There was a person who asked about the seroma that could arise after the breast surgery using an implant. I would like to share about this today.

If you put blood sample in the test tube and leave it for a while, the liquid rises and the blood cell stay at the bottom. The clean serum gathered together at a particular place is called seroma.

Small blood vessel damaged leaks plasma and cases seroma. Infection can cause seroma as well.



A hermatoma containing red blood cell is wrong and an abscess containing pus is different.



Seroma is formed due to some kind of trauma on the body. It gets sucked into the body as time passes. This may take days or even weeks. Calcification can be cause after the seroma disappears.

This happens a lot during the breast surgery (mastectomy), abdominal surgery, and reconstruction.

More the difficult the surgery gets, there is a higher possibility of seroma and the more larger the seroma is, it takes longer time for it to disappear.

Also, there is a possibility of second infection as well. Such a large seroma can take years to go away.



In 2012, there was a plastic and reconstructive surgery journal article written by Spear and others. They analyzed 28 cases of late seroma after breast implant. The seroma was formed at an average of 4.7 years after the surgery and most of the cases used biocell textured implant, Allergan’s textured implant.
One can remove the epithelium or replace the implant in order to cure this. There are cases where only the seroma was removed as well. Some used antibiotics for the cure.



96% were found to be cured properly, however we do not know the cause. There were no cases of infection or malignant altercation in the journal that Spear and other wrote.
The first scholar to mention about seroma in breast augmentation was Elizabeth Findlay. Dr. Findlay reported that all cases of seroma were found with the usage of Allergan’s textured implants. The reason for this is that all Allergan’s textured implants have a surface of Biocell that have strong friction and this causes trauma damaging the blood vessel - causing seroma. The seroma found by Dr. Findlay was found 6 months after the surgery (This is why the term ‘delayed’ was used).

From my experience, I think that it is more common to find seroma right after the surgery lasting for 6 months, which is different from what Dr. Findlay found out.
We, at our country, use Polytech, Mentor, Allergan, Silimed, Cervin, etc implants and I don’t think that the seroma formation only applies to Allergan textured implants. There were such cases found in Polytech and Mentor implants as well. Smooth round type implants had the same problem also. There weren’t any cases found in Silimed implants as of yet.


So, I think that instead of calling this “late seroma”, it should be called “Nonabsorbing seroma”.

If the pocket for the implant is larger than the implant itself, the contract-union of the implant and the pocket is not be conducted properly causing much space in between. There would be liquid formed in this space that do not get sucked in for a long period of time leading to the seroma formation.

A certain type of implant from a certain brand do not fit in with the size of an average Korean woman’s rib size therefore there can be a mismatch and empty space between the implant and the body. I think that this could also be a cause of seroma formation. Of course, there needs to be more cases gathered and experiments conducted to know about this with certainty.

Today, I share content on the complications that can follow after breast correction.
I hope that this content has helped you enough.
Thank you for reading and have a good day.

Q. How is the breast cosmetic surgery for those in 50’s ~ 60’s different?

A. It is difficult to say that those in 50’s~60’s are old these days. Our society is becoming elderly and there are many who are in the 90’s.

Today, I would like to share about the breast cosmetic surgery for those in 50’s ~ 60’s that many are interested about. There aren’t much information in this area even on the internet.

KIES-U Plastic surgery Korea

It is difficult to say that there are much difference for those in the 50’s~60’s and those in 2-‘s~30’s. But, as a doctor, I need to be aware of few things.

1. Thinning and loss of skin, breast elasticity 

As the skin gets older, it loses elasticity related components such as elastane. Also the skin becomes thinner leading to loss of volume in subcutaneous fat.

Therefore, the main focus of the breast cosmetic surgery is if one can regain the breast elasticity with the implant whether it is your first time getting a breast surgery at an old age, or you lost volume in the original implants due to old age.

It is same as saying that you want to wear a dress that is many decades old. But, this dress stretches down a lot. In order to make it more fixable, you take it to a tailor to make the dress fitting to you.

However, the first breast augmentation is not like tailoring the dress but adding more fat to your body to make the clothes more fitting.

For such reasons, the implant needs to provide enough elasticity and stickiness.
The implant need to provide anti-aging effect on the breast skin.

2. Sagging breast and change in the location of the nipples

The skin tissue becomes thinner as you age. This can be easily noticed on the breasts.
 
Cohesive gel implants are half-solid, therefore has a lot of liquidity. So, if you stand up the implant, the gel centers at the bottom making the upper part wrinkly.

The less wrinkly the upper part is, it fills up the volume better on the upper breast. We call such product to be stabled in shaped, therefore, form-stable implant. If you use an implant that is not form-stable, then the upper part of the breast would lose volume and the implant sagging down. You will not be able to fix the shape of your breasts.

The 1 and 2 contents above are to summarize that the implant used in the breast augmentation is to fill up the volume in the upper part of the breasts and to strengthen the breast elasticity.


3. Weakening of cardio pulmonary function and other various organs

As you get old, you might have weakened heart or any other organs due to the general anesthesia that is required for the breast augmentation.
 
If you have a severe respiratory problem, you might not be able to get the breast augmentation due to breathing problem.

If you have liver problems, then you will not be able to take anti-biotics, and other anesthesia medication because your body have not be able to respond normally.
So it you have decided to get the breast augmentation, then you need to get examination to determine that you can resist the anesthesia and other medication and have a healthy body.

If you have diabetes and are controlling your blood sugar level properly, there would be no problem with getting the breast augmentation.

Those with asthma would need to be at a good form so that they do not get asthma attack in order to get the breast augmentation.

If you have a high blood pressure but your body is healthy and the blood pressure is controllable, you can get the breast augmentation.


4. Complications

There is no evidence that aged patients are more likely to suffer capsular contracture or inflammation.

In theory, there are few side effects or complications that aged patients suffer more than the younger ones; able to feel the implant, able to see the border lines of the implant, and thinning of the breast skin, etc

Most of those patients in their 50’s ask me if they can get the breast augmentation at an old age that their husbands might criticize them, and they are shy that they have come to see the doctor for the breast augmentation.

However, I think that the age is not a problem when it comes to a woman wanting to look more beautiful. It is wrong to think that those in 20’s can use cosmetics and get beauty surgeries but those in 70’s cannot.

Today, we looked at the problems and concerns of those patients in 50’s~60’s wanting to get breast augmentation.
Thank you for reading.

Q. What is the name of the surgery that I am getting? Is it called breast augmentation or breast cosmetic surgery?

In truth, this is one question that I hope to be asked by my patients.
I think that this question carries the most important message for a breast surgery.
In medical terms, we call the breast surgery, ‘Augmentation mammoplasty’. This means breast enlargement cosmetic surgery.

The following definition can be found on the internet.

Definition about 'Breast augmentation' in Naver Korea

I do not like this explanation.
If I had to define this term, I would do it as the following.


"A cosmetic surgical method the makes beautiful looking and appropriate sized breasts, with an objective of setting the right beauty proportion, balance of the two breasts, and harmony with the upper body."


Proportion, Balance, Harmony

The three matters above are important to any cosmetic surgeries and the same applies to breast surgery as well.

When people consult about the breast augmentation, there is a lot of emphasis on the implants. Implants are used for the proportion and balance.

An implant is used for the beauty of the breast and not much more.
Volume is necessary for the beauty. Not the other way around.

One must know that this breast augmentation is not just to makes the sized bigger (cup siz bigger).

Let’s look at the two images below.

Breast augmentation surgery Korea

The above picture shows a patient who is about 170cm tall using 375cc round type implant.
The patient blow is about 167cm and she uses 270cc water drop type implant.

Breast augmentation Korea

Some patients think that the breasts are covered by the bra and others cannot know the difference exactly so they just want large size. But this is not a good decision. As you age, breast feed, get pregnant, the shape of breast changes. Therefore, in the long term, this would not be a good decision.

Golden ration of the breast

As you can see in the image above, the part above the nipple is the upper breast and the part below the nipple is the lower breast.

The upper and the lower parts need to have different shapes. The upper part needs to have a natural shape (beaker) and the lower part needs to have semi-circle shape. You can see the differences in the shape from the two pictures.

If you look at the image below, you would be able to recognize the golden ratio that I would like to refer to. The golden ration is known to be 1:1.618 and amazingly, this applies to breasts as well.

Breast augmentation Korea

It is not breast enlargement or breast cosmetic surgery. I think the right answer is “breast enlargement for beauty.”

The main message for today is that this is NOT "a surgery to make the breasts bigger”.


Thank you very much.