24 hour recovery after Breast augmentation 

Today, I would like to clear some misunderstandings and perception on the 24 hour recovery system.


It is mentioned on the same book that the 24 hour recovery system can also result in minimized side effects and revision.

This is not another type or advertising message that tries to influence the patients to get the surgery, but it is a mandatory technique that a doctor should know in order to minimize any possibilities of aftermath problems and side effects.

A 24 hour recovery system is: to recover quickly within 24 hours from the breast augmentation so that you can get back into your daily work and life without any problems.  It means that you can get the breast augmentation in the morning and go out shopping in the late afternoon. Those patients who were able to recover within 24 hours had less incidence rate of side effect than those who did not recover within 24 hours.


......24 hour recovery also deliver optimal long-term outcomes with low complication and reoperation rates. (Referred from the book)

.....such results along with the same elements that make the 24 hour recovery possible proofs that the long term result from the breast augmentation is optimized. (Referred from the book)

But, how can a patient recover in 24 hours? There needs to be much experience and know-how in order to make this possible. I conducted a survey on those patients that I had for a one year period starting Feb 2013. There were 172 patients who responded.



Hi, this is Kies-U. We introduce the “24 hour recovery system from anatomical breast augmentation” to our patients all the time. We would like to conduct a survey on those patients with breast augmentation who recovered in 24 hours. Please choose a response that best describes your experience and reply with the response number. Thank you very much. 
(1) Definitely recovered within 24 hours
(2) Recovered somewhat within 24 hours
(3) Did not recover within 24 hours

We analyzed the statistics of this question. Here is the result.



90.1% of all the respondents stated positively about the 24 hour recovery system. There were 9.9% of the respondents who answered that they did not recover in 24 hours.
 
I looked at some factors that slow down the 24 hour recovery system

Although most of the patients state that the ‘recovery was quick and there were no discomforts’, there are cases that are opposite. So I have gathered such cases to come up with the following findings.

1) If the size is too big
2) If the patient has different body shape (Abnormal bone structure / very tight skin tissue / bad case of bird chest, etc
3) If the patient was not in a good condition on the day of the surgery

There are many factors but we could sum them up as such.
If the implant is too big, then the pocket needs to be made big. In doing so, there could be much bleeding or much bothering on the pain receptors leading to long term continuous pain.
If you have a tight skin then there would be extensive force on the skin leading to much pressure. The pressure causes pain on the bones and other parts of the body.
If you are a patient who is very thin and have tight skin, you might want to make your breasts as large as possible. This greed might hinder the quick recovery that you could have.

24 hour recovery = Low complication

The equation above is what Dr. Tebbetts tries to emphasize. I agree with it.
If there is no pain, and if you feel comfortable, then this means that there is no trauma caused from the surgery, and the skin tissue can recover quickly resulting in no capsular contracture or other complications.

Today, we looked at the 24 hour recovery system. Thank you for reading.
Have a great day.

Why is 24 hour recovery important?

My patients tell me that they come to me because of the quick recovery from the breast augmentation.
Today, let’s look at why quick recovery time is important and how this can be achieved.

Here is the summary of 24 hour recovery system so that you can understand it easily.




Whatever surgery it is, a good surgery is one that least bothers your daily routine. This applies especially well for the cosmetic surgery more so than other health or physical function related surgeries.

The discomfort and pain from the surgery should be minimized and the social or economic activities of the person should not be restricted.

A surgery that does not penetrate important parts of the body and that ends quickly so that the patient can get back to daily life quickly leads to less possibility of complications also. If the night is long, then you will dream more. If the surgery takes long time and is very complicated, there is much possibility of increasing problems.



A world renowned breast augmentation specialist, Dr. John B. Tebbetts from Dallas, US, first introduced up with the 24 hour recovery system.

24 recovery needs careful analysis of the surgery, clear understanding of the patients, good preparation of the anesthesia and the surgery, and well prepared manpower that helps coordinate the surgery properly from the start to finish without any hesitation.


 
In order for 24 hour recovery to be successful,

Accurate planning before the surgery is very important
Everything needs to be decided in the first meeting with the patient.
What type of implant to use?
Is the size appropriate, what spec or profile to use?
How the symmetry should be controlled,
What is the problem that needs to be solved foremost?
Where to approach for the incision?
If the wrong decision is made in any of the question above, the surgery will be complicated and the recovery would be painful and slow to the patient. There would be higher possibility of side effects as well.



It is better to choose the inframammary fold approach for 24 hour recovery. This applies more so if the anatomical implant is used.
The inframammary fold approach leads to accurate and no fault surgery.
In oppose to this, if the approach is made far away from the breast, the surgery becomes more complicating, longer and the number of variable for the surgery increases. There would be more pain and the recovery takes longer than 24 hours.
I approach from the armpit often, and there is higher possibility of fault with this approach than the inframammary fold approach.
There is no one who wants to take risk on the surgical bed. Accuracy and certainty are very important in a surgery therefore there are many doctors around the world who choose and apply the inframammary fold approach.



A doctor’s technique is important for the 24 hour recovery. The doctor should not give any trauma to the patient and have the skills to perform the surgery quickly and accurately. The procedure should be conducted according to the surgery plan and should not be influenced by any variables caused during the course of the surgery. In fact, this is what determines the result of the surgery.

Also, other surrounding variables such as the surgery environment, tools and devices, endoscope, anesthesia and the experienced nursing staff are all important for the 24 hour recovery

There are many who are misunderstood about the 24 hour recovery system.
A quick surgery and recovery are necessary to result in a beautiful looking breast with no complications.

Quick recovery is not the ultimate goal. Quick recovery is necessary for the good outcome of beautiful looking breasts. Quick recovery means that the surgery was done without any problems or hesitations. This leads to less side effects as well.

Today’s post was for those who perceive that the breast augmentation is something that is scary and painful. The recent advances in the breast augmentation is the 24 hour recovery system.

Thank you for reading. Have a great day.

[Breast augmentation Korea]

Those who need recovery in 24 hours _ Career women

Everyone at our country is busy. But there are those who are busier than others. I would like to share about a quick breast surgery recovery for those career women in such need.

Let’s look at some occupations that I can think of.

Housewives who need to take care of their children
Flight attendants
Nurses / doctors, and other medical related
Skin therapists, beauticians
Athletes
And so on.





Those women who gave birth, breast-fed babies before and currently have babies that are about 5 years old have sagging and less volume breasts that lead to stress.
But is there anything more difficult than raising kids? Housewives are those who have the most need for 24 hour recovery.
It is recommended that you stay away from the children on the day of the surgery. Some simple house works are possible if necessary. You will be able to somewhat take care of the kids on the very next day. In about 3 days, most patients would not have any difficulty taking care of their children.



Flight attendants must be able to do their everyday job quickly enough. They have one of the most difficult physical jobs. Also, their daily schedule is rather irregular therefore they do not have much free time as well.
The frequently asked questions is something like, “when can I start carrying heavy luggage to put it in the glove compartment?” You can take care of luggage that is about 5kg within 3 days. But you would need to wait about a week to carry anything heavier than that.


Flight attendants are mostly worried about bleeding or other emergency problems that may arise during the flight or in a foreign country. Such problems can be avoided by 24 hour recovery system that is carried out by approaching the 밑선. Such women need to select surgery system that controls hemorrhage and minimizes pain.




There are many medical related patients who visit me as well. For example, it is difficult for nurses or doctors who have irregular schedule to get much time off from their work. Physical labor is intense and stressful. Also this is a very difficult occupation in that there are many lives at stake and you have to leave or delay your job.
These patients also need 24 hour recovery system. One must be comfortable and recover quickly to help the others.
If you can get 3 off, then you can consider having a breast surgery.
Other simple procedures can take place on the day of the surgery, but one cannot make beds or move the beds right away. The patient needs to rest about 3 days and then start doing these activities.



There are many skin therapists and beauticians who visit me as well.
These occupations do not require lifting of heavy object, however, they need to move constantly and they use their hands and arms a lot. So most of these patients are curious about how easily they can move their arms after the surgery. Such activities do not have any limitations in work on the day of the surgery, and if you are one with good fitness, then you can get back to your work normally on the very next day of the surgery.
You might even forget that you had a surgery.




Athletes ask a lot of questions as well.
There was a pro golfer who god cohesive gel breast implants. The biggest question was when she could get back to playing golf after the breast augmentation. I believe that she went back on the field with 3 days. She could not carry the golf bag herself, but she could swing the golf clubs without any problem.
Aerobic exercise such as walking or running lightly can be done by anyone on the very next day of the surgery.
Weight training would take some time. You need muscular strength in order to do this. The breast augmentation involves the chest muscles therefore; it takes some time for recovery.  Normally I recommend the patients to do weight training after two weeks.



I also recommend 2 weeks for those who enjoy swimming. There is no problem with getting into the water, but staying in the water continuously for 2 or 3 hours is a different story.

Today, we looked at the breast augmentation according to different occupations .It is not impossible to get the breast surgery when you are working. This is all for today.

Thank you very much.

Safe breast augmentation, breast surgery without any defects

Q. People choose plastic surgery clinics considering the safety. So what do the patients need to check?

A. I think that all cosmetic surgery should not have any defects although you might not look pretty after the correction.

 

The safety and having no problem after the breast augmentation surgery is the most important factor as well.
A surgery involves incision to complete its goal. Once the incision is done, the body bleeds and there is pain. Also, much microorganism can enter the opening of the skin. In any surgeries, one uses anesthesia to kill the pain and sterilize in order to prevent bleeding and infection.

When these three, anesthesia, bleeding, sterilization (disinfection), are not done properly, a problem arises and the surgery becomes dangerous

There are three things that you need to check if you want a safe breast augmentation surgery.

Is there a proper anesthesia for the breast augmentation surgery?

Can the bleeding be stopped after the breast augmentation surgery?

Is there enough measure to prevent infection?

First, breast augmentation surgery requires general anesthesia. General anesthesia is broad in term, however it involves intubation, the suction of the anesthesia. There is another method called LMA but this also involves the suction of the anesthesia.
General anesthesia can be helpful in reacting to any unexpected situations.




We conduct blood test, x-ray, and ECG tests before the anesthesia and also check if there are any test results that are out of the normal figures. This process itself can prevent much problems and unexpected accidents.

There are some cases when the patients find some problems that they have through the blood tests that they have before the correction. There was a case where a patient found out that she had leukemia through the blood test before the correction.
However, there are some unexpected problems that arise during the surgery procedure. In order to handle such situation quickly, it is important to do intubation or LMA.

Second, if there is much bleeding then a good result cannot be expected. There are thick blood vessels underneath the pectoral muscle of the breast. If this is touched, then much bleeding can happen.

In order to conduct a safe procedure, the surgeon must be aware of such problem and also know the exact cautionary measures to react to such a problem. It is rare to have much bleeding that leads to severe threat on life when conducting the breast correction, but if the blood gets into the implant, required in the breast correction, then the implant may be damaged in shape and form, and also could be misplaced causing further problems such as pain or infection as well.

Therefore, a surgeon must be sure that he/she does not leave even a drop of blood near the implant during the breast correction. The best method that helps to stop the bleeding is inframammary incision.

If you conduct the correction from the inframammary, you can gain 100% vision of the operation therefore, a well-trained surgeon can also stop the bleeding quickly and complete the surgery properly.






Also, it is important that the surgeon does not touch unnecessary parts of the body when doing the breast augmentation surgery.

Third, preventing infection and inflammation requires much training for both the surgeon and the nurses as well. Also, it is important to do the breast augmentation surgery quickly so that there is less time for the implant locating part of the body to be exposed with the exterior environment.

The surgery room must be isolated from the exterior environment and also all the personnel in the surgery room must be sterilized.
There is a method called No Touch technique that I would like to introduce.



No touch technique is a technique that prevents any bacteria or microorganism entering the body during the surgery. It is important to maintain the clean status of the body from the incision up until the closing of the wound and also, one must not touch the pocket of the implant during the procedure. Only the tools are used.
It is important to complete the correction procedure quickly in order to prevent infection or inflammation. The longer the procedure takes; we are giving more opportunity for the contaminant to enter the body. Using drains requires the opening of the implant pocket and the exterior, therefore, it is better to prevent such activity, or do this in a very short time.

Those medical personnel who are well trained with no touch technique can prevent contaminants entering the body when doing the breast correction with the implants. One must absolutely close the incision quickly so that there is no exposure to the surgery room or the exterior environment.
Therefore, it is important that the overall procedure completes as quickly as possible.

The three issues stated today are
General inhaling anesthesia
Minimum desquamation, 100% stopping the bleeding
No touch technique, quick surgery time

These are the issues that one must first consider and examine when wanting a safe breast correction.
 
This is all for today.

Thank you very much.

Breast Surgery To Know List 4.
Deciding on the Breast implant size

There are many posts on how we can decide on the size of the breast implants. Today, I would like to summarize the core contents with this post.




Before the doctor would see the patient and say “You would need xxx cc.” This was about 7 to 8 years ago.
But today, this process is different. There are several stages on how we go about in choosing the right breast implant size.

We usually use the below 3 stages.
 
1. Upper body measurement
2. Implant fitting (T-shirt test)
3. Sizing while conducting surgery

I will go in detail for each one of them.

1. Need to get upper body measurements in the first consultation with the surgeon

You need to take different measurements but the most important one is the width of the original breast.
The average width size of those patients (those in 20’s ~ 40’s) who come to have breast augmentation surgery is about 11 cm. If the upper frame is big then this width size is big. If the upper frame is small then the width is small also.
The greater then growth amount in the breast, the wider the width is. So if the original breast is small then the width is small as well.




The width of the implant depends on the width of the breast. So if the width of your breast is about 11 cm, we would choose an implant with width of 11 cm or less.





But there is another part of the body that is as important as the width of the breast. It is the extensibility of the breast tissue
There are those who have elastic skin, tissue, muscle, fat that surround the implant, and there are those with less elastic parts of the body.

The younger the patient is, before giving birth, the skin on the breast does not stretch out as the skin is less elastic.
As you get older, and give births, the skin becomes easily stretches therefore, losing the skin elasticity.

If the skin is tight and does not stretch easily, then it is difficult to use wide implant.

In opposite, if the skin stretches easily, then a larger width implant can be used.





Therefore, we decide on the size of the implant by measuring the upper body, i.e. the width of the breast and the skin elasticity.

This is preliminary, and is not the final decision.

2. Implant fitting (T-shirt test)

 
How big should the implant be in order to make my breast bigger? A question as such can be answered easily by fitting the implant just as you try different clothes when you want to buy one.

The size of the breast is very subjective and also the satisfaction survey of breast surgery is very subjective as well. So, it is important to check the breast size after the surgery although she knows how much cc implant has been used. If the patient is not satisfied, then this is not a meaningful event for the patient.
Let’s imagine that you are buying a dress.
There are those who think that size 44 is too big.
There are those who think that size 66 is too tight and small.






This is the same with the size of the breast implants. There are those who think that 200cc is too big and those who think that 400cc is too small.

The subjective feeling in choosing the size of the breast implant depends on the size of the upper body, not the absolute number in the size of the implant (cc).

It is not always the case that the size of breast implant chosen at the first stage of upper body measurement would be the same as the size that the patient wants.

So the surgeon prepares the implant that is recommended size and another with the size that the patient wants. There are many variables during the breast augmentation surgery and the size might look differently while having the surgery.

3. Sizing while conducting the breast augmentation surgery

Final decision making is done during the breast augmentation surgery. The measurement size and the patient wanted size are just references sizes for the implant.
During the breast augmentation surgery, we make look for the implant and fit in the implant imitation to measure again which size is the most appropriate one. We call this, sizing.

If the diameter of the breast is about 10.5 cm, and the patient wanted 270cc implant however the recommended size was 290cc, we would prepare all implants from 250cc to 300cc before the start of the surgery.

During the surgery while we test different sizes and decide that 290cc is appropriate, we fit in the 290cc implant into the breast.

In opposite, if there is enough room for the implant but the skin does not stretch so that the 270cc implant cannot fit it, then we used 250cc~260cc implant for the surgery.





There are some patients who visit various clinics but decide on the one that will use the implant with the size that the patient wants.

But, this could lead to trouble in the future. The young patients are too focused in wanting larger breast compared to what the body can take therefore, demand more volume rather than what is appropriate for the body.

We cannot decide on the size of the implant with just the first interview with the surgeon.
As we have stated earlier, there are many stages that are involved in deciding the size of the implant and the final decision is made in the surgery room.

A patient’s opinion is a consideration factor, and the surgeon cannot do everything that the patient requests or demands........
Doing what the patient demands may lead to future problems such as refilling, being able to feel the implant, damage to the implant, unnatural look, etc.




Today we shared the fourth post on the ‘To know list of the breast surgery’ that covered details on how the size of the implant is decided.
Thank you for reading.

Have a great day.

Hi, I'm doctor Lee.

24 hours recovery of breast augmentation surgery is not a marketing - promotion term, but one of essential points of this surgery.

Surgeons has to perfect himself in 24 hours recovery to minimize the complications and postoperative problems.


It means, morning operaiton and evening going out for dinner.

The patients who have recovered fast had fewer and minimal complications  than who have not.

In Seoul, many overseas clients come and return to their country in only 3~4 days, Russia, Mongolia, China, Hongkong, and USA.  Although more time is desired for the surgery for them, but under 24 hour recovery system, the time is not lacking.

"The same decision process and surgical techniques that deliver 24 hour recovery also deliver optimal long term outcomes with low complication and reoperation rate."
(John B. Tebbetts, AUGMENTATION MAMMAPLASTY, Redefining the patient and surgeon experience, Mosby, 2010, Elsevier Inc. pp.377~385)

But How?

How a surgeon can let the patient recover that fast?

It requires plenty of experiences and accumulated know-hows.

I have conducted survey about the 24 hour recovery after operation of my patients for 1 year.



The questionnaires were sent thru the phone message s and 172 patients responded. And the results are as follows.




90.1% of the responders answered positively. Who answered 'not recovered in 24 hours' was 9.9%.

Although the majority of patients answered "I recovered very fast. I didn't have much discomfort." . but some did not, so I have thought about the reasons of the delayed recovery.

And I can present a few factors for that.

1) Too big size implant compared to the patient's chest size.

2) Tight skin (breast envelope) which make it difficult to adapt to the expanded body surfaces.

3) The patient's bad condition on the operation day.

If the  size of  the implant is very big, then the surgeon has to dissect very wide space, then the possibility of bleeding or tissue trauma increases. And it is concluded to a delayed recovery.

And If the skin envelope is tight, or the original breast tissue is scant, small, then the skin will put pressure on the implant and the underlying periosteum. And it brings pain and the delayed recovery.




Fast recovery means there was little trauma on the patient's body.
And the tissue which has only minor injury can heal fast,
As a result, we can have optimistic view of the complications of the surgery including capsular contracture. They can be minimized.

Today my posting was about 24 hours recovery of breast augmentation.

Thanks for reading, have a great day.