No-Touch Technique of Breast Augmentation


Before the Keller Funnel was invented, surgeons would place the silicone implant through an incision by hand. The force required to place the implant in this fashion, could weaken the implant shell as well as cause bruising.

In 2009, breast augmentation saw its latest technological advance when the Keller Funnel method was introduced. This technique has completely changed and refined the art of breast augmentation and the next generation of this surgical procedure.

The Keller Funnel offers a no-touch delivery technique. The Keller Funnel is a clear, cone shaped tool that provides doctors with more manageability and ease to deliver breast implants safely into the breast during surgery without the doctor physically touching the implant with his/her hand.

This allows very little room for bacterial contamination or buildup on the implant surface. Due to the fact that the tool is clear, it allows surgeons to easily visualize and position the implant correctly before inserting it into the breast.

With the Keller Funnel system, insertion of the implant is much gentler for the patient and smaller incisions to the breast can be made.

There are four important benefits of using the Keller Funnel method in the breast augmentation procedure with silicone breast implants.

Smaller Incisions
The doctor is able to make smaller incisions by using the Keller Funnel. This means that there are more options for placing incisions during a breast augmentation procedure. It also means smaller scars and an easier recovery with less pain.

Decreased breast implant contact
Being able to use additional anti-bacterial measures with a Keller funnel reduces the risk of breast augmentation complications. It offers less risk of damage to the breast implant during insertion, helping to minimise the risks of pre-insertion damage to the breast implant product by reducing the  need to manually handle the breast implant. Excessive manual handling of implants has been identified as a potential factor in the compromise of the implant shell, reducing the longevity of the implant.

Quicker Healing
Using the Keller Funnel can also minimize trauma to the breast tissue. This makes for a quicker healing process, reducing post-operative pain.

Less Stressful to the Implant
The Keller Funnel is designed to minimize stress to the breast implant itself, which prolongs the implant’s lifespan and reduces the risk of the implant rupturing. The Keller Funnel’s slippery internal coating allows the surgeon to position and insert the implant with a minimal amount of pressure. In fact, research has proven that using the tool reduces the forces applied to an implant during breast enhancement surgery by 95 percent compared to the finger push method.

The implant is at lower risk of rupturing for the simple reason that less force is applied to them during insertion. This matters, because stress on the implant during insertion can eventually cause rupturing—even years later.



The Keller Funnel is the latest advance in Breast augmentation. This tool has completely revolutionized the plastic surgery industry by reducing risk, surgery time and over all stress to both patient and surgeon. The funnel has indefinitely been the only innovative tool used by plastic surgeons that has been able to fulfill the need of providing benefits to both the doctor and patient going under the knife. At KIES-U Plastic Surgery Korea, we believe that this tool is so ingenious that it has become absolutely necessary for our doctors to perform faster, safer and satisfying results to our patients, all while cutting down the risks of contamination and complication by a grandiose percentage.


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Today, I would like to share about the most commonly used breast reduction technique.
Straight line below the nipple is formed. This is one of the most common method, and it was developed in order to minimize the wound or scar formed after the inverted T  surgery.

This method is appropriate to young patients but is not good for those who have very large sized breasts.

I would like to refer to the below image for further explanation.



We need to decide what to do with the skin tissue removed in breast reduction surgery, and also decide on how we can fill the empty space.

Vertical(lollipop) incision Breast reduction surgery involves removing fat from the bottom part of the breast and pulling the two sides together for stitching, lifting up the breast and reducing the volume all together.




The result of the surgery would be as the image above. The procedure of this surgery would be as below.



Is the image good for your understanding?

Vertical incision Breast reduction surgery is rather quick and the stitching part is rather small. This is the big advantage and it is conducted widely around the world.
But this is not appropriate for very large sized breasts.

We could apply standard breast reduction but I would like to introduce L-shaped incision breast reduction to you.



The only difference is that the fat from the bottom part of the breast is put above the nipple. This leads to more removal of fat.



The surgery result on incision shown in the above image. This requires more time for recovery than the straight line breast reduction.

But L-shaped incision breast reduction is more effective for large sized breasts.
The procedure for this surgery is as below image.



Today, we looked at two common methods of breast reduction. One is vertical incision breast reduction and the other is L-shaped incision breast reduction.
Thank you.


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There are many types of breast reduction. Breast augmentation is differentiated by incision spot and the location of the implant, but breast reductions changes the shape of the breasts completely therefore there must be numerous types of the surgery.
I would like to start off by sharing on the simplest method. It is the fat removal surgery(Liposuction).



First, you need to think about if the breast is only composed of fat. There isn’t only fat in the breasts. There is skin tissue that produces the mother’s milk and there is the fat tissue.

If you need fat removal (liposuction), this means that you have much fat on the breasts. If you do not have much fat, there would be no need for fat removal (liposuction) at all.
Let’s say that you have large sized breasts. Do you need fat removal or not? How can we tell this? If you are thin, then you would not have much fat. Let’s say that you are thin but have large breasts. This is a very rare case. Most patients with much fat tend to have large breasts.

If you are young, have much fat and large sized breasts or if you gained weight all of a sudden and your breasts became large, then fat removal (liposuction) would be a good recommendation.

The good reason for removal (liposuction) on young patients is that is that their skin has much elasticity therefore, if the components get reduced the skin reduces as well and become very tight. If there is no skin elasticity, the skin would sag.
As you get older, the skin tissues disappear and the fat gets formed. This naturally would make you good for removal (liposuction). If you are old and have large breasts, there is a high change that you have lost skin elasticity. If we only apply fat removal and nothing else on older patient, then there is a high possibility that your breasts would not look pretty.

So if you are one who completed breast feeding and have sagging breasts, fat removal (liposuction) would not be enough but you would also need to reduce the skin.



We could conduct both at the same time or set-up a different date for the skin reduction.
Whether the fat removal (liposuction) is helpful or not depends on the patient’s age, pregnancy, weight gain, fat ratio, etc. If these are not enough, then we can conduct ultrasonic test. Ultrasonic tests can let us know the amount of fat in the breasts.
This decision method would be as below in the image.

If you want fat graft and have large breasts,



Then, how do we conduct skin reduction?
Skin reduction is similar to designing normal breast reduction. The only difference is that in normal breast reduction, we remove the breast fat and skin tissue together reducing the weight of the breasts. But the fat removal (liposuction) involves removing the fat first then measuring the skin tissue left and deciding what to do.
We call this complex fat removal (liposuction) breast reduction. One of the best options that we have in reducing the large sized breasts is fat graft.
Normal fat removal (liposuction) on young patients (aged in 20~30’s) with much fat or much breast skin tissue can end up with good results.




Older women (in their 40’s) who have less elastic skin must get complex fat removal and breast reduction together.
We need to consider such characteristics of the patients in order to apply different method to most effective breast reduction.

Today, we shared about fat removal and breast reduction.
Thank you for reading.


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About breast reduction

Today, I would like to share about breast reduction and things to consider.



1. What problems lead you to take the breast reduction surgery?

For most patients, the breast reduction is needed for cosmetic reasons and also for functional reasons that help with the daily problems.
Most young women want breast reduction for cosmetic reasons, because they do not want to be criticized for the breasts that they have.

For older women, they feel pain on the neck, back and other parts of the body. They feel like they are carrying something really heavy.
Breast augmentation and breast reductions belong to two separate categories.
Breast augmentation is 100% cosmetic surgery. Breast reduction involves daily problems that the patients have.



There are more older women than younger ones for breast reduction. As you get older, fat tends to build up in the body. After pregnancy and breast feeding, the skin tend to sag therefore if you have large breasts, you might want to get rid of the heavy fat completely.

There are two sides to breast reduction. One side is about young women wanting it for cosmetic reasons, and the other is older women wanting it for functional reasons. Also, the older women do not like the “weight” of the large breasts due to the inconvenience that they face daily therefore wanting the breasts to become smaller.

2. Past illness and heredity

Breast reduction is no small surgery. It is not big one also, but all the doctors conducting this surgery would say that it is somewhat big one. Why is that so?
There are much bleeding involved and there are much damage to the skin tissue. It is very difficult to design and it also results in large wounds. If you have problem with blood coagulation then you cannot get the breast reduction done. If you have high pressure, diabetes, or any past illness that do not help out in healing the wounds, then you should avoid this surgery. You need to take care of all these illness before you plan for the surgery.

There are some who think that the large breasts are hereditary.
You do not need to worry about this. The size of the breasts no only depends of heredity. There are also factors involved.

The nutrition during the maturity stage, hormone level, body weight, fat percentage, etc are all important in deciding on the size of the breasts.

3. When is the good time for breast reduction?

There are three important times on when you can get the breast reduction. First is during adolescence when the breasts start to become big. If you have too large sized breasts, with much body weight and stiff body, you would not feel comfortable around your friends.

If this becomes really bad, you might want to avoid people around you. In such time you might want to have the breast reduction. But for most patients, then wait until they are 16~18 years old when the maturing gets completed.

Second is during pregnancy. As you go through pregnancy, giving birth, and breast feeding, the breasts go through many changes. The breasts get bigger when you are pregnant. They get smaller after the breast feeding but the shapes do not go back to the original state. This varies from one person to another, but they are more cases when the breasts get bigger. But there are those whose breasts become smaller if the original breasts were very large. In some cases, the breasts loose elasticity and start to sag.

At this time, most patients talk about getting breast reduction and correction for the sagging breasts. So the surgery plan after pregnancy are mostly about reduction + sagging correction. Most young patients have good skin elasticity but they are very sensitive about the wounds. For such case, you can also consider fat graft.

Third, is related to weight change and fat. As you get older, your body loses muscles but gains more fat and weight. Your breasts also lose its original tissue and gain more fat. The breasts also lose skin elasticity. Therefore, most women have the need for breast reduction during this stage. Weight gain and aging that lead to large sized breasts could become a personal complex on women. The surgery at this stage would require to minimize the fat and reducing the breasts.

Tiredness from the age of the person and size of the breasts build up on the neck and back of older patients. Therefore much fat and skin tissue get reduced for them.

4. Does breast reduction have any influence on breast feeding?

Many might this that breast reduction involves the reduction of skin tissue and breast tissue therefore influencing the breast functionality of breast feeding. But there are reports in US that breast reduction does not have big influence that lead to stooping of breast feeding. But if there is much damage to blood vessels and other circulation function, there might be some negative effects on breast feeding.

5. How about breast cancer?
There are no evidence that breast reduction have any effect on mammogram or ultrasonic tests for breast cancer. You just need to check for breast cancer before the surgery and after the surgery as part of your routine check-up.

This is all to breast reduction. I hope the contents have helped your understanding.
Thank you.


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Composite breast augmentation Korea KIES-U Plastic surgery

Hello everyone. Today, I would like to share about composite breast augmentation.
This involves using the implant for augmentation and using fat to cover up the implant to make the breasts look more natural.

If you see the internet, you would be able to find some words on if the clinics make the patients choose between “implant and fat graft”. There is a clear classification between the two therefore if it difficult to say which is better than the other. Fat graft has longer history than implants. Czerny already conducted a successful transfer of a lipoma from the buttock to the breast in mid 1800’s. Fillers were used on the breasts from early 1900’s. The silicone implants that we use today were first developed in the 1960’s.

Fat graft is good in a way that you are using your own fat but it is difficult to know the engraftment success rate therefore, there is no unity in how the result would be. Using implant can lead to expected results but it is a foreign substance therefore your body reacts to it that could end up in complications. Therefore we can apply the two together to cover up each other’s weaknesses.

We can make a pocket and put in the implant. We can inject the fat into the breast envelope (tissue cells that cover the breast). This could be done as one stage or in two stages. I would recommend two stage procedure but most patients prefer the one stage procedure.

Then, how can the composite breast augmentation be applied?

Most patients who want breast augmentation have low level of BMI. Those patients who are thin or somewhat average tend to want the breast augmentation. If an implant is used on a very thin person, then others would recognize this easily. As the ratio of implant thickness : breast envelope thickness becomes bigger and bigger, there is a higher possibility that the implant can be seen from the outside and that there would be rippling and separated breast deformity. The breast envelope is as below.



Thin person using large sized implant would have more possibility of having the problems stated above. But, if you have large original breasts or if you use small sized implants, you would not experience such problems.



There are patients who want revision surgery due to separated breast. Also, you can see on the internet that those with separated breast have less fat between the two breasts.



An implant is a foreign substance. If the gap between the implant and the breast skin is not filled with fat, then there will be more edged look on the breasts. This leads to shadows and more artificial look of the breasts.



This unnatural look can be avoided by minimizing the size of the implant. But if the implant size is too small, then the goal of breast augmentation cannot be achieved. This is why it is better to use fat and implant together. We call this composite breast augmentation.

First, we need to exactly measure how much fat to inject after inserting the implant.
The engraftment is really important in fat graft therefore, a certain amount of fat must be injected for the engraftment rate to increase to maximum possible level. Usually about 500-700cc of fat is collected. When you remove the impurities, about 100-250cc would be left to use.

Cellular fat graft method is mandatory and the surgeon must be careful in carrying out the collection properly with no damage and no pollution on the fat. There are people with less fat in the upper body compared to the lower body (lower stomach, thigh, buttocks, etc). Those who do not have much fat in both upper and lower body cannot apply this composite breast augmentation.

The fat should not enter the implant pocket, but be injected from many direction to fill the gap between the envelope and the breast all evenly.
 


The fat used not for the purpose of making the breast look larger, but to cover up the implant for more natural work therefore the fat is injected on the margin of the implant and the boundary of the breast.

The fat used can slip downwards therefore you need to use correction bra after the augmentation. The correction bra helps hold the fat from slipping downwards.

Does the composite breast augmentation have any complications?
The most common one is the Touch-up. This means that there can be follow-up surgeries. The engraftment rate of one-stage fat is not as successful therefore we would need to inject more fat into the breast boundary after a few months.

The possibility of capsular contracture is about the same as when you only use the implant. The same applies for infection/inflammation.
More complications can be followed on the fat collected spot if you take out too much fat.

Composite breast augmentation is simple and it has many advantages. It is very effective for thin person to cover up the unnatural look that can be had from using implants. If is good to apply when you are thin but want to have large sized implant. It is also good if you want to change body line in the lower body (stomach, thigh, etc).

This is very effective if you want to correct some unnatural look on the breast or if you want to fill up the volume in some spot of the breast.

Today, we shared about composite breast augmentation. I hope you find this helpful. Thank you.