Is it OK to get breast augmentation in the summer?

There are many patients who consider the weather for breast augmentation.
There is peak season and off season in breast augmentation also where peak season is the time when everyone wants to get the breast augmentation and the off season is the opposite.



The peak season for breast augmentation is during the school break.
Like the school break, the adults have much time during the New Year’s and Thanksgiving.

Also in December, when most college students have winter break until February. This is a very important peak season.

Now-a-days, there are much difference in peak season and off season, also we have 40 hour week with many replacement holidays therefore the busy seasons are not what they used to be.

Why do you think there are many who want breast augmentation during the cold season?
The schools have longer winter break than summer here in Korea, but there are particular reasons why the patients do not want cosmetic surgeries during the summer.

What are the reasons?
When it is hot, you sweat a lot. The sweating can lead to infection and there are those who think that scars or wounds get worse during the summer. Some think that the cold weather kills bacteria and the wounds can get treated better.

Such perception arises from the thought that wound recovery can be delayed due to infection and inflammation and that this infection and inflammation get worse during the hot weather.

It is very discomforting to have bandage around the body during the summer. It is difficult to have shower as well.
But, what about the wound?



It doesn’t get any worse.
There are hotter countries around the world. Currently it is 32 degree in Seoul and 37 in Tokyo.

Hong Kong, Philippines, Taiwan, Thailand, Brazil, Florida, Singapore and all hotter than Korea. You would not be able to breathe properly in Hong Kong during July because of the heat and the humidity. If you do not turn on the air conditioner throughout the day, you will find mold on the walls.

So if the people in these countries get cosmetic surgeries, there should be much news about wounds not healing, and high incidence of infection and inflammation. But, we do not hear such information. There are no recording of doctors in such hot countries that state ‘patient’s condition gets worse due to the heat”.

Actually, healing takes longer during the warmer season than the colder one.
Hot weather increases superficial hematocele in order to release the body heat. Nerves coming out during the hot weather are caused by the enlargement of the nerves under the skin. This would help the blood flow and if there is good blood circulation, the bacteria causing the infection would not be able to penetrate easily.

Bacteria getting into the body are called infection and the immune system fighting this bacteria is called inflammation. Pus is the dead exposal of bacteria from white blood cell and others. Therefore inflammation is something necessary and it is not a bad thing. Infection is a bad thing happening to the body. Active inflammation can kill the infection that penetrated into the body.
 
The body must not lose heat during the cold weather therefore it decreases the amount of superficial hematocele. Not much blood flows through the skin therefore the skin becomes white. There is not much blood circulation into the wounds as well. This makes the body weaker to infection. The support of immune system is slower meaning not much oxygen and nutrition are provided to the damaged cells.

We use air conditioners when it is hot and use heaters when it is cold, therefore there aren’t much differences in what happens to the wound due to the weather. This is just the principles that I wanted to share.

There are some differences in how experts think and normal people think. But there are no evidences that surgeries in summer are worse or dangerous. Wounds can be healed without much trouble during the warmer days.

The recovery may take longer during the colder days. Sweating is the exposal of liquid in our body. This is not harmful or a bacteria. There is no evidence that sweating causes more inflammation.

Due to the usage of air conditioners and heaters, there are not much differences in the body heat during the different seasons. Therefore, there is no better weather or season for cosmetic surgery. But, if you ask me in which season the wounds get healed quicker, I would say warmer days without any hesitation.
 
I hope that you don’t get sick from the heat. It might be better to restrict outdoor activities in such hot weather.
Thank you and have a great day.

Microthane implant – is it safe to use in the long term?

Today I would like to share about a writing from Dr. Pompei from Rome, Italy, who is a World known specialist in microthane implant augmentation. As you read this post, you will be able to understand the characteristics of microthane implant better.



Ashley first adopted breast augmentation with polyurethane implant between 1970~1972. This is about 50 years ago, a very long time ago. Since then, there has been much advancement and improvement in the technique.

The first implants introduced were hard and had no elasticity. Glue was used to stick the polyurethane on the gel bag. This was not safe. The first generation implant with time would change shape, foam would fall off and also the silicone gel would be separated. This could result in silicone leakage.

Loss of foam in 1st generation polyurethane implant would make the shell become similar to smooth type implant. Some believed that this would increase the possibility of capsular contracture.

But this is not an accurate hypothesis. Capsular contracture is not formed due to the smooth shell but because of the silicone leakage, i.e. implant collapse.

1st generation polyurethance implant was made by BMS (Brystol-Myers-Squibb). I shared about this in my post of 30 year experiment on polyurethane implants used in breast augmentation.

Recently, Dr. Pompei announced his result on 10 year monitoring of more modern product, Polytech’s microthane implant. The essay was published on 2016 Aesthetic surgery journal  (Oxford Press).

131 patients (255 implants) received breast augmentation with microthane implants between 2000~2012 in Sandro Pertini Hospital, Rome. Most patients used round type polyurethane implants with dual plane or above the pectoralis method.

After an average of 110 month follow-up survey, there were 4 cases of malpositioning, 4 cases of rippling, 2 cases of capsular contracture after hematoma, 2 cases of collapse, and one contracture. There were total of 19 complications. Bottoming out effect due to malpositioning was found only on one patient but the cause is unclear.

But when we consider the characteristics of microthane implants, it is unusual that there were 4 cases of malpositioning.

Once the microthane implant is inserted into the body, it immediately sticks to the surrounding tissue therefore the implant does not move about although the patient takes some aggressive actions.

It could be assumed that the surgeon was not careful with the implant insertion during the surgery. The surgeon could have placed the implant in the wrong spot and the implant remained there. If the microthane implant was inserted into the accurate location, it does not move around.

Microthane was larger barrier between the polyurethane foam and silicone gel compared to the predecessor. Also the sticking process was largely improved. The possibility of gel leakage due to the separation of shell and foam greatly decreased.
This is why many expect that the chances of having capsular contracture also greatly decreased for microthane implants.
Of course, we need data that has been gathered for more than 10 years.



Capsular contracture was found in total of 3 breasts. 2 breasts had capsular contracture after hematoma. There was much bleeding during the augmentation that led to the forming of hematoma. The hematoma interferes with the polyurethane foam sticking to the skin tissue. The capsular contracture was formed within a very short period of time (less than 1 year).

The result of this experiment showed that the incidence rate of capsular contracture during 14.6 years is 2.3%. According to MD Spear, an expert in breast augmentation, the 10 year incidence of capsular contracture with textured silicone gel implant is 17.2%, and smooth silicone gel with 19.9%. But microthane implant had incidence rate that is about 1/8 ~1/9 of silicone gel implant.

The structure of micraothane implant is very active and strong. It is very difficult and time consuming to remove the microthane implant after the breast augmentation. The implant holds on to the skin tissue cell tightly.

If you remove the microthane implant from the breast after a few years, you would be able to fine urethane foam tangles with the epidermis. You would see the rest on the implant exterior. We cannot remove this tangled part with scissors or any other equipment.



The information that removing microthane implant harming the patient or that it is impossible to remove the microthane implant is not true. It is difficult to be removed right after the breast augmentation but after some time, it can be removed rather easily.

MD Pompei shows much confidence on his microthane implant research after performing many breast augmentation surgeries. There are some doctors who use microthane implants on capsular contracture patients, but it can be used in the 1st breast augmentation surgery with good results.

Today, we share about polyurethane foam coated implant, i.e. microthane implant and the research from Italy.

This is all for today. Thank you very much.



KIES-U Plastic surgery Korea
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
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Breast augmentation Korea
Today I would like to share 3rd posting on matching implant and tissue structure.



We have shared that in order for the breast augmentation to be successful, the foreign substance (implant) has to match properly with the body, and that size and form stability are important.

Today, I would like to share about the implant filling and the shell type. All are important but there are no accurate information on them.
Silicone implant is consisted of exterior (shell) and the interior (gel).
The shell has filling inside it. If the shell can be composed of max 250cc gel and has such amount, we call this 100% filled. In reality, most products are not 100% filled.



280cc shell is filled about 95% which is 266cc. Such product would have volume of 266cc marked on the package, not 280.

Almost all round type implants are produced such way. Why is that?
As the implant gets filled up to 100%, it becomes more form stable and strong. For stability means that the implant is able to maintain its shape no matter where and how it is positioned. Such problems could follow.

- If the disc shape is maintained when standing, upper block would look worse
- If the disc shape is maintained when lying down, the breast would look unnatural because there is no gravity pulling it down
- The breast would feel hard rather than soft
The manufacturers consider such factors and therefore produce products that are no 100% filled. Less than 100% filling leads to,
- Upper block cannot be found when standing
- Breast lean towards the outside when lying down, looking natural
- Feels soft when you touch the breast



However, such less filled implants have problems. Let’s look at some of them.
If the implant is not completely filled, one part might more gel than the other. There is no balanced distribution. Such could lead to wrinkling of the shell. The wrinkle from outside looks wavy and you can feel it when you touch it. We call this rippling. More accurately, it is called underfill rippling.

If there is much friction on the rippled part due to much movement, there could be some damage to the shell. This leads to high possibility of damage.
If you have ridden bicycle a lot, then you might know this. If you do not fill up the air in the tire and ride the bike, you might experience more flat tires. If you fill up the air, then there is less chance of you getting a flat tire.



The breast skin loses elasticity after giving birth and/or breast feeding. Loss of skin elasticity leads to sagging breasts. If underfilled implant is used on such breast, the breast would look like it had lost more elasticity than before.
Using underfilled implant on the patient with sudden weight loss or skin aging would not be good also.

The advantage and disadvantage of 100% filled implant, i.e. form stable implant is exactly the opposite. Fully filled implant feels hard and not smooth. The gel disperses less when the implant leans onto one side. But the durability is good therefore there is less chance of collapse and although the skin loses elasticity, the implant can maintain the shape of the breast. Such form stable implant is more effective in correcting tuberous breast as well.

If the disc shaped implant is filled as much as possible, and if the round type implant is filled as such, the implant would shape like a ball. This is why the round type implants are not 100% filled.

Most of the implants imported are underfilled ones. Micro textured implant from Sebbin, Motiva, Bellagel are introduced as 100% filled implants but the shells can extend easily therefore they are not form stable implants.

Micro textured implants have smooth exterior skin therefore although there is much filling, the implant is not form stable.



If you want close to complete filling and form stability then the best implant would be anatomical type. When the anatomical implant is filled 100%, it does not become round like a ball. The anatomical shape is maintained looking natural.
This is why 100% filled implants are mostly anatomical implants. Under filled implants are mostly round types.

Then, which implant is good to use? This may be the question that you want answered.

Like the title of the post, I wanted to express that the matching of the implant and the body is important. The answer to the question is that the implant selected must be in consideration with the status of the patient’s breast.


If the breast skin is very tight and you do not want large volume, you can use less form stable implant that avoid upper block. Round type implant would be recommended to you.

But if you have tight skin and want large volume, using the round type implant would lead to upper block. Although the implant is under filled there are much skin tissue covering the implant. Therefore, in such case, anatomical implant would be recommended.
If you have sagging breasts with loss of elasticity, or if you have tuberous breasts, then anatomical implant would be good for you. In rare cases, form stable round type implant would be recommended (this is very rare in Korea).



If you have good shaped original breast with good balance and skin status but want to make the breasts larger, then you can use any type of implants for cosmetic purposes. Smooth, textured, round, micro texture, anatomical, polyurethane, all would lead to satisfying shape of the breast.

Today we shared about how much implant shell is filled with gel. I hoped you understood this core concept in understanding what the implant is.
Thank you and have a great day.


Breast augmentation Korea KIES-U

About Form stability

[breast augmentation Korea]
The two key words that I share while I talk to the patients or write on this blog are “form stability” and “dual plane”.

Form stability of an implant is one of the core concepts in forecasting how the breast augmentation result would be. But, to most patients, this term would be very new to them.


Most of the information on the internet is about how the breast feels after the breast augmentation. The information is rather one dimensional.
The information is one the result such as soft implant, hard implant, implant that spreads easily while lying, and implant that feels natural.

No matter how soft the implant is when you lay it on top of the table but you feel that the breasts sag a lot after the augmentation, would you be happy with the result?

Although you were attracted to the fact that the implant balance shifts downwards and feels natural when lying down, you might suffer from rippling effect. Would you be satisfied with this?



There are some conditions that need to be met when using implants in breast augmentation.

Can we correct and control the shape of the breast as we want?
Will there be no complications or failure in the long term?

These are a few.
There are basic must-haves such as form stability and position stability in order to satisfy these conditions.
Breast augmentation has a lot of variables.
FDA statistics show that 20% of all breast augmentation leads to reconstruction due to dissatisfaction and complications. The reason for this is due to the loss of control.
We can expect any outcome if there are different results or some satisfying or dissatisfying results.

We cannot say that this was a successful surgery.

It may be impossible, but we need to estimate the outcome and control the process to result in a successful surgery. Also, there must be minimum level of complications and no reconstruction in the long term.

Of course, all these factors do not just depend on the implant itself. The surgeon needs to study the body properly, plan out the whole process properly, apply the appropriate plane method / desquamation method, efficiently close the wound with least amount of bleeding when inserting the implant, and conduct post-augmentation check-ups with proper management.

It is correct to say that the surgeon needs to select the implant that matches perfectly with the patient.




Stating which implant is the best or better than others is just a marketing tool.
All implants have their purposes in usage that determine the outcome.
It’s like selecting the right ingredients for a delicious meal.

We cannot use the same hot sauce for a pizza and soup. We need to select the right implant for a particular situation in order to derive the best result possible.
There is no one implant that leads to a successful outcome 100% of the time. The success is made by the surgeon and the implant is just one of the tools used.

One would be able to estimate and control the result with least complication by using a 'good implant'. But there is not just one implant that satisfies all these conditions.
The doctors selects the best implant possible and matches that with the patient’s body in order to achieve that goal.

The implant that we use currently is called a ‘cohesive gel’ implant

The terms such as micro texture, smooth, and macro texture are words that describe the shell of the implant. The substance inside the implant is all cohesive gel.
‘Cohesive’ means well integrated.

Many patients ask how micro textured or silk surface is. But there is no one who asks what cohesive gel is.

Why do the manufacturers use cohesive gel?

They use it because it does not leak out like the water does if there is some damage to the implant.

But more importantly, it is because of ‘form stability’.
The ability to maintain the form makes it easier for us to estimate how the shape would be and also helps us to correct the shape if necessary. Also, it helps to fill the upper block of the breast for a long period of time.

It helps to maintain the shape/form although the implant collapses. We call such characteristic form or shape stability.

But if the gel is formed similar to water, the one dimensional feeling can be good.
The state has to be close to water if you want the implant to feel more soft.

I don’t know if you would remember my writing on how using liquid silicone, illegally, can result in the best outcome possible if there is no complication. The more liquid it becomes, the gel becomes very soft and wavy leading to a very good sense of touch.

But if the implant collapses, the shape disappears as well. Your breasts would end up looking weird.

If you have breasts that need to be corrected such as sagging breasts, such result would be meaningless. You will not be able to change the shape of the breasts properly and the shape of the implant would also change.

You will suffer from complications such as rippling. Upper volume of the breast would not be filled and the gel would all move downwards.

Cohesive gel came into the market in order to be a substitute for such liquid silicone. Gel is sticky and feels a lot stronger than liquid silicone. It is more close to solid than liquid. The difference is from touching a white cream with your hand to touching rubber ball. This is the difference of liquid and solid.

The reason why "cohesive gel" was made by the manufacturers is to avoid any shape related problems due to implant collapse, less filling of the upper volume and others although the patients want the breasts to feel soft.

This is why cohesive gel was born. The cohesive implant is classified by how much cohesive the implant is. The more cohesive the implant is, we call the implant form stable. The less cohesive the implant is, we call the implant less form stable.

The most form stable implant that we use today is Allergan’s Style 410. It is an anatomical implant and is sold the most around the globe.



Form stable implants feel strong and hard. It also maintains the shape the longest and the upper breast do not loose volume as you age. The best part is that you can correct the shape of the breast easily. It is best for those patients with very short distance between the nipple and inframammary fold or the distance between the clavicle and the nipple.

The gel does not leak easily when the implant collapses and the shape is maintained for a very long time. There will not be any rippling of the implant as well.
I will share more on the details in the future but there are critics on Style 410 with the rough texturing that causes double capsuling, seroma, and lymph nodes making the doctors avoid this product.

Then which cohesive gel implant has the least form stability?
It is Mentor/Allergan smooth round type implant.

The gel’s elastomer is very thin and the shell is about 90% filled which means there is more possibility of implant collapse or folding.

The inner density level is very low therefore it feels more like water.
The implant feels very soft and wavy.

Also the implant shifts one sided when you lie down towards one side. This might feel natural to you but if you have less elastic skin or much fat then such outcome would be less welcoming.

Luckily, there are many implants that we can choose from and there are many spectrum that we can choose in between.

Bellagel, EuroSilicone, PolyTech and Cervin have micro textured cohesive gel implants that have just an average level of cohesiveness.

The implants are near to 100% filled.

The implants do not feel like gel but the shell’s elastomer elasticity is high which makes the implants feel somewhat good when you touch them.

Such implants have less texturing so they do not stick properly to the skin wall. So the implants might not be able to maintain their positions inside but move about so such implants cannot be made as anatomical type. (All micro texturing implants are round type)

I have stated previously that in principle, the implant has to match the tissue structure of the breast. It is best to select an implant that matches with the shape of the breast and helps balance the growth of the breast skin.

If you are young and before pregnancy (In the 20’s), have tight skin and somewhat good breast shape and volume, the best solution might be just to make the volume larger and maintain the shape.

If such is the case then the form stability of the implant is not important. You can use any implant that you like. We would recommend smooth, round type or micro textured implant.



If you gave birth, have less elastic skin, and upper volume is less filled then it is important to change the shape of the breast to make the breast look balanced. The implant must not collapse therefore we must use form stable one. Such implant would change the shape of the breast and provide much volume. Most of the form stable implants imported to our country are anatomical types.

We need to choose an implant that matches the patient’s breast characteristics, and the state of the breast skin tissue.

In summary,

If my breast is tight and hard, then I would need soft implant
If my breast is less elastic then I would need tight implant
This would balance out the breasts. Implants are used as a complement to the human body and what we use depends on how our bodies are.

We will share more in the next post. Thank you for reading.
 

KIES-U Plastic surgery Korea
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
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Does transaxillary incision always hurt? Does inframammary incision not hurt?

Many patients want inframammary fold incision because they want to recover quickly. Some say that they do not feel much pain so they want to avoid transaxillary incision.
We cannot say that this is completely false but as you think about it, it is not correct to say that the approach method, incision, is the only cause of pain in breast augmentation.



The conclusion is that pain is not caused simply by just one factor.

There are many factors combined that lead to pain after the breast augmentation. The incision spot may be the least important factor of pain.
Then what is the most important factor? I have summarized this into a diagram as below. These factors are the ones that lead to pain after the breast augmentation.


 
Going into the explanation, the pain caused after the breast augmentation takes place when implant with much volume goes into the body and takes up some space. The surrounding skin pressures the implant and the pain receptors feel this pressure. This is the origin of the pain. People have different level of pain receptors in sensitivity, location, density, etc. The most sensitive ones are near the bones. The skin feels much pain as well but anesthesia helps relieve the pain. The pressure goes through epithelium, muscles and to the bone leading to much pain.

This is why there is more pain if the implant is located above the pectoralis muscle and almost no pain if the implant is positioned above the muscle. This is more important than the incision spot.

More pressure leads to bigger impact on the pain receptors, therefore that larger the implant is, there will be more pain. If the skin surrounding the implant put much pressure, there would be more pain as well. The implant puts pressure on the clavicle resulting in pain which means that the size or the tightness of the implant can result as such.

So if you want quick recovery, then it is wiser to use small sized implants rather than thinking about the incision spot.

It is also important that the surgeon carefully operates without causing much tissue damage. If there is much trauma on the bone or if there is much bleeding, the tissue cells will swell up. The pressure from the swelling will stimulate the pain receptors. Therefore it is important that the surgery is complete with least amount of tissue damage and bleeding for quicker recovery.

Finally, that last important factor is the individual differences.
Pain is a subjective matter. The doctor is just another third party in the patient’s perception. The doctor just hears about the pain that the patient is feeling, he/she cannot feel the same pain therefore the doctor’s information on the pain are all abstractive.

Internal medicine and neurology department use pain scale. They want to make the subjective matter measurable.




Personally, I do not think that the level of pain can be differentiated into different level. This is why we say that there is individual difference. Same level of stimulant will be felt differently from one person to another. One person might have more pain receptor in stimulating spot and the other may not have much pain receptor. There is no way that we can know this until we poke someone. In same aspect, we cannot know if someone will suffer from pain unless we conduct the surgery.

Although we do not have the exact measurement, we have much gathered data through experience and come up with a method that could result in least amount of pain. First, you should not be greedy regarding the size of the implant but choose a size that is most appropriate for the body. Those in 20’s or are in stage before pregnancy have very tight skin so these patients must be more careful.  If you have much volume or fat already in the original breasts then having the plane above the pectoralis muscle is recommended. Also the surgeon must concentrate and be careful so that he/she does not damage the tissue cells.

Does axillary incision hurt? Not, always. Then does the inframammary incision not hurt? It does not. The factors shared above are more important when considering pain. There might be little differences but this is a general tendency.

This is all for today. Thank you for reading.