What is industrial silicone? Fake breast implants

KBS News

I became curious about how an industrial silicone looks like as I watched news on the people who tried to make and sell industrial silicone to many hospitals. I still have not seen one. I wanted to know the difference between the industrial silicone and cosmetic surgery silicone, so I searched for it on the web.

What is a commercial silicone? Let’s refer to the online information.



Polysiloxane is usually called silicon and has shapes of oil, rubber, and others. R is a form of methyl that is the most representative of the silicones. The properties are rather unique in that it has no reaction or toxicity. It does not burn well, and therefore used as lubricant and brake oil. The silicone rubber is made by mixing the linear silicone polymer. Silicone is not only used as oil but used as silly putty (play dough) and is used to make toys such as Superball that is very elastic. It is widely used for weatherproof materials, glue, cosmetics, rubber, medical tools, contact lens, etc. Silicone implant used in cosmetic surgery is also included.

Reference: Naver


Silicone is a molecular structure of polysiloxane that is chemically stable therefore does not react within the body or any type of environment. Silicone is widely used in the medical field because it has this chemical stability. The biggest advantage is that it does not react to any type of environment and stays as it is, unchanged.

A silicon is just a silicon, there is no distinction of industrial silicon and medical silicon. The problem is if there are an impurities added during the manufacturing stage and how pure the substance is.

The core problem is what type of impurities are mixed and what type of vinyl is mixed with the polyiloxane but these were not covered in the news.


Analyzing the news

So I tried to analyze the news.
The news said that a company with a plant in Kyungki Sihung has sold silicone withough Korean Food and Drug Administration (KFDA) certification to various hospitals.

There was an interview with contents that said "The skin decayed due to the industrial silicone…”

This news is shocking but is not medical or scientific. There was no news on what types of impurities were added, if these impurities cause cancer or what kind of effect the impurities have on the body. (I feel this a lot with the medical or scientific related news. There aren’t much details or analysis. The news only provides simple selective headlines)
When I do reconstruction nose surgeries on patients who are aged in the 50’s or 60’s, I see that those silicones are different from the ones that we use today. No matter how many times I see these silicones, I feel that these are not pure silicones. It feels very strong as well. I observed this many times. We cannot check on the substances because the silicones are too old.

But as the news said, “Does such silicone cause ulcer and infection, skin necrosis and decaying of skin?”

The answer is no in reality.
If you are one who is considering cosmetic surgery and want to check on the silicone that would be used, you can get the lot number, serial number of the implant and check it with the KFDA or Customs office.

But how worried would one be if she has used silicone for her body 20~30 years ago.
I think that people would feel sick if they hear that "industrial silicone leads to skin decay.”

What is the news said this?
"The purity is not up to standard, the those implants with impurities are not determined to be safe as it might cause cancer, capsular contracture, and tissue reaction, therefore, one needs to check with the hospital.”


Fake breast implants

As many of you know, there are many fake products in China. They sell fake eggs that are made of plastic.

I was invited to a Chinese hospital for breast reconstruction and found a breast implant that I have never seen before. It was not made by a company that I had heard of. There was no brand name either.

From what I know, I don’t think there is such a product in Korea. So this news was very chocking to me.

Breast implant was certified in 2007 July, and this cohesive gel product is registered in the KFDA so that there are records of the products. The hospitals also need to keep records of the implant and the patients.

Reference : KFDA Homepage

But those silicone used for the nose is not under the tracking scheme.
But those of you who want nose correction can ask for the package, manufacturing company name, production date and other information before having the surgery. I always use products from Bistool and show the complete product to the patient if he/she wishes to see it. I use products from Polytech Germany and Natrelle US for breast augmentation implants. They both have CE and KFDA certifications and are imported through official routes.

I wrote this for those patients who are worried due to the news (those patients who received cosmetic surgery). But you do not need to worry about this.
If you used low purity implant, the implant would have already caused chemical problems.

As for the silicone gel breast implant in China, I hope that the police find out about this and check on the substance in scientific investigating labs. If they find out what kinds of substances are in the product, it would be helpful to the patients as well as future customers. There should be no simple news that say “industrial implants lead to skin decay.”

Let’s summarize



We, at our clinic, provide the product certification sticker along with a patient diary that I have made for the breast augmentation surgeries.

Before you get a nose correction, ask for the implant serial number that will be used on your nose. Check the product package of the implant used, after the nose correction and match the product number.
I think that there will be some patients who do not check the above contents although I have mentioned it.

The most important thing is the conscience of the medical agencies. Find a hospital or a clinic with appropriate price. Do not go to a clinic because there are many patients. Go to a clinic that the doctor takes big responsibility under his/her own name. This is important.

Thank you for reading. Have a nice day.

How to get a good touch feel after breast augmentation

Many people think that one needs to use soft implant to get a good touch feel after the breast augmentation.

When I talk to patients, I get surprised that there are many patients who say “I want to implant with a good sense of touch.”



First, let’s talk about what is natural touch feeling

A good sense of touch is that the breast with the implant should feel as soft as the original breast.

An original breast of a person is made up of cells that come together to form subcutaneous fatty tissue, muscle tissue, etc, and makes that sense of touch when you touch the breast.

Then, what forms this exact sense of touch?
It is your own skin.




When your own skin fills up the volume of the breast, you will feel the best sense of touch.
But this is like a story from a SF movie.

In reality, you cannot generate skin on the body part that you want like that of a lizard. This is not possible as of now. It might be possible in a hundred years or so.

So we use fat transplantation but the only a certain amount of fat transplanted remain. Most fat are absorbed by the body, therefore there is not much volume effect on the breast.

This is why the doctors have tried numerous substances (including soybean oil) on the breast augmentation.




In the end, only the gel type silicone bag is commercially used today.
It is safe, and not related to cancer or any other illness
It is cheap, does not alter, and is strong. There is nothing like it today.

Also the silicone is closest to our body tissue but does the gel type silicone bag feel the best? It does not.

The liquid type silicone feels the best when used.
Liquid silicone feels softer than the human skin, therefore it was very welcomed when used at first. However, there was no solution when the liquid silicone caused inflammation or necrosis or any other side effects on the body.




The liquid put in through the injection disperses everywhere, so it was difficult to remove the liquid when there was a problem caused.

A close to disaster problems was caused leading to the disappearance of its medical usage.

The cohesive gel that we use today feels much like a rock compared to the liquid silicone.

But there are law restrictions that limit our usage to the cohesive gels and therefore we do not have choices today. Liquid silicone should not be used and the cohesive gel has been chosen for safety issues.

What are the factors that influence the sense of touch in the cohesive gel implants?

1, The thinner the exterior skin is
2, The less amount of gel that the implant has
3, The less dense the gel is
makes the product soft.

If the thinner exterior skin, less amount of gel and less density lead to better sense of touch, why is such implant not manufactured and used?
If you think about it a little, you will know the answer. This definitely has some cons in usage.




1. Thin exterior skin leads to higher possibility of implant damage

This is obvious.
If the exterior skin is thin, it can be damaged as you put it into the body (especially if the inlet is small).

An implant with a thin skin can get scratched when putting into the body, and also the bag can be damaged. This will lead to the leakage of inner substance.

2. An implant is less amount of gel will collapse. It will not have good durability.

Let’s think about a bicycle tire. If the tire is completely filled with air, the tire would not bust. If it is not filled, there might be a lot of substance stuck on the tire fold leading to a damage.



The same applies to the implant as well. If the implant is mot filled properly, the durability gets worse. The implant will be folded inside the body, and the folded part would lead to abrasion and higher possibility of damage. There is a high possibility of rippling as well.

But completely filled implant would not have much fold and the surface would extend fully leading to stronger durability and less possibility of rippling.

3. Less density of gel leads to damage in shape

A human being walks around, and there is gravity pulling us down.
A silicone gel bag type implant needs to stay at a standing position at all times except when we are sleeping. The implant needs to maintain its water drop shape but it if doesn’t, it will not be able to feel up to volume of the upper breast and the volume will be concentrated at the bottom.



This is something that the young patients in their 20~30’s, before pregnancy, do not understand. Mid aged patients understand this concept easily. Losing elasticity on the skin and breast tissue makes the breasts sag. The implants need to maintain the shape and keep the volume on the upper part of the breast in order to make the breasts look young.


But the more important thing is that the commercially used textured and smooth type implants cannot be felt easily (especially when put in under the pectoralis muscle).
All these implants feel alike (because they all are cohesive gel types, not liquid silicone)




I, myself, cannot know if the patient has smooth, textured, or anatomical implant just by touching unless I see the patient’s chart although I work with breast augmentation patients all day and every day.

Then, how can the patients know the difference?
In conclusion, if the implant is located under the pectoralis muscle, one cannot know any difference in touch feel.

The more important facts are that;

First, there should not be any capsular contracture.
Second, when the implant is put in the body, it should co-exist and extent appropriately inside the body to maintain a good sense of touch.
Third, one should not use an implant that is too big.
And, soft feeling augmented breast would lead to sagging of the breast that would cause more dissatisfaction of the patient. Soft implant is not good if you look at it a long term.

Today’s post was on the sense of touch of implant.

Thank you for reading, have a great day.

Polytech’s 2 Gel cohesive gel implant – Natural movement that feels the same as the original breasts

Today, I would like to introduce 2 Gel cohesive implant manufactured by Polytech in Germany but is not widely known here in Korea.

This implant is called Diagon gel implant but I would like to keep things simple and call it 2 gel cohesive gel.

The difference between the 2 gel and the conventional cohesive gel is that this product is formed in double layer of soft silicone gel and strong silicone gel.



As you can see in the image above, the back side of the implant is filled with the soft gel and the front side is filled with the hard gel. So we call this implant, 2 gel or Diagon gel sice there are 2 types of gel stuck together.
This 2 gel is Polytech’s independent and unique product.

The reasons why Polytech produced this implant are:
- To make the implant stick more naturally providing better support (compared to conventional one)

- To show natural movement such as the original breasts when the person makes much movement around the breast




As you can see in the image above, the 2 Gel implant has similar outer line formation as the conventional cohesive gel implants (round/water drop type). The only difference is the inside.

The soft gel at the back touches the rib bone softly to form molding. This is why the patient feels that the augmented breast feels much like the original one.

The hard gel at the front makes a projection that helps the nipple to find its position properly and also pushes the breast tissue up (Push up style).

Also, the strong gel helps to find natural movement, reacts slowly, and maintains shape stability (even for those patients who are really thin).



The patient with this 2 Gel implant will feel great sense of ‘wear ability’ and feel that the augmented breasts move naturally.


I am very amazed at Polytech’s developers who put much details into consideration when making this Diagon gel implants.



There are 4 series of products in 2 gel implants. These are oval shape, water drop, round textured, and microthane (polyurethane) coating. These are the core breast implant products that Polytech has.

The surface of these products helps reduce the incidence rate of the capsular contracture and is a technology that is well known of these products.

Diagon gel (2 Gel) implant is certified here in Korea but is not imported easily, so one needs to wait a long time after the order. It takes about 2 to 3 months. Also, the price of these implants are relatively high therefore the augmentation costs about USD 8,000. In Korea, it costs about 9 million won including VAT. This is a disadvantage. But if you are a person who wants more unique and natural differentiation, then this implant is the appropriate one for you.

This is all for today. Have a great day and thank you.

The types and differences of breast implants II 

Plastic surgery Korea KIES-U

Which implant looks and feels the most natural? This is a frequently asked question. My answer is always the same. There aren’t many differences in the 5th generation cohesive gel implants.

If you put a smooth type and a texture type implants on top of the table and touch them, you would feel a lot of differences. Also if there is less substance in the implant, it would be feel softer and better.

Some consultants train the nurses in such aspect and say that the smooth type feels better.

	If there is less gel in the implant, it may cause a rippling effect

 But the result of the breast augmentation is different from what you think.

The Allergan type that is perceived to the hardest one becomes soft once put inside the body. Therefore, it is difficult to make out if the implant feels good or bad by touching it from the outside.

I cannot know that implant had been used on the patient unless I look at the patient’s chart.

Breast Surgery Korea KIES-U

The softness of the breast is not depended on the type of the implant that you use, but by the skin that covers the implant. Although you use jelly like implant, but you have a hard skin covering the implant, you would feel that the breast feels hard.

So it is wrong to say that you need to use the smooth type for better sense of touch.

The answer to the good feeling breast is not to choose a soft implant, but to conduct a smooth surgery so that there is no bleeding or no trauma on the body. This would lead lower possibility of stronger epidermis.

The sense of touch is not depended on the manufacture but how the doctor performs the surgery and how the patient’s body reacts to the surgery.

Problem of durability

Which implant has the best durability?

There is no answer to this question as of yet. One can estimate it but there is no statistics to prove it. We can compare the implant not collapsing easily and lasting longer to that of a bicycle tire.

If you are riding a cycle on a road with a lot of substance on it, and you have a high pressure tire on the cycle, the small sized substances bounce off easily having less possibility of the tire being punctured. In opposite, if you have a low pressure tire, it would step on the substances directly leading to a higher possibility of a puncture.
If the implant is filled up with silicone gel there wouldn’t be any folds leading to no friction therefore leading to no breakage. But if the implant is not filled up, there would be many folds leading to more friction and higher possibility of breakage.

Breast augmentation Korea KIES-U

Also the gel has strong agglutinability therefore if the implant maintains its shape there would be no folds whatsoever avoiding any damage. But if there is less agglutinability meaning that the implant cannot maintain its shape, many folds are made leading to damage on the implant.

The implant with the most agglutinability is Allergan’s water drop type implant. I cannot say for sure but I can estimate that it as a good durability. SiliMed from Brazil has high agglutinability but not as much as the Allergan’s. The other implants are much alike.

Sadly, all the round type implants that are imported to Korea do not have high agglutinability.


In all cases, the water drop type (ones that are imported to our country) have stronger durability than the round type implants. 

Which implant leads to better shaped breast?

This is the part that bothers me the most. All the water drop type implants imported to Korea have the same level of durability, sense of touch, and side effect incidence rate. The biggest problem would be which implants is the most appropriate one according to the body type.

KIES-U Plastic surgery Korea

There isn’t much to think about when considering the round type. They are all the same. Whatever the manufacturer is, the shape and the volume are all the same. But the water drop type is made 3 dimensionally therefore there are a lot of differences.

There are two types of patients who want breast augmentation that requires implants.

First are those who want to look good and thin.
Second are those who want to fix the sagging breasts after giving birth.

For both the groups, it is better to use long height implants.
The think patients usually have long torso.
Therefore, it is more appropriate to use implants that are thin and long.

Also sagging breasts have empty upper part therefore it is good to use oval type implant that fills up the upper part of the breast. If you look at the breast, you would know that the breast is not shaped in perfect round shape. It is closer to long oval shape.

Germany’s Polytech oval shaped implants are long shaped that are fitting to the Korean women. Brazil’s Silimed water drop type has a good shape but does not export oval water drop type to Korea. If all the products from Silimed are imported to our country, I think that there would be a good market response to all the products.

Breast surgery Korea KIES-U

Sebbin from France has strongly filled implant that is round and thick. So the patients who have thin breast and cannot use wide implant but want to increase the cup size can use this implant.

The cancer causing agent from PIP in France that was reported early last year is not related to Sebbin implants.

Allergan implants have best stability and durability but have wide width when concerning the profile. The patients in Korea have narrow upper body, so they need to use rather small volume implants.

Conclusion

In conclusion, there has been many implants in the market, but there isn’t one that is 100% fitting. Also, one cannot say one manufacturer product is better than the other therefore it is important to find an implant that is most appropriate to your body.

Also, whatever implant you select, the skill of the surgeon is the most important factor.

We looked at the type of implants imported to our country and their differences. Has the post helped? Thank you.
Have a nice day.

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.

Feeling of touch after the breast augmentation

There are three things that interest you the most when doing breast augmentation; shape, volume and feel. Today I would like to talk about this “feel”.
There are common questions that the patients ask about “feel”. Below are the questions.

1. Does smooth feel better than textured?
2. Does tear drop shape feel better than round type?
3. Does the touch (feel) get better with massage?



I sure that some of you have already realized what I am trying to say. We cannot say those 3 things above for sure.

Which implant has the best feel? 

The implant with the best sense of touch is not cohesive gel but basic silicone gel implant.


There are many who studied through the internet but do not know anything about cohesive gel.

Cohesive means cohesiveness. Cohesive refers to sticky silicone gel.

Why was it made this way?

This was made to avoid leakage of the inner substance when the exterior gets damaged.
The stickiness makes the substance stay together so that the substance does not come out easily. This helps maintain the shape of the implants and makes it more durable also.




The old type of silicone gel did not have any cohesiveness.

These products are not compact but disperse easily. Of course, these products are not manufactured any more.

But which do you think feels better? Cohesive gel or this old type gel?

I think everyone can guess the answer. The answer is the basic old type gel. Less cohesiveness, i.e. easily dispersed product leads to a softer touch and jelly like feel.
Cohesive gel cannot have a good touch feel compared to the old type. It has substance stuck together that does not disperse easily.

The first truth is that “Cohesive gel does not have good feel.” The implant with the best touch is the illegal liquid silicone.




The implants advertised on the natural feel and touch at first, but changed to focus on the safety and durability.

The conclusion is this. Why do we not use the liquid silicone or the old type? Although these feel better?

It is because these products have low safety and low durability. If the exterior is damaged, the substance inside leaks out and as a result, the shape is damaged also.

These implants have less durability so the re-surgery is necessary. This is why we hear that “the implants need to be changed every 5 years.”

The implants originally focused on the sense of touch but after the regulations set by the US FDA in the 1990’s the implants have been focused on the safety and durability. This is how the “cohesive gel” entered the market.
 


 
Differences between the round type and the tear drop type

Let’s talk about the 2nd “truth”. The implant that feels good has less gel inside it. Most of the round type implants imported to our country has less gel on the inside.
Let’s think about a balloon that is fully filled with water and the other that is less filled. Which do you think feels better? Of course, it would be the one with less water filled.




Most of the imported cohesive gel implants in our country are less filled also.
In opposite, most of the tear drop type implants imported since last year are much filled.

Allergan tear drop implant has the most cohesiveness. If you touch it, it feels hard. Polytech implant is one that is filled the most.

In conclusion, the round type implants in Korea are not fully filled and have less cohesiveness therefore; these implants feel “good”.

But the truth is that it does not matter.

There is not much difference. All cohesive gel implants are alike. The cohesive gel implants are not focused on this sense of touch.

The implants should not only focus on marketing the parts that attract the customers.

In order to feel good, dissection must be done properly and the appropriate level of epithelium must be maintained.

The sense of touch is not depended on the manufacturer.
This depends on how careful the surgeon is rather than which product has been used.





One must select an implant based on the durability, product life, possibility of getting damaged, shape stability, etc.

There are some patients who say, “I want to use the tear drop type, but I am hesitant to use it because I heard that it does not feel good.”

A patient needs to use the tear drop type if it is necessary to use it. This is not similar to shopping where a customer chooses and buys the one that she likes.

An implant, once put into the body, needs to stay in the body for a long time therefore, it is important that you have the accurate information when selecting one.

This is all for today.

Thank you for reading.

Does Breast Implant Manufacturer Matter?

Currently in 2015, there are about 5 companies that import implants to our country.
There are many products therefore it is difficult to know the characteristics of each of these products.

I get surprised at times when I talk to the patients. They ask me things that they have heard elsewhere such as in other clinics or the internet. It saddens me that there isn’t accurate information out there.

Below is the review of the products that these companies are selling.




1. Allergan 

The manufacturer was originally called Natrelle. But, Botox manufacturing company, Allergan, acquired the company and changed its name. It is a US market leading company along with Mentor.

The first 5th generation cohesive gel is Style 410.

It is a very tight, tear drop shape cohesive gel. It is obvious, but this product is very stiff.
Also most of the Allergan implants are not thick therefore does not have much volume. Most of the implants are not shaped round but are in oval shape.

As there were words that Style 410 is very stiff, the company produced a new model, Soft touch, and started selling it in the market. Soft Touch is softer than Style 410 and therefore provides that softer touch also. However, this soft feel is not all that good because it could give an impression that the product itself it not durable. The pros and cons of Style 410 are clear. If you have a severe case of sagging breasts then it would be good to use Style 410 that has stable shape.



2. Mentor 

Mentor is a US based company and has been a dominant one, along with Allergan, for a long period. Mentor implants are smoother compared to those of Allergan. Also these implants have less rough textures as well.

Allergan’s textured surface is rather rough. (The engineering method in the manufacturing plants leads to differences in the textures.) So, the skin does not grow into the implant. This has led to critiques that the implants may not be able to avoid the capsular contracture. However, I think that this is not true because there aren’t many statistics that prove the texturing prevents capsular contracture. So this cannot be the problem of the Mentor implants.

The top part of the Mentor tear drop implant seems a little thick. Although the shape is tear drop, it seems closer to a round shape.





3. Silimed 

Silimed is a No. 3 company after Mentor and Allergan. The HQ is in Brazil and has an office in California, US.

The characteristic of this product is that the top part is very sharp and thin. This leads to the upper breast line looking more natural. Silimed is more intense compared to Polytech and softer compare to Style 410.

There are many who say that this is a bad product because the company is from Brazil, but this is wrong.

It received US FDA approval earlier than Mentor, and Allergan. There is no proof that Silimed is worse than mentor or Allergan.



4. Sebbin 

Sebbin is a French company. It is a different one from the other French implant company that had a CEO sentenced for using cancer causing substance.

Sebbin has round top that is similar to Mentor. It is rather roundly shaped although it is a tear drop shape implant. The density is similar to Silimed and Allergan Soft touch.

There isn’t one dominant French company but there are many small sized ones across the Europe. These companies include Arion, and EuroSilicon, that do not have much presence at our country.




5. Polytech 

Polytech is a German company. It has the softest product, and can be put into the pocket easily. The sense of touch is as good as the round type but the stability of the shapes is not as strong therefore, it is difficult to say that this is a definitely a good product.

Polytech’s textured surface is rather smooth therefore many doctors thought that the interaction between the epidermises would be less likely. This can be both pro and con.
Polytech has many product categories. It has the most number of product types and it is rather surprising that Polytech products all these products.

Polytech is famous for its polyurethane exterior that avoids capsular contracture, but we do not know when this would be approved in our country and enter the market. This is necessary product for the re-surgery patients but it is sad to know that we cannot use it.

 
So we looked at 5 implant manufacturing companies. Which one do I like? I do not prefer any over another. I use them all. I need to choose the one that is most fitting for the patients.

The implants that you use do not decide the outcome of the surgery. The surgeon needs to match the implant and the body properly in order to get the best outcome.

This is all for today.

Thank you for reading, have a great day.

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.

Textured silicone breast implant use in primary augmentation 

Academical findings do not stay fixed but the details are changed as new findings and results come out. So the doctors pay careful attention to the new findings.
The doctors who do not study would not provide outmost result to the patients.
Also, science is something that “you might think correct, but can be mistaken”.
Medicine is a part of science.

Below is an article, released on January 2015, on “Textured silicone breast implant use in primary augmentation core data update and review"





It is stated that in 2013, there were about 290,000 breast augmentations done in US. This figure comes from American Society of Plastic Surgeons, so maybe the actual number may be greater. One of the most popular plastic surgeries around the world is breast augmentation.

The most common side-effects of breast augmentation are
Contracture, moving location, refilling, seroma, etc

Why is a contracture?

There are various reasons but the most commonly stated one is that the strain around the skin and the breast tissue comes in contact with the implant and this contaminated implant causes infection within the pocket.

How does textured implant minimize the contracture?

In theory, the texture physically breaks down the epithelium tissue, leading to the breakdown of the collagen fibers and reducing the epithelium. This is what we currently understand. 
(But using textured does not mean that you are completely free from the contracture)

What can you do if there is a contracture? 

The most effective method would be to cut off the epithelium. The epithelium incision would reduce the muscle tension so the cell that makes the epithelium would not grow and therefore not survive. 

Does the appearance of the textured implants differ according to different products?

Yes, they are different. The most widely used on is Allergan’s textured salt loss technique which leads to deeper and more textured surface.
Mentor’s textured uses imprinting technique which makes the surface little thinner and smooth. 

Does the anatomical type lead to less contracture?

Yes. The 5th generation tear-drop type implants have strong exterior with strong agglutinability on the inside therefore, it causes tension with the breast tissue and sticks together more firmly leading to lower possibility of contracture.

There are many who thinks that the tear-drop implant feels better.

Tear-drop type implant feels better because the implant / breast / epithelium all move together naturally. 

But the smooth type implant is relatively more separated from the epithelium therefore when you touch it the implant seems to be separated from the skin. 

(This comment does not apply to all patients. This applies more to those patients who gave birth) 




Some say the refilling is more common with textured type

There is still not much reference for this. We are short of data on this. 
The type of the implant do not matter, but thinner patients have higher possibility of refilling than those who are not.
Also there are some who say that more texture implants lead to more refilling than the smoother ones.


Then which type shall I use? Textured or smooth?

It is said that textured minimizes contracture and also limits rotation and movement of the implant. However, there is a higher possibility of seroma and more texture it is, there is higher chance of refilling as well.

I tend to use the textured implant more.

As a surgeon, it is more relaxing for me to use an implant that does not move or rotate easily.

Today, we share a little about the textured implants.

Thank you for reading.

Breast Augmentation Surgery To Know List 3.
What types of breast implant are there?

I would like to present a simple description of the different types of implant for the breast augmentation surgery. There are many of those who are curious about this but it is not easy to distinguish the different types because there are too many.

First, we can divide into two types of saline solution type and cohesive gel.
This can be further divided into smooth type and textured type.
There is a smooth / textured in saline solution type, and smooth /textured in cohesive gel type. Also, we divide the cohesive type to round type and water drop type.

Types of Saline-filled Breast Implants

Types of Cohesive gel Breast Implants

The water drop type cohesive gel breast implants does not have smooth type, it consists only of the textured type. (Saline solution has water drop type as well but we do not import that in Korea)

Saline-filled breast implants is used primarily for re-surgery therefore it is not used in the usual 1st breast augmentation surgery that has the objective of beauty. So we will discuss about the cohesive breast implant today.

Cohesive gel Breast Implants

Therefore, we will talk about 3 types; Round smooth type, Round textured type, and finally Water drop type implant.

1. Round smooth type breast implant

Cohesive gel breast implant is made by filling the gel into the smooth surfaced layer. This type of implant is soft and is bendable.
Many say that the smooth type implant feels better than the textured implant but this is because the smooth type has a thin layer. Also, if the implant goes into the body, it is difficult to feel the difference between the smooth type and the textured type.

Round smooth type Breast Implant

The smooth type feels very thin and weak so many think that the implant might tear when put into the body. The biggest problem with the smooth type breast implant is that there is not friction between the layer and the body so we do not know where the implant would locate itself.
The layer is rather slippery so if the implant is not exactly placed in the room provided for it, the implant may shift to another location.

2. Round textured type Breast implant

Smooth type lead to different forms after the surgery, and so in order to prevent this, textured type implant was developed. The skin would grow into the textured implant therefore limiting the thickness in the epithelium however this was a failure. Different forms were made with the textured implant as well. Also, there was no difference in possibility of having different forms for both smooth and textured type if the implant was placed under the muscle.

Round Textured type Breast Implant

Then why do we use the textured type? It is used to stop the misplacement or the shifting of the implant to another location. Smooth type has smooth layers making it easy to move about to another location and also leading to deformation of the implant.
However, the textured type has rougher surface so it does not move about easily. I usually recommend the textured breast implant. There is no assurance that the implant will stay at the location that I intended.

3. Water drop type Breast implant

All water drop type breast implant have textured surface / layer.
Water drop type was made so that it would look natural on the body.
There are many of those who do not know about this properly but the water drop shaped cohesive gel breast implant was produced and sold at the same time as the round type cohesive gel breast implant. It is false that the water drop type is an improvement over the round type.

Water drop type Breast implant

The origin of water drop type breast implant is Natrelle Style 410. It was first sold in 1993 and was the first product of its kind.
This is the strongest of its kind as a cohesive implant, meaning that it is very safe. This is both the advantage and disadvantage of Style 410. It is very strong so it does not lose its form. Also it can fill up the volume properly.

On the other hand, since this is the strongest of its kind, it is very difficult to place it into the body. Also, the final feeling is not as good on a thin person. Recently there have been side effects of seroma and double capsule in the Natrelle product reported by the doctors.





So Natrelle develops a lower model Soft Touch in Style 410 lineup.
There is higher level of cohesiveness, and so it became easier to put in the implant. However, the safety level decreased as much as well.

The tight gel leads to longer formation of the breast and also improves on the sagging breast by uplifting it properly. But those who are young may feel dissatisfied with using this type as it feels less smooth.

There is no right answer in how you choose the implant. There are pros and cons according to different situations.





If you want satisfaction right now, you might want a soft breast implant, however, if you are looking long term, you might want to have a stronger breast implant.

However, there are many doctors and patients who say that Style 410 is too strong.
So other companies such as Mentor, Silimed, Nagor, Arion, Polytech, Sebine decide to make a softer implant than Style 410 and a tighter one compared to other round cohesive gel products.




If we compare the tightness and the softness of the imported implants, we could rank them as, Polytech being the softness, Silimed, Sebin, and Mentor at a similar level, and style 410 being the strongest.


I will prepare another post on the differences between the brands. Today, we differentiated various types of implants into three types and talked about the basics.

There is no absolute correct answer on how to choose the appropriate breast implant. This depends on the body, preference, age, financial status, and the doctor as well. One cannot say which implant is better than another.

Thank you for reading.

Have a great day.