Things to consider for breast augmentation

[KIES-U Plastic surgery Korea]



There are three ways to select the implant size.

First method is to select a size without any measurements. 

This depends largely on the preference of the patient and the doctor. Plastic surgery is referred to both art and engineering but this method is solely based on art as there are no measurements involved and the selection is done through visual method based on preference.

Breast augmentation Korea KIES-U

Second is the dimensional analysis system method;
The patient and the doctor deliberate on the wanted results and then measure accordingly. This method is to measure the breasts so that we derive the wanted implant size and the shape.

Third method is the tissue based planning; 
This is not based on the preference of the doctor, or the requirement of the patients. We select the appropriate size range through experiments and plan the augmentation accordingly. The doctor recommends the implant size according to the width of the patient breasts, skin elasticity, distance between the nipple and lower line of the breast, etc.

Plastic surgery Korea KIES-U

The current trend is with the tissue based planning.

According to the journals published, we observe that the highest satisfaction is gained from tissue based planning. After taking the measurements, the doctor introduces the appropriate implant size range to the patient. The patient can get a fitting test before the augmentation to see what type of final result can be derived.

The patient can choose the size from the size range provided to get the most satisfying result possible.

Just like any other plastic surgeries, breast augmentation is also an art and engineering, but it needs to be scientific as well.

Scientific decisions should not be made based on how you feel. In reality, art itself is not structural enough, and it cannot be said that it is craftsmanship like.

The selection should be made through statistical data measurements, but I think that there should be a little art too it as well.

This is one fact that everyone accepts in cosmetic surgery. The difference between the cosmetic surgery and others is that cosmetic surgery starts off with the patient’s hope that we need to respect. There are many methods that can be applied in order to respect such hope therefore, the doctor’s preference in the method and experiences are also important.

There is no one correct answer. The answer depends on the wants of the patient and the preference of the doctor.



There are many patients who ask why all the hospitals are different in their methods. The difference arises because we want to satisfy the cosmetic wants of the patients and set direction in such way. We do not focus differentiation for marketing purposes.

I have used tissue based planning from the very beginning but I think that one needs to be flexible in decision making when considering cosmetic surgeries as we center our decisions on patient needs. But there are some things that we cannot be flexible about.

Therefore, I need to invest much time in such area to make the patients understand the things that I cannot be flexible about.

Today, I shared contents with reference on Plastic and reconstructive surgery 2016 Nov publishment by Dr. William Adams from Dallas.

Thank you for reading.

Breast augmentation Korea KIES-U

There are some amazing things that I hear from the patients.

There are many who make final decision by generally thinking that something would lead to a particular result. But in reality, when we conduct a surgery, the outcome is different from what we thought prior to it. Therefore many of these patients get disappointed and require correction.

Breast augmentation Korea KIES-U

There are many of such cases, but today, I would like to focus on this one question, “do the shoulders look broader after breast augmentation?” Then answer is “no”.

But there are those who say “I have narrow shoulders and would like to have them broad”. This is possible in some cases.

First, we need to look at the physical structure of the body, carefully.


If you have broad shoulders and the body gets narrower as we go down lower the upper body, i.e. shaped like an inverted triangle, then your lower breasts might look positioned outwards after the augmentation (although you use small sized implants).

If you have a straight body from the shoulders down to the waist, then the implant would not look like it sticks outwards after the augmentation (even though you use large sized implants).



If the two nipples are distant apart compared to the width of your upper body, then the implants will look like they are sticking outwards (this will look more outwards with the usage of larger implants).


In opposite, if the distance between the two nipples is close then the implants would not look like they are sticking outwards no matter how large they are.



Analyzing how your body structure by yourself is not a difficult thing to do. Every person looks at her body often. But, each person is not subjective in this matter. This is why talking to a doctor is necessary. If I tell the patient that she has a certain body shape, 90% of the time the patients are surprised about it.

For example,

-  I want a large sized implant.
 - Why are you so obsessed with the size?
Such situation would require long communication before the patient understands it.
- One of the goals is to make the upper body look broad.
- Why do you want to make it look broad?
- My shoulders would look wider making my face look smaller. Also, my pelvis look too wide, which I do not like and I want that covered up as well....

No matter how large an implant you use, most of the time, your breasts would not look larger after the breast augmentation.

This is why analyzing your body is important. The doctor not only performs his/her skills but judges the patient status, recommends different methods accordingly, and explains the expected outcome.

If the patient is pessimistic without any reasons, then we tell her not to be pessimistic and explain the whole situation but if it is the opposite case, we as doctors need to show them the reality so that the patients do not have too much expectation.

Today, I shared on one of the topics that the patients question a lot when I meet them.

Thank you for reading.

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

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




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

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

I will go in detail for each one of them.

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

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




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





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

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

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

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





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

This is preliminary, and is not the final decision.

2. Implant fitting (T-shirt test)

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

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






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

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

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

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

3. Sizing while conducting the breast augmentation surgery

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

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

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

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





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

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

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

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




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

Have a great day.

When I meet patients for breast surgery, there are many frequently asked questions and there are some facts that the patients do not know well enough. I would like to post on these one by one.

Also, I would like to set facts straight, especially those wrong information on the internet.
If any of you have had thought about having a breast augmentation surgery even once, I am sure that you will be able to have more structured knowledge and have good interviews with the surgeons.

Breast Surgery To Know List 1. Knowing your body

The most important part of your body in breast augmentation surgery is the shape of your upper body.
When you interview with the doctor regarding the breast augmentation surgery, the whole process is a matching process that includes the implant and your upper body.
At times you may think that since “I am tall, I need a large implant.” However, the height of a person and the implant does not have any relationship.

First of all, we need to analyze the upper body then decide on the type and volume of the breast implant. Also, we need to go over some precautions before the surgery.




First thing that we check is the breast and the cortical organization – mainly how much of the subcutaneous fat and mammary glands you have.
In putting this in easier terms, we look at how thin you are, how much fat you have, and how big is your current breasts.

This is the most important factor in having a breast augmentation surgery. If the fat that surrounds your upper body is thick, then one will not be able to make out that you have an implant and there is less possibility of after-effects as well.

In opposite, if you have less fat then, one will be able to make out that you have had an implant. Also, there would be bad side-effects.

There is a paradoxical aspect here.
If you have thick upper body that means that you have a large breast. If you are a person with such body, then you might not need a breast surgery.
However, if your upper body is thin, then you would have small breasts, and may need a breast implant, but, this implant may not be good for you.




There are some people who say that “the rich get richer” and “the poor get even more poor” about plastic surgery. In some aspects, this applies to breast augmentation surgery as well. If you have a large breast then it is advantageous to have a larger implant. If you have small breasts, it is less advantageous for you to have large implants.
Those with asymmetric breasts need to be aware of this.

If your left breast is larger than the right, then a larger implant will go on the right and a smaller on the left.
However, in reality, a larger implant can be put into the larger breast (left) but the smaller breast (right) will not be able to take in a large sized implant.
An implant goes into a very closed and tight space therefore, the implant can be folded, or look unnatural.




A lot of the patients set a larger breast as a standard and think that “I might have to put this big implant.” In such case, a much larger implant needs to be used for the smaller breast.

If you want to lessen the possibility of side-effects then, you must consider the smaller breast as the standard one. First, you need to decide on the implant size of the smaller breast, then decide on the larger breast so that the two breasts look more natural and to minimize the side-effects.

Next, we need to consider the bones of the upper body.


Bones on the upper body are important because it becomes the framework of how your fat/skin is laid out. Therefore, it is important to see how the overall frame is shaped.
If the both ribs are shaped inwards, so that the breastbone sticks out, we call this a bird chest. The problem with the bird chest is that if we out in the implants, there is a high pressure in the center of the body therefore, the implants can be forced outwards looking far apart.

The number 2 ~ 4 ribs stick out so the upper body may look very thick.




If the breastbone is too low, we call this funnel chest.
The implants in a funnel chest act differently than the ones in the bird chest. The implants mover towards the center and make your breasts too large causing a problem.

As you can see, the cause of the asymmetric breasts is the shape and size of the ribs.

The surgery procedure will differ according to the shape of the upper body bones therefore it is important to check on the upper frame.


Third, we need to check on the location and the location and the placement (proportion) of the nipples.

This is one of the most common factors that I check when I analyze the breasts or upper body shape.
The core objective is to look at the upper body proportion.

All beauty surgeries are successful if the upper body proportion is good. The surgery becomes more difficult if the upper body proportion is bad.

Let’s call the middle inward part of the two collarbones, #1, and call the nipples on both your breasts #2 and #3. When you link the three points, you will be able to see a triangle.




If this shape is close to an equilateral triangle, then we can say that you have a good proportion.
If the triangle looks like an isosceles with tall height, then you might be having sagging breasts.
In such case, we need to select appropriate implant and plan the surgery accordingly.

If the triangle is wide, then the breasts are far apart, so we need to have surgery that will place the nipples closer or recommend short type implant such as water drop implant.

Fourth, we need to consider the skin elasticity of that which surrounds the breasts.

The size of the implants depends on the skin elasticity. If the skin is elastic then we can use a larger sized implant. In opposite, if the skin is less elastic then it becomes difficult to use a large sized implant.

Usually, as you age, or after you give birth, you skin becomes more elastic. Those in 20’s and 20’s would have tighter skin.


Today’s post was the first one for “Breast Augmentation Surgery – To know list”. If you have any questions, please feel free to ask me.

Thank you for reading. Have a great day.

Hi. I'm Dr. Lee.

Today I'll write about the details of the topic, 'how to choose the breast implant size for augmentation mammaplasty'.



Last time I mentioned breast width has supreme importance for choosing the size.
But another important factor is the breast envelope.

For some patients, it is not difficult, nor problematic, but for some patients, it is very difficult and problematic.

Let me compare it to space of a house.
The actual area of a house fits for just 4 persons to live in.
But if its space was applicated very well, there could be room for additional persons. 6 or 7.
These ideas have parallels in breast augmentation surgery - the extensibility of breast envelope.




If one's breast envelope is stretched very well, then a big size implant can be inserted easily, and the shape must be natural enough.

If one's breast envelope is very tight and tense, then a big size implant will not be available even for a big-built woman, and the shape must be unnatural.

What is breast envelope?

It is the covering tissue of the mammary tissue.
That is, skin, subcutaneous fat, muscle (pectoralis major), and fascia.

These tissues cover the underlying implant.

Breast envelope goes looser with age, less tight, more stretchy.

Other factors related to the stretchy breast envelope are  as follows ;

Number of delivery.
Massive weight loss (10~20 kg)
Big breast

Breast feeding is not yet established as the culprit of the saggy breast but could be considered as that of stretchy breast envelope.

If a breast augmentation surgery candidate is very young and has no history of delivery, the breast envelope  must be very tight.

It does not stretched well. The surgeon has to struggle to insert something under it.

If a candidate is aged or, has many children, with saggy breast then generally the implant volume could be very big. The envelope would be well stretched and the insertion process might be easy.

In these cases scar would be vague because, a bad scar is made when there is strong  tension between the opposite side of the wound.




But the size should be adequate even for these people because, if the implant is very very big, the weight of the implant must be very heavy and it can stretch the envelope too much. That condition could result in a saggier breast.


Big-built woman (wide breast width)  with  loose breast envelope, can have very big implant.

Small-built woman (narrow breast width) with tight breast envelope, should have smaller implant for natural - looking breast.

If a candidate for the surgery is small build but the breast envelope stretches well, then she can use bigger implant than expected.




That's it for today.

Thanks for reading and have a great day.

This is the most frequent question I get from my clients.



Many talkings with my clients go by as belows.

client ; "I do not want too big size. I want natural and optimal one for my body."

doctor ; "Then you want cup B?"

clinet ; "........ at least C or D."

doctor ; "Haven't you told me you want natural look?"

client ; "Yes, I hope natural one. But  I'm afraid I would not be satisfied with cup B after the operation."




Because the name of this surgery is 'augmentation', generally the bigger, the better.

But as long as it does not exceed the acceptable limit of one's body.

If the implant is too big to look natural, then we would not call it 'successful'.


1) Weird shape

If the implant is too big, it could exceed the acceptability of the breast envelope.
The skin - breast envelope expand here and there, to the maximal tension.
That tensile power makes the breast shape not good.
The breast might have  upper fullness, and it makes big but not beautiful shape.

2) implant durability

If the space is narrow but something big is inserted anyway, then the contents should be collapsed or folded. With time goes by, the folded portion of implant get frictional forces repeatedly and finally it can have crack or rupture.

3) tissue atrophy

A big implant present expanding power on the skin envelope. It makes the breast envelope thinner. With more time, skin must be even thinner.

Ultimately the implant can be palpable and visible through the paper thin skin at the margin. We call this, 'tissue atrophy of the breast envelope'.

If a big implant put enormous pressure on the bottom of the chest cage for a long time, then the rib bone can be dug. (bone erosion)




Breast augmentaion surgery is, a technique that inserts a foreign material  into human body.
The point of this surgery is, How well the material does match the patient's body.

Once the operation performed, then the implant will dwell in the patient's pocket permanently, so it is very important for the patient how well it fits for the body. The volume, the height, width, thickness, every parameter is important.



Firstly the surgeon measures the width of the patient's breast. And it is the first considerable factor for decision making.

The second factor is the skin tightness. If the breast envelope is tight, then the pocket space would not be enough for the implants. And the skin envelope will get too much tension.
For large volume implant, the skin envelope has to be loose.


These 2 factors are the most important points for decision making processes of the implant volume.

Breast width and the skin tightness.

A surgeon has to measure them objectively and make a rational and discreet decision.



So that's it for today. Thanks for reading and have a nice day.