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.

What is double bubble after breast augmentation?

Let’s look into one of the most common side effects of breast augmentation,
double -bubble

Today, I would like to share about one of the most common side effects in breast augmentation, double wrinkle ( double line, double bubble).

One must know the anatomy in order to understand this side effect, but this is difficult for a normal person, therefore, I would like to refer to an image below.

Normal structure of the breast

This is the normal structure of the breasts. There are some conflicts among the scholars, but the cause of the Inframammary fold is due to the Inframammary fold ligament.

But there are some with a clear Inframammary fold and one that is not so clear. If you are a patient with a clear Inframammary fold before the breast augmentation, then there is a high possibility that you would have double wrinkle after the breast augmentation.

The possibility is higher for those who have sagging breasts or large breasts.

Case of double bubble after breast augmentation

As shown in the image above, if the implant is positioned under the muscle, there is a high possibility of the double wrinkle due to the Inframammary fold ligament.

If the surgery is done above the muscle, this possibility is lower.

If you are the one who has read many articles in this blog, you might know that if the implant is positioned above the muscle, you will be able to feel it easily unless you have thick skin or the original breasts are large. There are much limitations to patients having under the muscle implant if the patients are thin.

That is why we need to conduct double plane correction.

Double plane correction leads to the implants not being felt easily and also preventing the double wrinkle.

How to prevent double bubble after breast augmentation

When the double plane surgery is conducted, most of the implant would be positioned under the pectoral muscle therefore one will not be able to feel the implant easily. And, by cutting off the inframammary ligament, one can prevent the double wrinkle.

However, this is not the only reason that leads to double wrinkle.

Capsular contracture can lead to double wrinkle, and also the position of the implant within the body can lead to double wrinkle as well.

Also, certain part of the body may become really thin during the course of the surgery, leading to double wrinkle.

It is difficult to think that the double wrinkle will be formed in each of these cases but there are various methods on how to remove the double wrinkles. Therefore, it is important that you consult the doctors in order to do so, especially those patients who are thin or have sagging breasts.

This is all for today, thank you for reading.

Today, I would like to share about a few things that came into my mind when doing a rhinoplasty. First, I would like to share a though, “curved line (known as barbie doll nose job) nose job is similar to wearing high heels.”

Why do you wear high heels?
 "High heel was invented by a woman who got kissed on her forehead.” (Christopher Molley)???
 


Very common answers to why women wear high heels could be that they want to look taller, or they want to have their legs look pretty. A body changes according to whether the woman wears high heels or not.

Second might be because of pride. All women want to look arrogant and proud. All women try high heels at least once. It is difficult to express exactly, but women have sense of superiority when wearing high heels.

The bottom layer of the high heel that touches the ground is very little, and people want to be at a higher place than others. There is a little danger when wearing high heels, but women feel beauty from the heels as well.

Third is that the curves on the high heels attract women. High heels look most sophisticated from all the products that are laid out in the shopping malls.




There is another reason to why women choose high heels. People do not know this but there is one important reason.

Other women, too, wear high heels!

For example, if your friend wears 10cm high heels and your wear flats, do you think you can walk side by side with that friend? (ㅠ_ㅠ)

In Korea, where sociality is strong, you might not want to be the only one wearing flats. This is virtually impossible.

Anyway, high heels can be a source of pride to those women who want to look edgy.
 



Then why curved line nose?

Now, let’s talk about nose (high nose). If we refer to beauty surgery textbooks, most women want to escape from psychological stress by having a nose job done.
Why do you want curved line(barbie doll) nose? The answer to this question is the same as those for the high heels.

First, high nose makes the face look smaller and solid. This solid looking nose makes the face look thinner although you have a wide face. This is same as when a woman wears 10cm high heels and looks like she has long legs and good body.

Second, high nose makes you look arrogant and proud. The part of the high heel that touches the ground is very small, and so does the curved line nose that points up high. Historians say that if Cleopatra had smaller nose, the history would be changed. Also, when we say that someone has much pride, we say that the person is “hard (high) nosed.”
Curved line nose can be an expression of a woman’s pride as well.

Third, it is figuratively most beautiful. The curves on the nose makes a woman look beautiful.




But, Rhinoplasty is supposed to solve problem on the nose, and is a high technique measure to make the nose high or low so that it is in harmony with the rest of the face.

“Curved line or barbie doll nose” is a simple term to express the shape of the nose and cannot be an answer to everything.

If you are wearing shoes and if your feet feel pain or uncomfortable, you can take off your shoes, but this is not the case for the nose.
Curved line nose just refer to the nose tip. It does not define what a beautiful looking nose is.
This, too, is not the answer for pretty looking nose.


All these are important. A nose is a three dimensional figure and can look natural or unnatural on your face.

There was a Korean drama, “On-Air”, televised few years ago, and the main actor said the following to the main actress;
"You think you are popular since many people recognize you, right? You think that you are highly popular. But the only thing that is high is your high feels.”

The main actress in the drama has a character that is in danger, and is really excited. The author must have compared the character to high heels.

I have compared high and proud looking nose to high heels. Although curved line nose is popular, I do not recommend this to everyone. Just like any other beauty surgery, rhinoplasty procedure is applied according to different type of noses.


This is all for today. Take care and thank you for reading.