.

There may be future implants that improve on this problem. There is a high possibility that texturing implant who disappear although it has been made to avoid the capsular contracture. There may be implant with sterilized or antibiotic coating. We expect there to be less cases of capsular contracture and inflammation once these products are in the market.

Thank you for reading.

Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
YouTube: www.youtube.com/kiesu0202

Some people who come for breast augmentation in our clinic (KIES-U Gangnam Plastic surgery clinic) just think that it is getting the breasts larger by spending some amount of money.

Such perception becomes more solid as they visit more clinics. When they read reviews on breast augmentation in Korea on the internet, they think that they will get the same result after the breast augmentation. Such perception can make you think that breast augmentation is something that you can easily shop for.



The first step in treatment is finding out what the problem is, but most of the patients who come to visit us(KIES-U Plastic surgery Korea) do not think so. We talk about the problems and the methods in solving the problems. Then we share some choices that could be made. This is the process of talking to the patient at first.

But, they feel offended in knowing that they have certain problems and that the doctors just point out the problems to them.

Accurate consultation, the effort for treatment can lead to worse result. Then, why does this happen?

The patients who come for breast augmentation in Korea are not confident about their breasts therefore I think that they tend to become uncomfortable if I share too much medical talk. You might be surprised at this but this is the reality.

This is different from keeping the problem that you have and visiting the doctor when the problem is at the worst state. If you do not treat illness, you might be paralyzed or die but if you do not fix unpretty looking breasts, nothing radical happens to you.

But this is my thinking all the time. Breast augmentation involves cutting and bleeding. This cannot be the same as shopping in a department store for an ear ring or bag. The doctor must share the contents that may not satisfy the patient.



Also, all bodies are different. The process of the augmentation may look alike abut they are all different. The process, method, and after treatment all must be different according to the patient. A body is not as simple as it looks.

Therefore it is important that you talk to the doctor about your body characteristics, the best method for your body, and how you can recover. If you only talk about the brand and the product, then there might be some big problems after the surgery.

'I have never heard of this before the surgery ', 'I didn’t read about his in other reviews, what is happening to me? What is wrong?”

When this happens, the patient can lose trust for the doctor and become highly unsatisfied. Therefore, whoever comes for consulting on the breast augmentation in Korea must change their perceptions.

Breast augmentation is one of many medical treatments. 

You must share the problems that you have, what kind of differences you have compared to others, your body characteristics with the specialists (along with other basic factors) and listen to the best option that the doctor will have. You need to have two-way communication in order to reflect the content on the surgery.



There is no other patient just like you.

Even the twins are different. (Only their genes are the same and they have different eating habits and so on)

You must know the difference and plan the procedure accordingly.

Long before in the clinics, the doctor would wait for there to be 3 ~ 4 patients. These patients would be gathered to one place and the doctor would share how the augmentation would take place. Then the nurses would schedule these patients.

We cannot say that this is absolutely wrong but there are many methods to breast augmentation. We cannot say that one method is the best one for all different cases. A particular method may apply to one patient but not the other. The implant is the same and so is the incision method.

Some patients have thicker fat than others, and some have more elastic skin layer that others. There are some patients who come during pregnancy and others who come after the pregnancy and breast feeding.



There are patients who removed a lump but have come for breast augmentation with the lump again. There are patients who removed some breast fat due to breast cancer that they suffered. Some have different types of shapes and some already had pretty looking breasts.

Some have severe case of bird chest but some have concave chests. Some have sagging breasts and some with breasts that are positioned real high. Some have different volumes on each side and some with different degree of sagging. Some have different locations of the nipple and some have different chest structure.
All these lead to different methods.

We consult or communicate with the patients so that we become aware of their situations and also make them understand how the surgical procedure and recovery can be carried out. This is really important. The breasts are hidden behind the clothes and are not exposed like the eyes or the nose. Therefore people are not aware of it as much as they are with the faces.

It is important to know that accurate and the best result possible can happen through clear understanding and communication.

This is all for today. I hope that the contents have helped you out.
Thank you.

Breast augmentation revision surgery, Neo plane technique

Today, I would like to share about the breast augmentation revision surgery method that I apply.

I would like to answer few questions that you may have.

1. Is there incision in breast augmentation revision surgery? 

We usually use the same incision spot as the original correction.
If we used inframammary fold, we use that for the revision. If we used areola incision at the first correction, we use the same for the second one. Same applies for the axillary incision. But the same cannot be applied for naval incision. Naval is too far away from the breast....

We need to use endoscope for axillary incision, therefore it is somewhat difficult to conduct on the second surgery. But most patients want it....


 
2. Do you have to remove the capsule? Is there a special method in KIES-U Plastic surgery Korea?

Different methods are applied for different reasons for the revision surgery. Some common reasons are capsular contracture, size exchange, implant dislocation or rotation. Such reasons lead to replacement of the implant.

If we replace the implant then we need to remove the capsule. All the textbooks on breast augmentation state this fact.

But there are some special cases when we do revision surgery on Korean patients. There are too many thin patients therefore in most of the time the implants are located below the pectoralis muscle in the first surgery. It is easy to remove the capsule if the implant is place above the pectoralis muscle but if the implant is placed below the muscle, the capsule is stuck right on the rib. There would be too much trauma on the rib if we remove all the capsule.

Therefore, most of the doctors do not completely remove all the capsule but only some part if the implant is placed below the pectoralis muscle. Axillary incision is the same because the visibility is not good enough.

In order to solve this problem, I apply the Neo plane technique. The objective of the revision surgery is for the implant to be placed at a new environment properly whatever the cause of the revision is. We need to completely dissolve the previous environment. We do not need to completely remove the capsule and but place it on the bottom and make a new plane between the pectoralis muscle and the capsule, just like the image below.



You do not remove the bottom and leave it as it is. The result would be as the below image.


We can reduce the time of the breast augmentation revision surgery in such way and also avoid unnecessary bleeding and pain.

Whatever the reason is for breast augmentation revision, the failure of the revision surgery is due to the usage of the original capsule. We cannot use the capsule with capsular contracture, but provide absolutely new environment for the breast augmentation revision surgery in order to avoid any possible problems.

3. What is a good implant for breast augmentation revision surgery?

As stated above, the main reasons for revision are capsular contracture, changing the size, rotation / change of position. Patient who got revision surgery due to capsular contracture, would not want to face capsular contracture again. In order to avoid the capsular contracture, one should use the polyurethane implant. If you have faced sever case of capsular contracture or faced it multiple times, then I would recommend Polytech’s microthane implant that is imported here to our country.


Silicone can lead to capsular contracture. You might feel normal for some time, but after 10 years, your breasts might feel tight and hard. A person who loves to eat peach but suffer allergy all of a sudden even just by touching it. Microthane can avoid rotations and misplacement also.

But this is really expensive. If you want to save as much money possible in the revision surgery, then you might have to choose the silicone implant. In such case, I would recommend you to change the type of the implant.

If you used microtexture in the first surgery and suffered capsular contracture, then you could use macrotexture in the revision surgery. If you used macrotexture in the first surgery, then you could change to the smooth type. Basically, you would use the implant with opposite effect in the second surgery. Macro, micro, smooth, etc are all silicone implants. It is impossible to go over the limitations. But, there are little differences among the products.

4. Choosing a large or small sized implant in the revision surgery, what leads to more problems? 

If you are the one who wants to use larger implants in the breast augmentation revision surgery, then you need to know that the original breast tissue contraction may come earlier than expected. As a result, you may be able to feel the implant more than you want and you may feel rippling or other complications.

If you use smaller implant, then you might suffer from rotation or misplacement because the original pocket is too big. One must remove the capsule. If you used small implant in the original surgery and then changed to a larger one, then there would not be much problem.  If you already used large implant in the original surgery and change to an even larger on, then there might be sever contraction, therefore we would not recommend this. If you used very large implant in the first surgery but want to used small sized one in the revision surgery, the surgeon needs to be very careful. If not, there would be bad problems.

5. Does the breast augmentation revision surgery cause more pain than the first? 

Usually there is less pain in the revision surgery and the recovery time is shorter.
There might be those who think that opening up the wound would hurt even more but the patients do not feel much pain in the revision surgery.

The reason for this is that the skin is already extended a lot after the first surgery so there is not much tissue to contract the implant. Therefore, this is less pain in the process. Also, you can get back to your social life really quickly.

 
All the patients who are in the second surgery must feel the same. You might be thinking that you do not want to come back to this status ever again. In order for the 2nd surgery to be successful, there needs to be good planning by the surgeon.

Approaching method, implant, technique, etc. all must be appropriate for the patient.
This is all for today. Thank you very much.