[Breast augmentation Korea]
Wound/Scar after breast augmentation

There are certain things that patients worry about on breast augmentation in such order,
First, do I really need to do this? How much does it cost?

When the above questions are answered, the patients look for how long the recovery period is.

Finally, they worry about the scar that is caused by the breast augmentation.

Today, I look like to review on the scars that are caused near the inflammatory fold and axillary crease when performing breast augmentation with water drop type implants.
As you have visited my blog and have noticed, the contents here are those that you cannot find on any advertising contents online. I like to blog in order to correct the wrong information that the patients have and ask when they visit the hospitals and also to be a communicating bridge between the surgeon and the patient.

First the scar near the axillary crease disappears after 6 to 12 months.

Breast augmentation Korea KIES-U

This is a photo of the breast augmentation on the axillary crease after 8 months. The wound is becoming lighter without any problems. Maybe the doctors would not realize that a surgery was done on it if they look at it.

Breast augmentation Korea KIES-U

 This is a rare case. This is called hypertropic scar. (It is different from keloid). A hyertropic scar was formed about a year and a half after the surgery. It is difficult to forecast if such a scar would be formed or not in advance.

Breast augmentation Korea KIES-U

This is a picture of the scar after the scar removing injection. The scar is getting lighter but this injection is needed again in the future. I have only seen one of such cases until now.


For your information, there aren’t many who can differentiate hypertropic scar and keloid. Keloid does not have any limitation on the location that it can be formed and it is formed largely without any control. Hypertropic scar can lead to swelling but stays at one position.

A scar from the breast augmentation is rarely a keloid and I have never seen one as of now.

Let’s look at a scar on the inferior breast crease. This scar is different from the one on the armpit in that the scar can be formed on the breast, therefore, this is rather scary. But let’s see if this scar is indeed scary or not.

Capsular contracture Level 3, revision surgery patient Photo after the revision surgery KIES-U

This patient changed the saline type implant and then faced capsular contracture. In the past, the saline type was put through the armpit but the reconstruction was done on the inferior breast crease. As you can see, the incision line is very clear on the inferior breast crease.

6 month after revision surgery It is difficult to find or see any scar from the front view.

Let’s look at another patient’s photo.

Breast augmentation Korea KIES-U

The above and below photos are those of a foreign patient. She did not like the size of the implants and therefore wanted to change then. This is a phots taken after 6 months, and as you can see, there are no scars that you can see from the front view.

Breast augmentation Korea KIES-U

Scars cannot be seen easily from the side view as well.

Breast augmentation Korea KIES-U

 The scars can only be seen if the patient cups her breasts to make the scars be shown easily.
(Normally, one would not be able to see the scars....)

This is a photo taken 4 months after the surgery. I think that the scars will completely disappear in a year or two.

Inferior breast crease scar is more advantageous when you go swimming. It is a place that the swimming suit always covers. In fact, the armpit would be more suspicious to others if you go swimming.

If you are the one who likes public bath, then you might be worried about the inferior breast crease. But you would have to lie down on the ground for anyone to see and notice the scar.

A scar cannot be a decision making factor. The surgeons agree that the major claims after the surgery are shape, symmetry, and volume. There are very rare number of patients who are unsatisfied with the scar.

Today we looked at the scar formed from the best method, inferior breast crease incision, with the help of different photos..
Have a nice day. Thank you.

Q. When do you need to have a breast revision surgery?

There are few reasons for the breast revision surgery

First, when the breasts become hard due to the capsular contracture.
Second, when the breasts look awkward because the location or the position of the implant changes.
Third, when there is a damage on the implant (this is common on the saline type)
Fourth, when there is inflammation, bleeding, etc.

Breast revision surgery Korea KIES-U

The most common question is on the capsular contracture. I will talk about breast revision surgery considering the capsular contracture.

The reason why the patients are scared of the capsular contracture is that the breasts look “artificial or surgically repaired.” The implants are out of the original position, the breasts become hard, and the two breasts look different from one another.

The upper part sticks outwards or the implant is pushed away from the breast. Also there is much pain or at times there may not be any pain. The two breasts do not face the same type of capsular contracture, each faces different types.

Before & after Breast revision surgery Korea KIES-U

The above image is not the worst case of the capsular contracture, but the breasts have become hard and the implant is pushed upwards.

The patient received breast augmentation through the armpit using the smooth type implants. The breasts started becoming hard after 3 months and there has been a severe upper block.

The patient received a breast revision surgery after 7 months from the first one. The original implant was takes out from the sub-pectoral part and put into sub-glandular location.

The lucky part is that the patient had some volume on the breasts even before the first surgery, so the sub-glandular part could be used for the re-surgery.

If there is not much volume in the original breasts, the implant pocket cannot be formed on the sub-glandular part therefore, we need to form double layer for the revision surgery.

The patient had sagging breasts, therefore, we selected water drop type without any hesitation, and used oval shaped 290cc implant. The patient is now satisfied.

In the next posting I will talk about 'Why is the capsular contracture formed?'
This is all for today, thank you.

What is water-drop breast surgery? 

Breast augmentation Korea

Things to consider before breast augmentation surgery

What is a water-drop breast surgery? This might seem like a very simple question to answer but there are many who do not know exactly about it. Today I would like to share about the difference between the water drop breast surgery and one that is not.

1) The name of ‘water-drop implant’

There are many people who refer to this as water drop implant, but this is not an accurate term. We call this implant, an Anatomical shape implant.

This means that the implant is shaped as the shape of a breast. The English speaking countries refer to it as Tear drop implant as well. The term ‘Water drop’ is used in Korea mostly.

Breast augmentation Korea - water drop implant

2) When was it developed?

The water drop implant is not a new product. This was made in about 1992 by McGhan (currently known as Allergan) and Mentor.

They named is as cohesive gel by using sticky silicone gel on the implant and developed it into various types such as the one with a surface that is round shaped and another which is cohesive gel with tear drop shape that is anatomical.

So the water drop type implant that we use today is about 20 years old and is not a new product. It was certified late here in Korea.

Breast surgery Korea KIES-U

3) Which water drop implant is good to use? 

The advantage of the water drop type implant is that the outer layer of the implant is well made to maintain its shape. (Round type is also made to main the original shape but is not as effective as the water drop type) So the shape is maintained after a long time.

Another is that the upper breast volume is maintain although the patient gets older or has sagging breasts. (Round type shrinks at the top so it cannot fill up the upper breast volume effectively)

Next advantage is that if you are a thin person with less volume in the original breasts, this would lead to a more natural look of bigger breasts.
Another advantage would be that one can choose the different types of implants according to different body types. (This cannot be done with the oval shaped implant)

These are few of the biggest advantages, listed above.

Breast augmentation Korea KIES-U

4) What are some problems of water drop type implant? 

There aren’t many disadvantages of water type cohesive gel compared to the round type cohesive gel.

Water drop type implant is more stable and strong in its shape therefore it require bigger inlet so one needs to dissect the skin more. Some young patients might think that there is less volume in the upper breasts compared to what the round type can provide. Also, the price is more expensive.


5) How is the water type different from round type when having breast augmentation?

A lot of clinics have rather strong advertisements that try to communicate that there are differences in the technique, but this is not true. There is no difference in the technique or procedure with using the round type or the water drop type. Same dissection and same closing are required. The only thing one should be careful of is that the water drop implant needs to be put in in a certain direction. This is the only difference.

Some inexperienced people think that the water drop type implant requires some different method. Both round type and water drop type require same surgery method and after surgery treatment.

Breast augmentation Korea KIES-U

6) Why is water drop type expensive? (The cost of using water drop type) 

There was a big problem is huge difference in prices of the implants. All the implants are manufactured by foreign companies. There are many companies involved in various stages of importing the implants to our country. The products are manufactures in Europe, shipped to Singapore and then brought in to Korea. So this leads to big differences in the prices of the products.

But the price of the water drop implant has dropped a lot since September 2012. The usage has become popular and many companies hurried to import the implant leading to price competition. Now, you can find water drop type implant with price that is not much different from the round type.

The reasons why I tend to recommend the water drop type is because it is more advantageous for Asian patients who have tight small chest that require more safety, secureness, and durability. It is more advantageous for sagging breasts as well.

This is all for today, thank you.

About breast size - breast augmentation Korea 

There are many patients who do not know how the breast sizes change after the breast augmentation.

The doctors say that he/she would use 300cc or 275cc, but the patients do not know how the breasts would change along with the different sizes of the implants.

About 13~14 years ago, the internet shopping started.

At that time, people didn’t know how to buy the clothes on line just by looking at the clothes through the internet. Most people though that one must wear the clothes to buy one.

This was something unimaginable at the time, however, this internet shopping industry has grown tremendously in the past 10 years. Now, there are many who buy clothes on line. People are more comfortable with the internet shopping and they are aware of different sizes.

Internet shopping website providing explanation on sizes

There are some common sizes in shoes such as 235, 240, and 245. As for bra, there is a band size 70, 75, 80, and cup size of AA, ,A, B, C, etc.

A size is something that a person remembers as she buys things with that particular size.

But breast surgery is different from clothes in that a person would have a breast surgery just once in her life time and it is also difficult for her to know what size other people use.

I have divided the size of the implant into 3; small, medium, and large; because the patients are not aware of different cc. Below is the explanation of different sizes. (Most patients do not choose small and X-large so one can say that there are only 3 sizes)

Natrelle anatomic shape implant cannot be officially imported to Korea

　 　


This reference may help you understand the increase in size.
The difference in the cup size is difficult to estimate, as explained before.


Most of the women in their 20’s select high medium size. The next popular choice is large size followed by medium size.

This is similar with those in their 30’s as well, but there is relatively high percentage of large sized implants. The numbers are the same. (Most patients decide to get breast augmentation after giving birth and breast feeding their babies, therefore the patients tend to select large sized implants)

Most of the patients in the 40’s have re-surgeries or want to fix the sagging breasts therefore they tend to choose medium and large sized implants.

In Korea, an average patient would be 163cm tall, wears 75A bra and the diameter of the breast is about 11 ~ 11.5cm.

However, most of the patients want their breasts to be larger than small or medium sizes therefore choose high medium sized implants the most.

There aren’t many of those who have large enough breast diameter to use the large sized implants here in Korea.

I think this would kind of give you an idea of what sized implant you could use.


Today’s post was to provide a measure guide to those of you who do not know how cc is related to the size that you could have.

There is no scholastic reference for this, but I looked at many catalogues to come up with the measurement matrix to give a simple explanation that has led to positive feedback.

However, there is a downfall in this, it is a profile of the implant.





As you can see in the image above, ‘Low profile’ refers to long diameter and low height implant, ‘High profile’ refers to short diameter and high height, and there is a ‘Moderate profile’ in between the two.
People who study after breast augmentation at home through the internet do not know about this also.

Another point is that although you use the same 275cc implant, meaning although the volume is the same, the shape would not be the same once the implant goes into the body due to the different profiles.

We will explain more about this profile at a later posting.


It is already summer in Mid-May. I think one can expect how the weather would be in the next two months. Most people are already in short sleeves and pants. Are you worried about showing off your body? I am!

This is all for today. Thank you for reading.
 

Using artificial skin(alloderm) for breast re-surgery [KIES-U Korea]

We have been using the artificial skin in breast revision surgery since the early 2000’s. It was first used for the breast cancer patients but then the usage has expanded into the beauty area and is now applied on the breast surgeries.



The artificial skin is made by pig skin but has been biochemically alternated to fit into a human’s body, therefore, it is different from Alloderm that uses the skin from a corpse.
Alloderm is a brand name and the product from the brand is called Strattice.
Today, we will look into how the artificial skin is used for the breast revision surgery.





There are many causes that lead to breast revision surgery, one of which is the capsular contracture.
Also there are other causes such as the position of the implant, implant defect, leakage, hematoma / seroma.

The artificial skin(alloderm) is used when a patient’s skin becomes really thin so that the artificial skin is necessary to cover the implant.

This usage is rather an additional measure for the breast surgeries.

The position of the implant, such as going too much to the inside, lower bottom, or coming out, can be a problem, but this is caused because the pocket is too large compared to the size of the implant. So the artificial skin(alloderm) is used as a barrier for the implant to be fixed at the most appropriate position.




Capsular contracture is the main cause of breast revision surgery. Usually, we will cut off the epithelium or remove it and also change the plane of the implant, i.e. depth, during the revision surgery. Alloderm used in this case means that the implant would be covered by the product.

The artificial skin(alloderm) minimizes the possibility of the capsular contracture, and acts as a barrier between the implant and the patient’s immune system. Also, through this, the epithelium becomes really thin.

As for the reconstructive surgery, the incidence rate of the capsular contracture is decreased from 10~16% to 5% when using the artificial skin.

The sagging of the breasts is caused because the skin becomes really thin after the breast augmentation. The skin becomes thin quickly if the implant is too heavy or as the patient gets older. Normally, one would consider breast lifting is such cases but we could use the artificial skin(alloderm) so that it supports the implant therefore avoiding the sagging breast.



Rippling and wrinkling: This is normally found with patients who are thin. We use the artificial skin(alloderm) by covering the implant from the top on the part where there is refilling or wrinkling.

Many patients apply the methods mentioned above for the revision surgeries. Statistically, we have seen great improvements with the capsular contracture, and some with the sagging breasts and the wrong positioning of the implants.

However, we see many recurrences of refilling or wrinkling even after the artificial skin so we do not have much statistically significant data for such cases.




Today, we looked at how artificial skin is used on the breast re-surgeries. In summary, we can say that the artificial skin is used only when it is necessary for re-surgeries or re-constructive surgeries. Also there is a high cost for it.

Thank you for reading. Have a great day.

Bleeding after breast augmentation surgery [KIES-U Korea]

We do not call bleeding and pain as side effects. We need to know the cause of these problems.
All surgeries have bleeding. A good surgery requires how effectively you stop or minimize the bleeding. So the important thing is that the surgery be done without bleeding.

Breast augmentation Korea KIES-U Dr. Lee

What happens when there is much bleeding?

If there is much bleeding or if the bleeding is not stopped during the breast augmentation surgery, the blood builds around the implant.

The blood from the blood vessel becomes solid, i.e. hematoma.

The body can take it naturally if there isn’t much amount of hematoma, however the body cannot take in large amount of it so there will be some hematoma left. The large sized hematoma can force the implant to move into one direction causing an awkward shape and can be a cause of infection or inflammation. It also leads to pain as there is much pressure from the hematoma build-up.

If the hematoma is build up near the dissected part, then it can penetrate through the skin, finally leading to opening of the wound and worsening of the scar.

KIES-U Korea Breast augementation

What do you do when there is much bleeding?

We can diagnose if there is a problem with bleeding from 0 ~ 2 weeks of the surgery. Abnormal swelling or pain, change in skin tone, infection or inflammation can be examined. If there is not much bleeding or if the side effect is not severe, we can put pressure on it and stop the bleeding. However, if we find that there is much bleeding then we need to remove the hematoma.

If the surgery was done on the areola or on the bottom line, we use the same spot to check on the bleeding, use galvanocautery, and quickly remove the hematoma.

But if the surgery was done through armpit or the belly button, we cannot use the same spot. We would have dissect the bottom line and remove the hematoma.

Breast augmentation Korea KIES-U

If we dissected armpit in the original surgery and there is much bleeding, we can open up the armpit again, clean, and use the endoscope to stop the bleeding. If we are lucky, the surgery would be a success, if not, then we need to pull out the blood for a week and pressurize the part.

In such case, although we have saved the implant, the patient feels much pain and loses sense for a long period. Also there is a high possibility of capsular contracture.

How to avoid bleeding?

In the first two weeks of the breast surgery, one must be very aware of one particular problem, bleeding.

In order to avoid such happening;
The dissecting area should not big. The space must be appropriate for the implant size. (Minimizing dissection technique)
The implant, itself, should not be too big. (Large implant requires large pocket that leads to more damaging of skin and blood vessels)
You need to get the job done by an experienced and careful surgeon.

Bleeding in revision surgery

If the revision is necessary due to the capsular contracture, we need to remove the formed epithelium completely causing much bleeding. So we do not completely remove the epithelium but leave some that would help the new implant fit into the pocket. Removing the epithelium completely can be an another cause of the capsular contracture and also we need to change the method in order to minimize the bleeding as well.

Breast augmentation Korea KIES-U

One must be very careful about the bleeding in the breast surgery Bleeding can lead to other problems such as capsular contracture, infection, implant collapse, scar, opening of the wound, etc. The bleeding during the revision must be controlled properly as well. The result of the uncontrolled re-surgery would be obvious.

This is all for today. Thank you.

Selecting the Implant Height in Breast augmentation with anatomical Prosthesis

[KIES-U Korea]

Here in Korea, we have a short history of using tear-drop implant breast augmentation, therefore we limited know-how in various types of surgeries. In oppose to this, tear-drop implants have been used in Europe and North America for almost 20 years. Therefore, these countries have built-up knowledge and data that are important for the surgeons.
Today, we will look at a publishing by Jose Martin del Yerro, M.D from Spain and also criticize on it.




The satisfaction of breast augmentation is highly correlated with the beauty of the breasts after the surgery. This is because when you wear clothes, the upper breast can be seen easily and also the one can see the shape of the cleavage.
So this important upper breast is composed through the height of the implant, however, there isn’t much mentioning about it. The doctors do not consider this much and so does the patients.

Dr. Yerro published a paper that states that the height of the implant should be selected according to the body type.

Kretschmer and Sheldon were few of the people who divided the ‘body type’ into three. In easy terms, the types would be ‘thin’, ‘normal’, and ‘obese’.
Dr. Yerro stated that the pocket of the implant of a thin person is shaped oval vertically, round for normal person and a horizontal oval shape for those who are obese.



And through many analysis, he found that the ‘normal’ type is the majority, and the other two types of ‘thin’/’obese’ are rare. This is why there is much usage of round type implants rather than the oval shaped ones.

Dr. Yerro published his paper based on the analysis of 5123 patients that he has worked with for 13 years, starting from 1998.
This means that the thoracic perimeter has been divided by the distance between the center of the collarbone and areola to determine the height of the implant.




The result of the data can be seen in the image above. The ones with the ‘normal’ body shape were the most and the average length of the thoracic perimeter was found to be 80cm, with the average of the collarbone-areola distance being 20cm. Also, the round shaped implants were used the most.

I think that Dr. Yerro’s findings are very important in how we select the height of the implant. There aren’t many surgeons in Korea who are much experienced with using the tear-drop type implants. These surgeons only focus on the fact that they are using this type of implants and do not consider important 3 dimensional variables including the height.

 Dr. Yerro’s findings are not directly related to how we do things here in Korea, so some findings feel unrealistic. The biggest difference is that the Europeans and Koreans have different body types. My personal statistics show that the patients who want breast surgeries have average of 17.7cm in distance between the collarbone-areola, so this is much different from what Dr. Yerro has announced.

Also the thoracic perimeter is not as large as the average of 80cm. Most of these patients have very thin thorax as well. Many people with large thorax and those who are obese do not need breast surgeries.

One needs to know that most of the Korean women have short thoracic perimeter and narrow breast diameter. So, when we consider Dr. Yerro’s data, most of the patients that we have are composed of those who have ‘thin’ or ‘normal’ body type.

This means that most Korean patients need to use the vertical oval shaped implants





I will write another post to explain about how to select the appropriate height of the implant according to the various different types of the implant at a later date.
However, much of Dr. Yerro’s findings are those that have been neglected in our country, and I, personally, was glad to see such findings.
This is all for today.

Thank you.

What is double bubble after breast augmentation?

Let’s look into one of the most common side effects of breast augmentation,
double -bubble

Today, I would like to share about one of the most common side effects in breast augmentation, double wrinkle ( double line, double bubble).

One must know the anatomy in order to understand this side effect, but this is difficult for a normal person, therefore, I would like to refer to an image below.

Normal structure of the breast

This is the normal structure of the breasts. There are some conflicts among the scholars, but the cause of the Inframammary fold is due to the Inframammary fold ligament.

But there are some with a clear Inframammary fold and one that is not so clear. If you are a patient with a clear Inframammary fold before the breast augmentation, then there is a high possibility that you would have double wrinkle after the breast augmentation.

The possibility is higher for those who have sagging breasts or large breasts.

Case of double bubble after breast augmentation

As shown in the image above, if the implant is positioned under the muscle, there is a high possibility of the double wrinkle due to the Inframammary fold ligament.

If the surgery is done above the muscle, this possibility is lower.

If you are the one who has read many articles in this blog, you might know that if the implant is positioned above the muscle, you will be able to feel it easily unless you have thick skin or the original breasts are large. There are much limitations to patients having under the muscle implant if the patients are thin.

That is why we need to conduct double plane correction.

Double plane correction leads to the implants not being felt easily and also preventing the double wrinkle.

How to prevent double bubble after breast augmentation

When the double plane surgery is conducted, most of the implant would be positioned under the pectoral muscle therefore one will not be able to feel the implant easily. And, by cutting off the inframammary ligament, one can prevent the double wrinkle.

However, this is not the only reason that leads to double wrinkle.

Capsular contracture can lead to double wrinkle, and also the position of the implant within the body can lead to double wrinkle as well.

Also, certain part of the body may become really thin during the course of the surgery, leading to double wrinkle.

It is difficult to think that the double wrinkle will be formed in each of these cases but there are various methods on how to remove the double wrinkles. Therefore, it is important that you consult the doctors in order to do so, especially those patients who are thin or have sagging breasts.

This is all for today, thank you for reading.

Q. Is it better to use the round type or the tear drop type implant?

This is not a simple question to answer.
First, one must know the difference between the round type and the tear drop type.
Another important thing to know is the status of your breasts. One must know the status of the breasts/chest to decide on the type of the implant, therefore round type might be good for a particular patient and the tear drop type might be good for the other.




Round type implant has substance that is not tight, meaning it has less cohesiveness. So the round type changes share according to the environment it is in.

Tear drop type breast implants has substance that is tight therefore strong cohesiveness. So the tear drop type implant does not lose shape according to the environment that it is in.




So the round type implant does not remain round when inside the body but much of the weight of the shape is focused downwards (low stability of the shape).
However, the tear drop type maintains its shape when it is put inside the body (high stability of the shape).


But this characteristic changes according to the different manufacturers. Some manufacturers have round type implant that is tight and tear drop type that is not.



The secureness of the implant itself is important, but the skin elasticity of the patient is important as well.

- If the patient is young and has not been pregnant before, with small breasts, then the skin (that surrounds the implant) is tight and elastic.
In such case, whatever implant used, the implant would not lose its shape. If the round type is used, then the implant would look round, and if the tear drop type is used, then it would look like a tear drop. In this case, the breast would look natural with the tear drop type.


- If the patient is young and has enough volume in breasts, then the skin would not be too tight. In such case, it would look more natural if the tear drop type is used.
- If you are old, have been pregnant, and have large breasts, the skin would be lose and less elastic.
In such case, the secureness of the implant would be important. If the less secure implant (i.e. round type) is used, the breast would not look round but sagged. The upper part of the breast would look empty and the cleavage would be positioned lower. So, one must use more secure implant.


- If the patient is young with tight skin but the distance between the nipples are wide, the upper breast volume might be less. In such case, it is more appropriate to use the round type.
- If the distance between the nipples is short or narrow, then it is better to use the implant that focuses on the bottom part of the breasts. Tear drop type would be more appropriate in such case.
- If you need a breast augmentation re-surgery and would like to use a smaller implant than the previous one, it is better to use the round type. If the pocket is big then the tear drop type implant can get in easily.
- If you have dissected your breasts because of breast cancer or any other reason, and need to reconstruct your breasts, you would need to continuously press on the skin that surrounds the implant. In this case, the round type would be more appropriate.





So the type of the implant that you need to use differs case by case, and is not a simple question to answer. First, you need to know your body and the shape of the breast then know the differences of the various types of implants, and finally, know the differences of each brands.

Today, we looked at how to choose between the round type and tear drop type implants.

Thank you for reading.
Have a great day.

Breast augmentation massage 

Massaging is to maintain the large space around the breast implant

Many surgeons believed that in order to reduce the capsular contracture, the pocket needs to be larger than the necessary size so that the massaging would be able to maintain the large space of the pocket in order to move the breast implant.

This would prevent the breast implant being adhesive, minimizing the risk of epithelium tightening.
Also, when the patients lies down, the surgeon think that it is good if the breast implant spreads outwards so that it looks natural on the person and the patient would like this.

However, having this large space leads to much problems.
1) The range of the surgery becomes larger causing that much more wounds, pain, inconvenience, and other complications while recovering.
2) At times, when a patient lies down, the implant spreads more that it is supposed to.
3) It looks better if the two breasts come together closely when standing up, but large space might lead to wider separation of the breasts.
4) Also there is no clinical data that massage leads to less capsular contracture. (It means that massaging has no effect)
5) The most important fact is that one cannot control the implant to be at the most appropriate position. The large space makes it difficult for the implant to be located properly leading to deformation of the breasts.





In other words, if the pocket space is large, then the correction must be done on the larger space than anticipated, leading to higher possibility of side effects, and lower accuracy in estimation of where the implant would be located after the correction.

It is not always the case that the breast implant has to be placed in a large pocket in order to look natural and feel good. Although the space is not large enough, the implant can feel more natural just by the movement in the area where epithelium and the tissue meet.

The large space does not minimize capsular contracture and does not lead to greater satisfaction of the patients.

Clinical results from the implant positioned exactly in the appropriate space (diameter)
 

Type of Implant	Duration	Possibility of Capsular Contracture
Natrelle textured water-drop type saline solution bag implant	7 years	0.7%
Natrelle textured water-drop type silicone gel implant	3 years	0%
Round smooth saline solution bag implant	5 years	Similar to large dissection

There is no difference in the possibility of capsular contracture between small pocket size that leads to less bleeding, and more accurate correction compared to that of large space.

Also, the small space leads to accurate firm positioning of the implant avoiding any movement of the implant and reducing the recovery period.




Today, many clinical results show that whatever type of implant is used, it is important to do the necessary and accurate amount of dissection, and not massage unless it is needed. This applies to both textured and smooth types.

Thank you for reading, have a good day.

Breast fat transfer [KIES-U Korea]

Q. Is it effective to do fat transfer for the breast augmentation?
A. Yes, it is.
Q. Is the breast fat transfer safe?
A. Yes, it has been determined that it is safe.
Q. Which is the better method? Breast fat transfer or the implant?
A. It is difficult to say which is the better of the two. It depends.





The questions above are the frequently asked questions. Today, we will talk about the fat transfer breast augmetation.

When did the fat transfer breast augmentation start?

First, let’s talk about the history. Some people would be bored with this term, “history”, but you would be surprised to know this history of beauty surgery. You will be able to know that a lot of what we do today, has already been done in the past.
 
People do not think much differently.
In 1890, somebody started a surgery that required the usage of liquid paraffin. This was the beginning of the breast augmentation surgery.

Of course, there were a lot of problems. Infection caused inflammation and necrosis. People said that none of such this happened, but you could feel lumps on the body.
This method disappeared after the 1920’s.



 
Fat transfer breast augmentation started in the 1920’s. It was not much different from what it is today. You take the fat from the abdomen or the buttocks and transfer the fat to the breast. This fat did not cause infection like the paraffin but the problem was that the fat dissolved quickly. The result looked good however, the result was not maintainable. The number of people who wanted fat transfer decreased after the 1920’s, but this number started to increase as those patients who needed reconstructive surgery after the breast cancer surgery increased.

In 1987, US Cosmetic Surgery Association objected breast fat transfer because it perceived that the scar tissue caused from the breast fat transfer and calcification caused difficulty in examining the breast cancer through x-ray. There were many doctors / surgeon who are concerned about this, therefore, agreed to the objection.

Introduction of structural fat transfer

Then in 1990’s NYU’s Dr. Sidney Coleman introduced a new idea of “Structural Fat Grafting” and stated that the newly transferred fat with good technique would lead to good grafting and longer maintaining period of the fat.

Also, Dr. Coleman proved that the fat transfer did not cause any problem in examining the breast cancer.

There was no problem with this theory and many doctors agreed to the theory as well, leading to a big expansion of fat transfer. US Cosmetic Surgery Association backed off from its objection and accepted the fat transfer as a good method. (This happened in 2007)

Dr. Coleman is perceived to be an expert in the fat transfer sector. Most of the fat transfer originated from this “Coleman technique”.

Dr. Coleman stated that each surgery requires about 300 cc of fat. If more fat is used then this would lead to necrosis and he also stated that the fat transfer is a good alternative to solving breast size and form problems.

Limitation on fat transfer
 

Then, let’s look at some limitation on Dr. Coleman’s breast fat transfer.

"For those who want very big breast, it is recommended to use the breast implants rather than doing the fat transfer". This means that the fat transfer breast augmentation is not effective to product a large volume on the breasts.

Another limitation is the body type. Those with thin body would not have enough fat to transfer to have large breasts.
Usually, we would need to transfer 250~400cc of fat on each breast for other people to visually recognize that the breast has become bigger.
So, approximately, 800cc of fat would be needed for both breasts.
In order to get 800 cc of fat, we would need 1600 cc of fat from the abdomen or thighs.
This much amount of fat is not possible from a thin person. Also, fat transfer is not a one-time procedure. It requires 2 or 3 procedures.
If you take the fat from the stomach or thigh that do not have enough fat, it would lead to uneven shape of the stomach or the thigh.



It is important that the breasts become bigger. The fat that has been transferred properly to the breast leads to better feel than any other implants that have been used and also there are no problems with shape or structure. But, if you compromise on your thigh or abdomen to make the breast look better, you might want to reconsider this.

This is the biggest limitation of breast fat transfer. This is only recommendable to those patients who have enough fat.

To whom is the fat transfer breast augmentation applicable?

If there is a limitation on the amount of fat used in one procedure, then you might need a second one.
There must be about 4 month term between the first and the second procedures. We must check if the fat transferred remains or not after 4 months.
Therefore, fat transfer requires patience.

All the surgeries that have originated from Coleman technique must be done 100% by hands. There are many advertisements that the clinics have certain tools or products that lead to better results but these tools or products have not been verified. Fat transfer takes about 4 to 5 hours therefore, requiring a lot of labor.
You might think that your breast look larger after the long surgery, but this could be a hallucination. About 50% of the fat disappears at that moment.
Most of the patients are not satisfied with the loss of volume after 4 months. Most patients give up rather than asking for the second fat transfer.



There are some requirements for those who want breast fat transfer.
First, do not expect to have large breasts
Second, you need to have the patience to do this 2~3 times for a period of 6 months or more
Third, you need to have enough fat on your body. Your weight needs to be more than a certain level.

You need to be familiar with these three points and find an appropriate method. Breast fat transfer is a very good method but this does not apply to all patients.
Thank you for reading.

There are several number of corrections / surgeries that you can do simultaneously with the transaxillary breast augmentation. We will cover a few in details.

The most common one that the patients ask about is the bra line liposuction.



When you do the liposuction in the forearm, the incision site that you take the fat out from is different from the incision point for the breast augmentation surgery.
We put in the medication that melts the fat into a spot different from the incision spot and conduct the liposuction.

 
Therefore, there is no activity near the arm when we do the breast augmentation surgery. The two are independent from one another.
But, when we do the breast augmentation, we need to sterilize the upper body including the arm and cover the parts with draping; therefore, forearm surgery is easier to conduct.

Bra line liposuction involves removing the fat that sticks out when you wear a bra.




Let’s say that you are standing straight with arm by your sides. The part where forearm and the body meet has much fat. Removing this fat is what we call arm liposuction, and removing the fat on the body is called bra line liposuction.

There are times when you have to do the bra line liposuction on both front and back of the body.
We need to turn the anesthetized patient upside down in order to do the liposuction on the back. Although there is not much fat at the back, we need to move the body leading to spending much time on this procedure.

If you were to have bra line, forearm liposuction, and also breast augmentation that require armpit incision, what would be the order of the three procedures?

The order is as below.



First is the anesthesia.
Then we turn the patient upside down to conduct bra line liposuction on the back (at times we do the liposuction on the back side of the arm as well)
Then, we turn the patient back to the normal position and conduct breast surgery.
After implant and the rest of the procedure are complete,
We continue with the bra line on the front part of the body and the forearm.
When the liposuction is complete, we stich up the incision on the armpit
We dress with the compression bandage and complete the procedure. 

If the surgery is conducted in such a way, it is completed rather quickly although it requires many steps.

Second is the removing Axillary breast tissue
This is not much different from the bra line front part liposuction. Although the conditions of the two corrections are different, the methods are the same.


Third is the axillary osmidrosis treatment
Axillary osmidrosis treatment involves minimizing the apocrin sweat gland on the armpit.
This procedure requires using suction tool. We use this to scratch the layer under the skin to suck in and damage the apocrin sweat gland.



We are damaging the apocrin sweat gland so that the sweat does not come out easily.
This treatment is simple to do therefore; it can be done simultaneously with the transaxillary breast augmentation as well. First we need to do axillary osmidrosis treatment then do the transaxillary breast augmentation.

Today, we looked at some of the other corrections or surgeries that we can do together with the transaxillary breast augmentation. By doing several procedures simultaneously, the patient can save cost and also shorten the recovery time.

However, this might be more stressful on the body, and the patient might need to be more careful with her body during the recovery time.

This is for now. Thank you very much.