Q) Are there any bad things or side-effects of having implants that are too big? 

There are many problems. I will share them one by one.

1. Over-dissection

Measuring the width (cm) of the breast and fitting the correct width of the implant would be the first stage of selecting the volume of the implant.
 


If the volume of the implant is too big, then the width is wider as well. If a wide implant is put into a narrower pocket, then the surgeon would have to dissect the side of the ribs or dissect into the mid part of the chest.

If the side of the ribs is dissected, then there is high possibility of damaging the nerves of the blood vessel. This damage would trouble the patient continuously for a long time.

But if the inner part such as the mid point of the chest is dissected (due to the bigger size of the implant) then the two implants might touch each other (Synmastia). This side-effect, if caused, would last forever.
 

2. Implant Collapse 

If the implant is put into a pocket that is narrow, the implant might collapse and lose its shape.
No matter how large an implant is, which is made of half liquid, cohesive gel, it can be forced into the pocket that is small.

Such collapsed implant would leave some space at the folded part, and the folded part would hold onto anything that is positioned. This would cause seroma, inflammation, and hematoma.

If the implant is folded, there would be much friction caused when using the arms. This friction would damage the implant exterior causing leaks.
 

3. Original breast atrophy

Let’s say that there are two women with same sized breasts. The widths are the same and the extent to how much the skin extends is the same as well.

One patient uses 290cc implant that is appropriate for her. The other uses 340cc implant that is larger than the appropriate size.

Two years have passed after the surgery. Who do you think would have bigger breasts?
This might seem like an easy question to answer but rarely does one answer the correct one. The reasons why the answer to this question is different from common sense is that the body is not like a mannequin and the body changes through time.

Silicone is located between strong ribs and smooth skin. The ribs under the implant are strong, and the skin above the implants is smooth, therefore, the skin is pressurized.
The pressure on the skin continues 365 days a year.

Let’s say that you have a bandage on your arms for 2 years. When you open up the bandage, the arm would be thinner than the other without the bandage.

This applies to the breast with the silicone implant as well. The pressurized skin would not have blood circulating therefore becoming thinner and wrinklier.
We call this atrophy.

The 340cc implant has more pressure than the 290cc one. The patient with 340cc implant may have her breasts look bigger right after the surgery, but after 2 years, there would be atrophy that causes the breasts look like those with 290cc.

The patient with 290cc would have skin that well preserved therefore, the breasts look feel more natural than the one with 340cc.

4. Unnatural appearance and feel 

If the implant is too big, then it would pressurize the skin a lot and pull the skin as well.
Let’s say that you bought a leather jacket that fits you tightly from a shopping mall. You might not be able to close the zips easily. The implant would be much like closing the zips of the jacket.

Others might think that this is too small as well. Your jacket might look all new, but if you touch it, you will feel that the jacket feels tight and rough.

This happens to the breast. The breast would look unnatural, and it would feel rough making others recognize that there is something inside the breast.
 

5. Ugly scar  

If the pocket is too small for the implant, then there has to be much stress when putting in the implant. The tools used for this input might cause damage on the skin.
When the implant goes through the entrance, there would be much stimulation and friction on the skin.

Wherever the surgery is, this type of activity would cause less circulation of blood on the scar, causing the scar to worsen.

6. Visible margin or rippling

If the implant is too big, the margin of the breast would be formed elsewhere then the place that it is to be formed. This happens to all parts of the breast. If the margin starts from a different location then it is supposed to, the breast would look unnatural.
Also, if the implant is folded and this can be seen at places where the skin is very thin, we call this “rippling”.
 
There is not one patient who does not want a large implant, but there is a limit to this. If you ignore this limit and carry on with using larger implant than the one you are supposed to use, then there would be discomfort and side-effects. Majority of these problems cannot be fixed at later stages.


Today, we looked at what happens when you use large implant that is not appropriate for you.

Thank you for reading the post. 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.

Solving "separated breast" deformity on thin women with composite breast augmentation

Today, I would like to introduce a thesis on the fat transplantation in between the breasts, especially for the thin patients.



The article is from a renown magazine, Plastic and reconstructive Surgery 135. April version. It is written by Francisco Bravo from Madrid, Spain. The name of the thesis is “Parasternal Infiltration Composite Breast Augmentation”. (You can think of this as solving the separated breast deformity of thin patients)



There were many others before Dr. Bravo, who conducted composite breast augmentation that requires using an implant along with fat transplantation.

The thinner you are, your breasts would look unnatural if you use larger implant than that is appropriate, and therefore, one uses fat as a covering tissue to make the breasts look natural.

But there is a limitation in such a method. It would be difficult to get sufficient amount of fat from a thin patient. Also the fat cannot be engrafted properly on to the implant therefore; the outcome is rather disappointing to many.

The characteristic of Dr. Bravo’s research is that you transplant fat between the breasts of a thin patient making the upper body look more beautiful.



This process does not require much fat and solve is judged to be helpful in providing solution to the ‘separated breast deformity’ of thin patients after their breast augmentation with the implants.

Fat transplantation cannot be a substitute of the implants but is helpful for the implant outline or the contour. This is more applicable to re-correction patients and thin patients.




The original breasts are important for the shape of the breasts with the implants.
Those thin patients with thin soft tissue on the breast bones complain about one being able to see the edges of the implants.

The patients think that their breasts have been “separated” far apart in such case.
But the fat transplantation  on the edges of the implants make the breasts look more natural and less separated apart.

We can see the improved results from the experiment done on the 2 groups; one with just implant and the other with implant + fat transplantation.



The amount of fat used was about 6-~140cc , an average of 117 cc, which is rather less that the amount that we usually use, 300~500cc. The fat is transplanted just under the skin.

The fat transplantation was done through the breastbone line.

I have used this method many times before, and there are other doctors who have used this method as well. But I believe that Dr. Bravo is the first person who announced such structured thesis.

Here is the summary.
Fat transplantation cannot solve all the problems that thin patients have with the breast augmentation. However, fat transplantation can be a solution to the separated breast deformity.

Thank you very much for reading.

Anesthesia for Breast augmentation

This is a frequently asked question. Today, I will answer this question through this post and also share some wrong information that some advertisements state about the breast surgery.


 
The difference about the breast augmentation and other surgeries is that breast augmentation requires a large substance to be put inside the body.
The important factor here is that, this large substance should not cause any discomfort on the body and that there should be no side effects also.
Therefore, it is very important that there is absolutely no problem while doing the breast augmentation.

Important factors to consider in breast surgery
1. The form of the breast must be stable for a long period
2. Implant should not have any influence on the original breast tissue
3. 24 hour recovery system, i.e. the patient must be able to recover within 24 hours (Quick recovery = Low possibility of side effects)
4. There should not be any bleeding or damage on the tissue
5.There should be semi-permanent stability / harmony of the implant and the breast tissue


I was really surprised at what I found on the internet about breast surgery. I found marketing statements as the ones listed below. Many of these surprised me. Here are a few.

Others apply general anesthesia, we apply local anesthesia
- When we refer to the textbooks of breast surgery, there is no recording that IV sedation has quicker recovery time than the general anesthesia
- Some might be quick to think that conscious sedation may lead to a quicker recovery, but this is not true. If you have breathing problems, or others that may danger your life, there is no way to solve these problems
-  An experienced surgeon can have the patient leave the hospital after 2 hours of the surgery although the surgeon has applied the general anesthesia
- Using conscious sedation as a marketing source to attract the patients is wrong and dangerous activity

Other hospitals cause 5cm incision but we only cause 3.5, therefore, the scar is very small
- An implant is pushed through a small hole and it needs to remain there for decades maintaining its form and shape. Size of the incision cannot be appealing marketing information
- The possibility of damage, breaking, contracting of the implant is higher than normal. For example if the implant is about 275cc and this goes through 11~12cm inlet. The small inlet might cause the implant to lose its shape inside the body.
- If a hospital wants to appeal that the incision size is 3.5cm or less, then it must also provide research data of MRI or ultrasound that an implant put through this small inlet has no problem for 10 years or more. Just using this advertising message is not appropriate for the patients in the long term.



We has our special technique that makes your breasts larger than 300cc
- This is absolutely false. The size of the implant is decided by the patient and also the size should not cause harm to the original breast size and shape. It is wrong to say that a surgeon will just make the breasts bigger.

I really hope that such marketing activities by the hospitals are avoided in the future.


Here are additional details about the anesthesia.

In plastic surgery, we use the general anesthesia that has muscle relaxant and other anesthesia so that the patient does not feel pain in the muscles. This is done through using anesthetic gas and oxygen put into the respiratory system.
Conscious sedation uses sedative, pain killers such as propofol. This does not relax the muscle so the patient may be able to move about during the surgery.

The reason why we use general anesthesia for the breast surgery is so that the breast muscle has no movement that may cause harm on the breast tissue or discomfort on the patient.

If you have conscious sedation, your muscles (i.e. pectoral muscle) might move without any intention causing tissue harm and inaccurate desquamation causing delay on recovery and bad outcome.

One must apply general anesthesia when doing the breast surgery.

Conscious sedation does not lead to quicker recovery but instead, a long one. Also, conscious sedation is more dangerous and has higher possibility of causing problems.

Anesthesia is very important to a surgery. Today we looked at various anesthesia methods and some problem associated.
Breast surgery cannot be corrected like eye/nose surgery.

 

I hope you will be able to get accurate information in deciding what is right for you. This is all for today.

Have a great day.

How the shape of the implant and different methods change the shape of the breasts 

An interesting report on how the breasts change according to the shape of the implants has been introduced based on various experiments conducted on 17 corpses. It was written by Dr. Antonio Jorge Forte of Yale University and Dr. Alonso of Sao Paulo, Brazil. (Plastic and reconstructive surgery, Apr, 2015. vol.135-4)




21.8% of re-correction of the breast surgery in US was done to change the size of the implants, and 8.2% was to reposition the implants.

Getting the right position to make the breasts look better is an important factor when knowing if the surgery is successful or not, however, it is not always easy to find the appropriate position for the implants.

The research team experimented on how the nipple position changes when using the tear drop implant or round type implant. One of the difficult things about such experiments is that we cannot apply various implants on the same person. It is difficult to state that tear drop implant produces one result and the round type produces the other result unless the tested bodies are of same condition.

So, it is meaningless if different implants were used on different persons with different conditions.

Therefore, using corpse to test various types of the implants makes this experiment an important one.



We call the state where the nipple sticks up front as “projection”.

Projection becomes bigger when using the tear drop implant compared to when using the round type. The nipple sticks out forward and this degree of nipple sticking out is directly associated with the cup size.

The experiment shows that 100cc leads to a projection of 0.6~0.8cm.
Implant on sub-glandular leads more projection than sub-pectoral.
Also, the distance between the lower wrinkle lines becomes wider when using the tear drop type implants. This means that the sagging breasts become higher after the surgery.

As the volume of the implant increases by 100cc, the diameter of the areola increases by 6%.

So what influences the projection of the nipples after the breast augmentation? The  research shows that the type of the implant, whether it is the tear drop type of the round type, does not matter, but the volume (cc) of the implant influences the projection. So it is common to see a patient with not too severe case of sagging breasts corrected due to the breast augmentation.

However, there is a limitation to this research.

The corpses used were 8 to 12 hours after death, so the body might have been little stiff and also the results were based on the findings of the short period after the surgery.



Summary:
1. Sub-glandular implant leads to more projection of the nipples and higher positioning of the areola. (When compared to sub-pectoral and when using the round type implant)
2. Larger implant leads to more projection.

Thank you for reading the post. Have a great day.