Important scientific discoveries have always started with an observation. Profound scientific advancements have begun with an observation of a seemingly mundane phenomenon and testing a hypothesis formed from intuition. 

It is significant that several recent studies reported that patients who received breast augmentation surgeries using textured implants experience a higher incidence of ALCL (anaplastic large cell lymphoma). Comparing the properties of the textured shell to the smooth shell and analyzing how they can relate to the pathophysiology of ALCL can help us find important clues for preventing serious complications such as capsular contracture. In Korea, ALCL is not given enough attention and it is important that more plastic surgeons started learning about ALCL.

The first case of breast implant associated ALCL (BIA-ALCL) was reported in 1997 by John A. Keech Jr. He reported a case of anaplastic T-cell lymphoma developing in a 41-year-old woman who received a breast augmentation using saline implants (John A. Keech Jr., ANAPLASTIC T-CELL LYMPHOMA IN PROXIMITY TO A SALINE-FILLED BREAST IMPLANT. Keech, John A. Jr. D.O., F.A.C.O.I. Plastic & Reconstructive Surgery: August 1997 – Volume 100 – Issue 2 – ppg 554-555).

Previous to the above report, a dermatologic study reported three cases of cutaneous T-cell lymphoma in association with silicone breast implants. However, the association was only a conjecture and was not scientifically supported (Duvic, M.,Moore,D., Cutaneous T-cell Lymphoma in Association with Silicone Breast Implants. J. Am. Acad . Dermatol. 32:939,1995).

Keech reported that a small mass was felt in the lateral right breast of a patient who received bilateral breast augmentation with McGhan’s textured shell round type implants 4 years ago. In 1996, the mass grew larger and excisional biopsy confirmed anaplastic large cell lymphoma.

Image 1. ALCL CT image (Source: Keech’s report).

On CT imaging, lymphoma is seen surrounding the right breast implant and scattered axillary lymph nodes can be observed (Image 1). The patient received chemotherapy and achieved complete resolution. Radiation therapy was carried out and complete clinical recovery was achieved. Implants were not removed and did not obstruct chemotherapy or radiation therapy. The aesthetic appearance was not compromised after cancer treatment. However, the association between saline implants and non-hodgkin’s lymphoma could not be clarified with this single case.

At the time of publication of this study, there was a growing concern over a possible association between silicone breast implants and autoimmune diseases and breast cancer in the US. The academia was too preoccupied with in this concern that the rare association between silicone breast implants and ALCL seemed much less important at the time. 

However, other reports of ALCL developing after breast augmentation with silicone implants followed. In 2011, FDA issued an announcement recognizing breast implant associated ALCL. However, the association was not scientifically confirmed. 

The science of plastic surgery is rapidly changing. The changes are so fast-paced that I started comparing today’s trends to last month’s, not last year’s. Things that were thought impossible before are becoming reality before our eyes. In such a volatile environment, we are pushing on without knowing where we are going. However, we still need to prepare for the future and that starts with reviewing the past. Dr. Joo-hyuck Lee of KIES-U Plastic Surgery Korea leads a new series on the present and future of plastic surgery.

What is behind the recent popularity of microtextured implants?

I am seeing more and more patients asking about microtextured implants for breast augmentation. Sebbin or BellaGel products are some of the most popular. Many doctors may still be unfamiliar with the term ‘microtextured implants.’ In the past, Allergan’s Biocell was categorized as macrotextured implants and Mentor’s Siltex as microtextured implants [Derby, Brian M.; Textured Silicone Breast Implant Use in Primary Augmentation: Core Data Update and Review, PRS Jan2015;135(1), 113-124]. However, such categorization was used within the academia and was not widely used by the public.

The current popularity of the term microtexture does not accurately reflect the scientific concepts and is being rampantly used as a marketing keyword by distributors and even some plastic surgeons.

The microtextured implants of Sebbin, a French manufacturer, have become very popular in Korea. Advertisements claiming they offer a natural texture with a lower risk of capsular contracture have successfully won over the public. And naturally, Sebbin’s implants have become very hard to come by in Korea. Catching on to this new trend, BNS Med quickly developed a microtextured implant line called BellaGel and entered the Korean market.

These microtextured implants have micro bumps on the surface that are only 30-40 micrometers wide. This creates a very smooth surface. What is the reason for designing the bumps to be that small?

Sebbin’s product catalog does not mention “natural feeling” anywhere to describe their microtextured implants. 

1. Ease of insertion and less friction on the tissues.
2. Minimizing the rate of capsular contracture.

It does, however, explain that the implants are “textured and are not prone to capsular contracture. The microtextured surface makes it easy to insert them.” However, there is no clinical or scientific data supporting this claim. It is surprising that many people have accepted as a fact that microtextured implants are safe from capsular contracture due to aggressive marketing.

 Any surgeon specializing breast augmentation would know that the resistance of textured implants to capsular contracture is irrelevant in Korean patients who mostly go through submuscular placement. When McGhan first developed the textured shell, the primary goal was to promote tissue ingrowth and prevent capsular contracture. However, there is a growing consensus that they failed in achieving this goal. 

Early on, Tebbetts already explained that the textured shell is not effective in preventing capsular contracture.¹ He found that some plastic surgeons mistakenly think that tissue adherence of the textured shell is important for preventing capsular contracture. However, FDA’s PMA study (comparing textured and smooth saline implants) already found there is no difference in the incidence of capsular contracture between the two types. 

Image 1. Source: S. Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

Image 2. Source: S. Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

Image 3.

Image 4. Source: S.Barr, BSc, Current Implant Surface technology: An Examination of Their Nanostructure and Their Influence on Fibroblast Alignment and Biocompatibility,; Open Access Journal of Plastic Surgery, 2016:9:198-217.

Image 5.

Table 1. The 14 point plan for preventing capsular contracture. It cannot be said that all surgeons agree with this but various peer reviews have mentioned similar measures for preventing capsular contracture in the past few years (Source: William P. Adams, Jr., Macrotextured Breast Implants with Defined Steps to Minimize Bacterial Contamination Around the Device: Experience in 42,000 Implants., Plast. Reconstr. Surg. 140:427,2017).

Things to consider when conducting inframammary fold incision

In the first surgery, I tend to select axillary / inframammary / areola incision in ratio of 4:4:2. I tend to hear some weird informations when I talk to the patients. Some tell me that “inframammary fold incision is only for the beginning surgeons because it is a basic skill.”



I thought that this was some nonsense when hearing it from a perspective of a well experienced surgeon. This is why today, I would like to share about the things to consider when conducting inframammary incision.

Inframammary fold incision is not something good for beginners to perform.

All surgeries have some things that are easy and not, but we cannot say that appendectomy and cesarean or any other operations are easy. Nothing are as simple as you say.

The problem with the inframammary fold incision is the location of the incision.



Desquamation and putting in the implant are enough for areola or umbilical incisions. But for inframammary fold incision, first we need to estimate where the inframammary fold is and then conduct the incision.

So if the incision itself is done is the wrong place, there is no turning back. When we design the surgery, we need to exactly estimate the correct incision spot. This requires much experience.

This is not something that can be done lightly. There are many different variables for different patients such as the area of the implant and the other is how elastic the skin is.



The area of the implant can be found in the information provided by the manufacturers and we refer to that when drawing out the location where the implant would be put in. The problem here is that when the implant goes in into the breast, the skin gets pulled and becomes tight causing the areola/nipple to shift from the original location. So we need to foresee this change and know where the areola/nipple to shift to in order to draw out the implant housing position.

There is another variable. It is the distance between the nipple and the inframammary fold. The skin in this area extends in different degree from one person to another. So when we design the procedure, the assistant has to pull the breast skin towards the collar bone and measure the distance from the nipple to see where the new position of the inframammary fold would be.

In most of the time, the doctor uses formula of implant height and others in order to find out the distance between the areola and the new inframammary fold. The number would increase for aged patients who have loose skin and decrease for those young patients who have tight skin.

It also becomes difficult if the location of areola and the breast mound are different. If the right breast is rather higher than the left, then the implant pocket of the left breast would have to be made below the pectoralis muscle and there should be dual plane on the right breasts so that the right breast is pulled up more with the usage of the implant. We consider this point and design the procedure so that the left and right breasts are at the same height level after the breast augmentation.



It becomes a little easier if the left breast if lower than the right but it is larger than the right breast. If we put in larger sized implant on the left breast than the implant would pull down making the inframammary fold of both breasts at the same level.

Suture is also important in inframammary fold incision. It is different to that of axillary and umbilical incision. The incision is done on the bottom part of the breast and this has to hold the implant. If there is some inflammation caused or the stitch loosens then the whole surgery must be conducted again.

Not only is stitching necessary, but we need to maintain the capsule and others as much as possible along with precise desquamation. We need to suture all the structures in the body in perfect shape. The surgeon needs to be careful of all these factors in order to avoid any complications that might be caused.

Inframammary fold incision can be applied to any shape of breasts and any situations with many different techniques to come up with best possible result. But, one must be more careful about the things that you do not need to be careful of in other incision methods in order to avoid any complications and problems.

This is why inexperienced doctor cannot perform with good result.

I hope the contents have helped you today.
Thank you for reading and have a great day.

How to prevent bleeding during breast augmentation

Surgery is an act of open reduction in order to treat the patient. Internal medicine does not involve any bleeding but surgery does. This is how we differentiate the two.



This is why bleeding is always associated with surgery. If there is no blood, this is not a surgery, it would be physical therapy, internal treatment, etc.There is some contraction to 'no bleeding' in a surgery. It is rather important to think about 'how to minimize bleeding' in a surgery...Breast augmentation requires  using of implant and in order to put in this implant, we need to conduct incision. Bleeding is caused in this incision as well. But breast augmentation does not lead to much bleeding. Breast augmentation, therefore, does not cause much bleeding in its procedure.



But then, there are many doctors who fall into this trap.
There is not much bleeding during the surgery, but the patients come back to the hospital because of the much bleeding caused.
Implant is not a part of your body, and it plays independently inside the body. if there is bleeding near the body part, the body tends to suck in the blood back in. However, if there is bleeding near the implant, the implant cannot do so. Such blood gathers and solidifies at one side of the implant.

Blood gathers on the bottom side forming hematoma that then pushed the implant upwards.


All the doctors who conducted breast augmentation have experienced this. This is why they all contemplate about how to stop bleeding and forming of hematoma after the breast augmentation.

Some doctors spray blood coagulant around the implant and close up the incision. Some also spray medication that contracts the blood vessels. There is not just one method on how to avoid bleeding. The doctor must consider the bleeding problem before the surgery starts.

Most young people have elastic muscle and fascia tissue cells. The blood wall that penetrates the muscle is also elastic. This is why it does not get damaged easily during the surgery.  But older people have less elastic muscle and blood wall. Little damage on these parts in order to gain more visibility during the surgery, leads to bleeding. The blood flows little by little and this makes it more difficult to stop the bleeding. But, if there is bleeding in elastic cells, it is quicker to stop this bleeding and also the doctor can recognize the bleeding rather quickly which makes the treatment quicker as well.



We need to be more careful of those with less elastic tissue cells and also be more careful in pressurizing for bleeding. There are certain know-hows that come with experience to minimize the bleeding. Also the relationship between the volume of the implant and the size of the pocket is important. If the pocket is larger than the implant volume, there would be less pressure effect providing more space for the hermatoma to form. The ideal match would be the pocket size equaling the implant volume. Pressure bandage or pressure bra must be used after the breast augmentation and there must be pressure from all sides.


If there is more pressure on one spot than the other, the blood will gather on the spot with less pressure. Hemovac drain cannot stop the bleeding. It only helps to dispose the blood if the bleeding occurs. If the blood vessels look weak and if there is a chance of delayed bleeding, then the doctor should place the hemovac drain. There are some advertising on the internet that reads we do not use hemovac drain because we are skillful. This basically is neglecting basic principle of open reduction, surgery. It is not good to use hemovac drain every time, but it is a problem if you don't use it when you have to.

All patients feel fear when facing a surgery. It is only natural to feel scared that something is cutting through their bodies. (It is scary to open your mouth in the dentist also) There are other fears that build up as well such as "What if I don't wake up after the anesthesia? What if things go wrong during the surgery? What if it hurts a lot?"  Bleeding cannot be avoided in a surgery therefore treating that bleeding is very important in a surgery in order to avoid all the problems. Bleeding causes inflammation, inconvenience and consumes more time in healing. However, there is no surgery that can avoid bleeding but we can minimize it as much as possible.

This is all for today. Thank you very much.

Conditions for resulting in successful breast surgery - Plastic surgery Korea KIES-U

I have read a newspaper article regarding underwear company that released statistics on underwear sizes for women that came up through a project.
It was unexpected that there were more Korean women in the 20's who had size C cup than A cup.
.

This new statistics is radically different than the one from the past. Also the fact that those in 20's had larger cup size compared to older adults had led to a conclusion that the breast augmentation surgery has become popular.

Breast augmentation has become this popular but there are studies on the satisfaction, recorrection, and complications that can arise from entities in US and EU. It is difficult to find such statistics in our country but we have identical breast augmentation methods to that of US and EU therefore, I think that the problems and complications that arise in the two parts of the world can also be applied to those patients in Korea.

The satisfaction rate after the breast augmentation is rather high. People are satisfied with the results but there are some claims due to minor problems.

Most of the complaints are about the size, asymmetric breasts, and sense of touch. It is mostly satisfactory, but there are some things that could have been better. Such findings are shown a lot in cosmetic surgery magazines and they can be found at our country as well.

The most common complication is not the capsular contracture but the mispositioning of the implant, and being able to feel the implant. I would like to share what things we can consider in order to have non-regretful breast augmentation surgery that leads to pretty looking but no pain of whatsoever.



First, you need to know your body.
You need to have interest in your body and try to find accurate information about it. Such people are on 1 out of 10. Other 9 of those patients are more aware of the advertising products. This can be found easily with younger women. The shape of the breast, bird chest, etc meaning your bone structure must be considered. If you have center of the chest sticking out, you would need to think that the breasts might look too much separated apart when the implants get in. If you have a bone sticking out at the top part of the breasts, then breast augmentation may lead to upper block sticking out. In such case, you might have to consider anatomical implant which not too large size in order to minimize any complaints that you have after the augmentation.



Subcutaneous fat i.e. the thickness of the soft tissue. ; If you have much fat on the upper body, your body lines would not be clearly visible after the surgery. There are complaints related with this also. If you have much fat in the upper body, your soft tissue is thick therefore, when the implant is put in, there is a less chance of rippling and you being able to feel it. So it might be better if you use larger sized implants.

In opposite, if you do not have much fat in the upper body, you would have great body line after the breast augmentation but you could also suffer from rippling, being able to touch the implant, unnatural looking breast line and other problems if you use large sized implants. If you are one of such, then it might be better to get rid of that greed for larger size.



Second, you need to be clear about your goals.
There are many patients who do not know why they want to get the breast augmentation done. It is rather meaningless if you just think that making them bigger is good enough. There are certain values that each patient wants from the breast augmentation. At times, these values coincide one another.

Perfect shape
Natural feeling
Large size
Correcting sagginess
Correcting structure
Correcting shape

 

These are some goals that you might want to solve. You need to prioritize the list and let the doctor know about it. It is important to share such values wanted to the doctor.

Third, you should select an implant that has been verified.
It is difficult to select an implant from variety of the products that we have in Korea today. About 6 years ago, say in 2011, there were only 2 products that we could select from. There are about 8 manufacturers now that is leading to some problems. In order for the doctors to recommend which implant is good and say which is not, we need to use the products for about 5~10 years.



But in reality it is different. "This product was released last year. It is new." Such statements are worrisome.

When a new car comes out, people go on a test drive and wait for the reviews to come out. Saying that something is new for a product that is to be put into your body, cannot be an advertisement. This fact should be something that disqualifies the product from your choice. It only seems that the new product should be tested on your body. The doctors can only recommend those implants that have been in the market over time with much researches and results published. If you narrow down the choices in such a way, there isn't many that you can choose from.

Fourth, you need to trust the medical personnel and depend on them with the surgery.
It is important that you ask difficult questions, share ideas and question about the treatment to the doctors. There are some accurate and specific facts that the patients must be aware of as the overall procedure takes place. Also, it is not wise to be 100% reliant on the doctor. However, you should not leave a perception that you "do not trust the doctor." It is because the doctor will take that he/she must take all the blame for even a very minor problem therefore would think their way out of it from the planning stages.

If you want the best possible result for the patient, there are many things to make decisions on before the surgery and at times the doctor needs to be forceful about those decisions. Therefore if the  patient does not trust the doctor, the doctor would self-defend as much as possible.

"I told you that this method would have been better. Why didn't this patient agree to my decision?" can be a statement made by the doctor.

In oppose, "This patient trusted the medical personnel and also communicated a lot. So, I did my best to come up with the best result possible." The medical personnel with such thought would perform better on the patient.

Today, I shared about few things that you could consider before  breast augmentation. Hope the details have helped you.

Thanks a lot.

Does fat grafting have any influence on breast cancer?

If you had to remove breast tissue due to breast cancer, then you would need to have fat grafting to cover up the loss caused due to the incision of the breast tissue. This is a widely applied approach.



Fat grafting requires injecting half-liquid substance into the body, and is very simple and quick. There is no need for incision which also means that there is less chance of complications. Also, there is not much scar therefore it is widely used.
However, there was a report stating that it might lead to formation of cancer cells based on tests conducted on animals (mostly on scientific magazines).

In humans, fatty tissue cells or adipose tissue cells practically injected into the body. Even if you hear that the procedure is stem cell transplantation, you don't use pure stem cells but  extract and inject adult stem cells. However, it is impossible to conclude that the result of injection of fatty tissue in the animal experiments is directly linked with humans as the animal experiments used is stem cell transplantation..

Anyway, we need to study further on whether the fat grafted actually has any influence on the cancer redevelopment if the fat was used to replace the loss of tissue cells in breast cancer surgery.



Dr. Jean Yves Petit from Europe Cancer Center in Milan, Italy reported on the “Fat grafting after invasive breast cancer, Case control experiment” on the latest edition of Plastic and reconstructive surgery.

This experiment was conducted on 322 patients who received fat grafting as breast reconstruction surgery from 2006 ~ 2013. Also there might be some differences on how much cancers cells are left in the body in those patients who got complete incision compared to those who got partial incision, therefore, the experiments looked at the difference between the two groups as well.

The monitoring period on the average was about 4.6 years after the fat grafting. There was no differences in the recurrence in the vicinity of the previous lesion, occurrence of the opposite phase, or occurrence of the axillary and lymph nodes in the event of the transfer.

There was absolutely no evidence that the fat grafting used for reconstruction had any negative influence of the recurrence of the breast cancer therefore, Dr. Petit and others concluded and reported that fat grafting is a safe method for breast cancer reconstruction.

Fat grafting can be applied on any part of the body. It can be applied on the breasts as well.

Breast cancer incidence rate is rather high in US and EU therefore it is a threatening disease to women. It is also the most common malignant disease on women therefore I think that hospitals in our country also needs to actively conduct studies on it.

Thank you for reading. Have a great day.

Today, I would like to share about breast implant associated Anaplastic Large Cell Lymphoma (ALCL).

Many doctors, WHO and FDA have continued to study and state problems on the correlation between breast implant and ALCL.



In FDA’s report on March 22nd, it concentrated in showing significant understanding of textured implant having high correlation to side effects compared to smooth type implant.

There were many who asked if they should remove the textured implant that they used after reading this report.

But first, let’s talk about how common or rare this ALCL is.

The most knowledgeable journal in cosmetic surgery is PRS journal. In the January edition, Professor Miranda and 8 others from Texas Anderson Cancer Center published that the prevalence rate of ALCL from implant was 3 out of 100 million (0.0000030%). The prevalence rate on textured implant is 2.03 out of 1 million people (0.000203%).



The lifetime prevalence rate is 33 out of 1 million (0.00330%). This is a very rare disease.



Let’s see how dangerous ALCL is. Anderson Cancer Center report says that the survival rate within 5 years is 93~89%. This is pretty good rate compared to other severe cancers. It is defined as curable disease as well.

All reports show that the textured implant has higher prevalence rate compared to other types but this texturing method on the implant is different from one implant manufacturer to another.

The texturing process involves the usage of salt loss crystal on implant (Allergan, Cervin, etc) or negative imprint stamping on implant (Mentor). Almost all ALCL cases are found on the salt loss crystal processing.

But, we do not have enough data to conclude on this. It is because the disease is very, very, very rare. There is no way to get related information easily.

Here is the link of March 22nd FDA report and guideline. I would like to summarize the important contents.



The 231 patient records that FDA collected were reported in MDA. These records are important but unreliable and inaccurate.

Because it has generally only been identified in patients with late onset of symptoms such as pain, lumps, swelling, or asymmetry, prophylactic breast implant removal in patients without symptoms or other abnormality is not recommended.

And, they recommended routine care and support as usual for treatment.

One recommendation to the patient is,

If you have breast implants, there is no need to change your routine medical care and follow-up. BIA-ALCL is rare.

There is not one case report of BIA - ALCL in Korea.

Breast implants are not perfect, they have various problems.

But if there are more to gain from them than problems raised, we tend to use them. There is a chance of getting into an accident when driving a car, but no matter what, we do drive our cars. This is the same in some aspect.

But, I really do think that we do not need to have much fear about ALCL.

This is all for today. Have a great day. Thank you.

Possibility of breast implant rupture vs MRI, is it necessary?

KIES-U Breast augmentation Korea

The US FDA approved silicone gel implant sales in 2006 for the purpose of breast correction and augmentation. It also provided guideline that there should be MRI test once every 2 years starting from the third year of breast augmentation.


There is no change to this guideline.
Of course such is necessary, if there is a damage to the implant and the patient needs some treatment. but there are those who oppose this.



Today, I would like to introduce a data of an experiment that Teresa Wang M.D and other from Sloan-Kettering Cancer center in NY conducted with 383 patients.

There was a tracking study in this hospital for 10 years starting from 1999 on the patients with correction surgery. MRI was tested and data was gathered to see if the implants have been ruptured or not. 963 MRI were conducted over 53 months (4 years and 5 months).

The result showed that the damage rate was 1.9% through MRI and the false positive rate is 8.4%.

The statistical findings showed that the rupture rate of implant within the 3~5 years was 0% and 2.3% for 7 years. 15.1% for within 10 years.

The rupture rate of the implants is very low therefore all the high costs and time needed by the patients for MRI test (in the first 5~6 years) are a burden. Therefore, the authors conclude with a question of whether the MRI inspection is really necessary.


There are opinions that MRI is unnecessary for those patients without any complications for 7 years after breast augmentation.

Since the first day that the cohesive gel has been imported until now, I have never seen a patient taking a MRI test because she was worried about the implant rupture.



It is not saying that these patients are not interested in their bodies. It is just that they did not have any problems or discomforts therefore this expensive MRI (MRI is not reimbursed and costs about $500 or more) is not tested by many.

Also there are other findings, that the silicone when leaked from the implant, does not get dissolved within the body and it does not cause any complication or illness.
Is this guideline of getting tests once every 2 years really meaningful?

FDA should remove or edit this guideline not only because of this finding from Teresa Wang.

I think that it is more realistic to consult with the doctor 10 years after the breast augmentation. If there is any problem, then one can use ultrasonic test that is less costly to find out the problem. I think this is more realistic and better scientifically for the patient compared to the MRI.



Thank you for reading. Have a great day.




Breast augmentation Korea KIES-U | www.kiesu.com | +82-2-3452-0202 
 

Breast augmentation Korea issues 

There was a news from SBS stating that the silicone from a collapsed implant flew into a baby’s mouth while the mother was breastfeeding her baby.
There are many of those who are concerned and curious about this when planning on breast augmentation.



Journalism is always different from science. “Accusing the fact” is journalism and this is also its role, but there is no science to it. There is no one scientific sentence that catches your attention. One needs to see many numbers and contemplate on it to get a step closer to the scientific truth. So, I get discomforts whenever I see such news article.

There are many feeds on naver under this article. “You should have removed the silicone before giving birth.” “How can you feed your child a silicone?” “All of you should be careful if you had breast augmentation.. this is awful.” “Why do something on your body, when you should not do anything on it.” About 80% of the contents were about criticizing the mother.’

The reason why I talk about the scientific truth is because, if you know the reality, then you cannot criticize the mother.


There are many aged, old male users who criticized the mother on the internet and these users are writing some cruel words to the victim.

It is like when I am driving my car to work, I stop at the light for a min or so. A truck driven by someone who is really sleepy crashes into the back of my car and I get hurt. People them criticize me by saying “why not take public transportation to work and get your body spoilt?” This is very absurd.

I am sure that the reporter did not want something like this to be the outcome. But the result turned away as such because the article was focused on the implant, not the doctor or the hospital where the surgery took place.



One of the most common surgeries held around the world today is the breast augmentation. A lot of breast augmentations are done in US, Europe and in South America. There has never been a case or a journal or a content in a textbook that describes on the silicone gel from the implant leaking into the baby through breast feeding. This is the very first case in the world.

Then one must talk about the surgeon and the hospital. But the article only concentrates on the implant and this somehow leads to the criticizing of the mother. This is sad.
When the reporter writes such an article, he/she wants to attract the attention of the readers. There has always been some activity that involves putting in a substance into the body in medical history. If a patient got a surgery that led to complications, such simple article would not be attractive enough. But if it involves something that is real common such as the implant, people would be talking about the problems that arise and this story would be big in the news.

Let’s look at the new again. If the substances in the implant are to go into the baby’s mouth, there are 3 certain conditions related to it.

1. The implant shell must be damaged
2. The silicones must leak outside the capsule
3. Silicone must dissolve into the liquid in the breast

Condition 1 is likely to happen. The statistics from Chosun Ilbo (3600 complication, 66% damaged within 4 years) is not accurate so it is not this common.

In order for condition 2 to happen, the implant must be damaged before the capsule is formed. It takes about 2~3 weeks for the capsule to be formed on a normal person, therefore it is highly unlikely that the damaged implant has been used during the surgery.
The implant gets damaged due to the purpose act of the inexperienced surgeon who wants to put in the implant no matter what.

The silicone from the damage implant disperses everywhere in order for it to penetrate into the liquid in the breast. The silicone cannot penetrate once the capsule is formed.

There is an another problem. Silicone gel is a combination of large molecules. Each one of the molecule that form the silicone is large. If this is to penetrate and leak from the breast, the substance must enter the cell. Not just one or two cells but a lot of the cells in order to see the light.

This is impossible if you study the cell biology.
In 1993, FDA opened a commission to study what influence the silicone from the implant has on the body (cancer, metabolism, etc). The commission warned the manufacturers to stop the sales and required clinical datas. (This has been stopped since 2006)



In 1999, well know scholars of biology and medication/toxin gathered to publish a journal named “Safety of silicone breast implants”. We can conclude that this book proves the safety of silicone implants.  

(The value of this book is that the authors are not plastic surgery specialists. Those who do not have any interest in selling breast implants have gathered to publish this book therefore the contents are more reliable.)



"It is difficult for silicone to directly disperse into the breast cells. There is no such happening on the women who breast feeds as well.." This is stated in pg 11 of this book. But, the first case came out in our country.

In 1996, Lugowski and others compared the density of silicone of a person with implant and a person without one. The density of silicone on a person with the implant was 0.0637ug/ml, and the density of a person without the implant was 0.061. There is no significant difference between the two.

Same results followed in number of experiments conducted later. The density of silicone does not increase due to the silicone breast implants. There is no difference between a person with breast augmentation and those without one.

There are millions of experiments with same results.

Let’s refer to a more recent experiment.

In 2003, there was an essay written by Holmich M.D and others. It states, “there is no absolute difference in the bodies of the women with normal implant and collapsed implant in regards to disease, complications, and protein.



It means that although the implant collapses, there is no influence on the body, and you do not get any illness. There are many experiments supporting this as well.

"Damaged implants are relatively harmless, and they do not lead to any other further damage even with time."

There is only one reason for what happened with the incident report on the 12th. In order for this to happen, the cells must be damaged a lot leading to trauma. Also, the implant should be damaged when inserting.
So basically this says that there is a path formed for the silicone to go into the cells.
It is like a fistula being formed. Originally there should not be a path, but the path is formed somehow.

I don’t think there is a possibility that the path is formed automatically and the gel within the capsule came out through that path into the breasts.



All the experiments until today had the hypothesis that the silicone from the implant breaks up, penetrates into the body cells and the blood, travelling throughout the body and reaching the breast cells, and finally coming out through the mother’s milk. The silicone molecule has been tested for density to see how different it is from the normal one.

But the new yesterday said that the silicone that came out could be seen easily visually. This is not what we have been known about. This is not possible unless there is a highway through the silicone and the nipple.

This is repeating itself, but I would like to answer the question what many ask over and over again.

"There is no evidence that there is more silicone in the body of a mother with breast augmentation and that without when breastfeeding.."  It is the same. There are so many evidences and this is the scientific truth. Many scientists have proved this and this is what we can call fact.

SBS news report can be judged as medical accident.

FDA reevaluating the safety of the implant, canceling the permit if there is a problem, enforcing much more on the regulation… are distracting the audience from the fact and getting the mother criticized.

The hands of the surgeon are important.
Not the product.

The patient trusts the doctor, not the product.

I would like to share one last thing before I finish off.

What happens if you eat the silicone. I heard that if the silicones gets in the body, it cannot be removed. This is a big thing. What should I do?

Is silicone really a toxic?

Is silicone really bad for your body if it gets into the body once or even repeatedly?

Semple and others studied on the density of the silicone on the women with implants and those without. The result was 0.0555 ug/ml, and  0.0511.

This is really a little amount and one that cannot be found with basic equipments.

The silicone in the milk for the babies is 0.7. The formula for all those products for the babies in the marts are 4.40.

I was raised with not only mother’s milk but by milk powder and formula as well. There is a very rare number of babies that grow up with just the mother’s milk. What I want to say is that, there are many processed food with silicone when being produced. There are silicone in cow fodder, and even in bubble inhibitor of milk as well. There are silicone in milk package also.

In this industrialized age, we are exposed to silicone in various ways. (1986. Adler and Berlyne)

I am sure that all of you know what the baby milk bottle and etc are made out of.

It is silicone.

Methyl simethicone, nylicon are treatment for baby intestine, stomach behavior. These are silicone as well.
Let me provide you with a summary.

1. Silicone accident was not caused because of its safety but can be looked as a medical accident.

2. There have been many experiments on the silicone gel implant in many countries for many years. The common result in all those experiments is that the “silicone implant is safe”. We must trust this.

3. There is no difference in the density of silicone in the body of the woman with implant, and those without an implant in the breast milk. (This is a fact)




I am quite upset that the news is all about “can silicone be trusted?”
If there is some proper reference from a specialist, there would be more focus on medical accident.
That mother should not be criticized but be cared for and we should pray that the baby stays healthy.

This is all for today. Thank you.

Q&A on Breast Augmentation KIES-U Plastic surgery Korea

There are many of those who think much about where the incision should be when getting the breast augmentation.

Some say that this is confusing because different clinics recommend different parts.



The doctor should be the decision maker but I would like to share an algorithm that you can use in deciding the incision area.

First, it is important to have good visual when conducting the breast augmentation therefore you need to choose a spot that gives you the best visual. The visual coverage is best with inframammary fold 90%, areola 70%, armpit less than 10%, and belly button 0%.

The visual coverage is the most important factor in leading to the best outcome. Therefore, this should be the first considering factor.

So, usually inframammary fold is the most popular spot of incision for breast augmentation but the problem with this is the scar caused. Please refer to the images below. If you are case 1, then it is difficult to make the inframammary fold as the incision spot. So, we tend to choose another spot for incision because of the scar.
Please refer to the images again.


Second, if you have a wide areola, then it would be best spot for incision. The most commonly used implant size in our country is in the late 200’s. Such implant with cohesive gel would require an areola with a diameter of at least 3.5cm for incision. Areola for incision is also good if you want to correct sagging breasts or want to reduce the size of the areola.

Third, is the armpit. If the inframammary fold is not appropriate and if your areola is too small then armpit would be the best choice. The armpit incision and breast augmentation is at times difficult and can lead to unwanted result. This happens if you breast is pointed outward or if you have sagging breasts. If you also need breast correction together with breast augmentation, armpit incision might not be a good choice for you.

Fourth, the belly button incision is recommended if you decide not to use the cohesive gel for whatever the reason is. Belly button incision has minimum pain and is located away from the breast therefore the scar is difficult to be noticed. The only disadvantage is that you can only use saline bag type implant for the belly button incision.

But if the patient is aged or the skin is less elastic due to number of pregnancies then the scar would not be a problem for her. Inframammary fold incision would be recommend for such patient.


If there is a particular request from the patient, then we tend to follow that request. If you are a bikini model and do not want any scar around the armpit, then we do not recommend armpit incision. If you are a patient who do not want the scar to be shown when lying down, then we tend to go for the armpit or belly button incision.

If you enjoy wearing crop-top, or have piercings on the belly button, we would avoid this spot for incision. We need to find another approach in such case.

Below is the algorithm that I have made.





Things such as the body and breast structure, age, pregnancy, patient’s demand, correction, etc are all considered for the incision spot.
This is not something that is easy to decide. You must also consult with a specialist.

This is all for today. Thanks a lot.