Why is the upper pole fullness caused?
Breast augmentation Korea KIES-U

What is an upper pole fullness?

The breast looks good when there is a straight line that links the upper part of the breast from the collarbone to the nipple, and round line that covers from the nipple to the bottom of the breast.



But if there is much filling or volume on the upper part or the breast, we call this upper pole fullness.

How is the upper pole fullness caused?

1) It is caused when there is a mismatch of the breast of the implant after the breast augmentation. It happens if the implant is too big.

The chest can only accept an appropriate size but if a very large volume implant is used, the body cannot take it in properly causing upper lift on the breast. The bottom part of the breast is round shaped but if the upper part also becomes round, this is an upper pole fullness.




2) If a patient is in her 20’s and has not given a birth yet, the skin of the breast is very tight and elastic. If a round shape implant is put into the breast, the skin does not extend but pulls more tightly causing upper fullness.


3) If the doctor did not desquamate properly after the augmentation – especially when putting in the implant from the armpit – the implant moves to the upper part of the breast causing the upper fullness. The upper fullness does not get better even with time in such case.

4) There is some level of swelling after the breast augmentation therefore, there is also some level of upper fullness. However the upper pole fullness caused due to swelling gets better after a few weeks.

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5) At times, you can have upper fullness in a few months or years even after the swelling has disappeared from the surgery. This happens although the surgeon did proper procedures.

This is caused due to the capsular contracture that pushes the tissue into one side of the breasts. This direction can be anywhere. If the upper part is pushed then the upper pole fullness becomes more severe.

How to avoid the upper pole fullness? 

1) Do not use too large sized implant. When you consult with the doctor, the doctor will take proper measurements of the chest, breast and try to match an appropriate sized implant. Of course, the patient’s opinion will be taken into the consideration but the patient should not require too much. Such greed might lead to upper pole fullness that lasts for a long time.

2) If you want breast augmentation before giving birth, you would have tight and young skin. Water drop type implant would be appropriate. If you choose too bi sized implant, whether it is a water drop type of not, the upper pole fullness might be caused.

3) The surgeon needs to desquamate properly. The surgeon must be more careful when the dissection and the input is done through the armpit as it is less visible on the eyes as well. Therefore, much knowledge and skill is required of the surgeon.

4) The upper fullness caused right after the augmentation disappears after 2 to 3 weeks as the swelling comes off.

5) If you are certain that you have a capsular contracture, and have a severe case of upper pole fullness, then you need to consider reconstruction.

The reconstruction would require epidermis removal or opening.
But it is important to do everything you can in order to avoid the capsular contracture.

Today, I shared on the upper fullness. Thank you for reading.

Have a great day.

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.

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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.

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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.

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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.

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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.

The types and differences of breast augmentation implants Part.I [Breast augmentation Korea KIES-U]

In Korea at present, there are 4 water drop type brands, and 5 round type of breast augmentation implants ones imported. There are many patients who ask about the differences in these products whenever I talk to them. Surprisingly there are many doctors who are unaware of these differences. Today, I would like to share about the imported implants that are used in our country as of 2013.

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I think that there were a lot of implants used at our country before the official registration in Food and Drug department in 1990’s. Those who had breast augmentation at this time do not know the origin of the implants that they used.
In 1993, FDA in US restricted the usage of silicone gel implants and only allowed the saline bag type. Korea followed this act and allowed only the importing of saline bag type while restricting the silicone gel. (Korea tends to follow US restrictions)
So as the breast augmentation became popular (in early 2000’s), we could only use the saline bag type therefore, most of the patients had them.




Then in 2007, FDA neutralized this restriction leading to a trade of cohesive gel, i.e. silicone gel implants, causing a great demand and interest of breast augmentation due to the “good feel on the breast”.
At this time, Mentor and McCann (Known as “Allergen” today) were the two companies that were approved in Korea. Both manufactured only the round types.

As time passed, the interest grew and in 2012, Germany’s Polytech silicone gel type ( = water drop type) was approved leading to greater variety of the product in Korea.

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Reason why we still use the silicone type today

A good implant:
First, it does not harm the body or cause side effects.
Second, it should look similar to the body so that it looks natural
Third, the price must be reasonable
Fourth, it should have the durability which the shape does not change over long time period
Fifth, it should be easy to replace for reconstruction
Sixth, it should be adaptable to the body so that it matches well

These are the characteristics that an implant should have. But there is no such one right now. This would only be possible in Sci-Fi movies and it is difficult to make something that is perfectly fitting for the body.

So we still use the silicone type today. The silicone type is soft and feels very much like our body. It is separated well from the body and is well fitting with the body causing no harm, and it can be removed easily.
But there are some disadvantages as well. Separation from the body means that it caused metabolic effect of the body by creating a barrier that leads to capsule. This capsule can become stiff at any time lading to capsular contracture.

Therefore, silicone gel separating itself from the body can be both advantage and a disadvantage.






Entrance of Texturing technology

In order to overcome the limitation of the silicone type, texturing technology on the surface of the implant was applied. The idea behind was that the tissue would grow into the different textures leaving no space therefore avoiding the capsular contracture.

But in conclusion, this was not a successful effort. Textured implants did not have better incidence rate of capsular contracture compared to the non-textured types (especially for the sub-pectoral).

But the textured form prevented the changing of the location or the move abouts of the implant in the body. The main objective behind the usage of the textured type today is to securely fix the location of the implant.

Mentor has a textured implant named Siltex. It has small pores with smooth surface. So there is a lot criticism that it cannot stick to the body properly.
There is a water drop type form Mentor as well called CPG, but this cannot be imported to our country. (I do not know why)



The textured type from Allergen is called Biocell. This is different from Siltex in that it has big pores and rough surface. So Biocell sticks well to the body and has strong texturing. But as always, advantage and disadvantage is like the two sides of the coin. Some say that the rough surface on Boicell causes trauma on the surrounding cells that may cause capsular contracture.

Polyurethane

Since long time ago, many people thought that is there was a coating on the surface of the silicone implant so that the coating extends to the body having one natural feel of the breast and the implant itself that this might lead to the avoidance of capsular contracture.

There were many substances used for the coating material, but the only certified one was polyurethane.

The Polytech’s implant from Germany is known for the polyurethane coating implant. There isn’t much findings or results from the lab experiments for this product at our country so we cannot import it. But I have seen it used in Germany and Hong Kong. The capsular contracture incidence of this polyurethane coated implant in near 0%. The capsular contracture is almost not caused on the body. But we still need to know what long term effect polyurethane has on the body, and the durability of the implant in order to know that it is secure and use it.

We will share more in Part 2.

Patients are from Mars, and doctors are from Venus [Plastic surgery Korea KIES-U]

The Importance of a Consultation before Breast Surgery

A doctor’s concerning points about breast surgery


I think that this area is more confusing and difficult as I talk to more patients.

I feel hopeless when.....
the patient’s response is completely the opposite of what I am trying to get across.

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This is a communication problem. It is not easy to get an agreement with a person trying to convey one thing to another.

There are some patients who catch on what I am trying to say accurately and understand it well but this is not always the case. Sometimes, both sides are talking about different things.

I thought about why this happens.

There are many reasons but I think that one important one is the pre-information that the patient has before visiting a doctor.

A patient has a need for plastic surgery (including breast augmentation) and asks things to those around and also searches information on line.

In this stage, she catches both right and wrong information. There are some information that oppose one another.

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There is some wrong information from non-experts that they get.
The fundamental behind a medical activity is to provide a treatment to an ill patient.

But breast augmentation is not for illness but for those who want to improve on some beauty related problem and therefore this is much related to product sales and advertising.

I think there is a big problem here. I think that the miscommunication between a doctor and a patient starts at this very point.

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Commercialized hospitals or non-experts spend much money to advertise on 000 surgery,  000 methods, to cover up a surgical method and communicate on a product.

This would lead to differentiation. For example, if you are advertising on an energy drink, you will talk about different substances in it and say that is why the drink is more superior than the competitor products.

But this type of thinking cannot be applied on to the surgery method or any other medical activity that requires dissection.
All patients have different problems and characteristics.

A surgery should be applied according to the patient. A certain '000 surgical method' should not be mentioned as the most outstanding one and advertised as the best one for everyone.

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A patient needs to quickly forget or disregard any information on the internet that says you will have an uniform effect if you use '000 surgical method' or '000 implant', etc.
A medical activity is different from a bag shopping.

In the first meeting between the doctor and a patient, the doctor analyzes on the patient’s body and any special characteristics.

And needs to look at
1) What is necessary to improve on and what can be improved on
2) What is necessary to improve on but cannot be improved
3) What does not need an improvement

A doctor needs to differentiate the things above and communicate them to the patients. One should not say that he can improve on something that he cannot.

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Everyone can buy the same bag with a certain amount of money, but this is not the same for a medical activity, especially in a surgery. If there are 1000 patients, all 1000 patients have different problems and after a surgery, all of them would have different results.

This is the part that the patients do not understand and this is why the communication gets difficult. I spend the most time explaining on the problem that the patient has in the very first interviews.

It is difficult for a person to have a rational thought about one’s body. However, this is necessary prior to any surgeries.

I have small breasts

There are many with small breasts. But it is important to think about what are my special characteristics, and what is different about me comparing to others.

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Is there asymmetry? Why is this caused?
Are the nipples in the correct position when comparing to the shoulder bone and the belly button? What caused this wrong position?
Is the width and the under-band diameter appropriate compared to the body shape?
Are both axillary creases symmetric or not?
How is the extensibility or the elasticity of the skin? Too weak or too strong? Why?
Is the tissue close to one another or not? How is this caused?
Is there something that you can feel on the breast? Does the patient have past records? Is this related to breast augmentation?
How big is the areola? How is the costal cartilage?
Are the ribs or spine bent? Or shaped differently than normal?
Are the breastbones shaped evenly?
And finally, do I hope for mentally normal and appropriate results? Or am I expecting unrealistic results?

All these things are important during the communication stage. If you disregards these things, then the interview with the patient might not be worthwhile.
It would just be like any simple talk on beauty surgery.

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But surprisingly many patients….

When I talk to the patients about the body and breast, they cut me off and say things like “I have heard that 00 brand smooth round type implant is good. I want it.”

This is similar to when you are buying a house.
You are busily talking about school district, house size, price, location, distance from public transportation, noise level, accessibility, but then all of a sudden you say that you like a certain lighting system in a particular house and decide to buy it.

If you look at the patients who want beauty surgery with a perception of marketing, the suppliers would explain things with the purpose of selling any good that they make. This is not a consultation, this is sales.

Consumers would just talk about what they want and try to get discounts, whereas, the suppliers will try to promote and sell the products that they have. The communication would be centered about these points and nothing more.

The problem is that there are too many people who are like this. The hospitals too, try to what the patients want and are not focused or interested on how the patients would be in 10 or 20 years.

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Looking at those who want breast augmentation to solve a problem as a patient and looking at them as just another consumer who wants a product are different.

The hospital should to observe and analyze the patient, communicate on the problems and have the patients realize what the problem is.
Then provide information on how the problem can be solved with what limitations, and finally decide on whether to have the surgery or not.

But in today’s capital oriented society, the hospitals, whether they like it or not, have characteristics of a salesperson.

But a surgery that uses knife for dissection needs to remove such sales thinking, and strive to communicate on how to solve the problem that a patient has.

This would lead to great mental and physical satisfaction of the patient with minimized dissatisfaction, surgical accidents, side effects, or any other problems.

This is all for today, thank you for reading.

Have a great day.

Teenagers need “cosmetic (plastic) surgery” education
KIES-U Plastic surgery Korea

If I recall correctly, I think that I received sex education in 9th grade.
My teacher played a video in the AV room at our school and the teacher explained on the difference between a man’s and woman’s body, how the hormone secretion takes place, secondary sex character, differences in the body, genitals. It wasn’t so bad talking to our teacher about those lower parts that we as boys used to giggle about. I think this education was rather meaningful.




I am aware that this sex education has become more advanced with growing interest and I am also aware that there are many programs related. The society knows that hiding this would only hurt it therefore, people are opening up more towards this education even at schools.

I think that these teenagers definitely need sex education

My reasoning is that the teenagers, especially those girls in middle school, are at an alarming stage regarding their perception on beauty, and plastic surgery. Also, this perception can have great influence on the rest of their lives.
 
 

1. Our children’s perception on cosmetic/plastic surgery

Middle schools talk about this area a lot and already are much aware of it so that their parents cannot even say a word about it. Some middle school girls come with their friends to talk about the plastic surgery and I have recognized that those who are 14 to 16 years old already talk much about plastic surgery with their friends.

This might be too early for them. They are at a stage where they cannot objectively talk about plastic surgery and that is why they easily say “I do not look good here so I need a plastic surgery on this part.”

But it is not right to conclude that “kids today have a lot of problems.” Our society such as the TV and other mass medias have made our kids think in such way. Our society is too much focused on the outer looks and this has been communicated without any means to the teenagers.
 
 
The perception of our children on cosmetic / plastic surgery starts as they go online looking at all the pretty looking male and female celebrities and comparing themselves with these celebrities.

All dramas or movies have an ending where a pretty main actress has an happy ending.

- I am not good looking
- Things get bad if you don’t look pretty
- So bad things happen to me

This is the result.
 
And so this conclusion naturally moves on to the next.

- I get look pretty if I get a plastic surgery
- I will be happy if I look pretty
- So, I must get a plastic surgery

The reason why our children’s perception is serious is,
They do not know about their attractive points and characteristics but also think about their negative points and are focused in trying to fix those negative points.

They need to those that their outer look is just one small part of what their identity is.

- I have certain positive points
- Those with positive points are loved by others
- Therefore, I can be loved by others

If our kids can think in such a way, they will have more rational perception on cosmetic surgery.

They will realize that the outer look is just a small part of “me”, and not everything.

If you have too much expectation on cosmetic/plastic surgery, you will rely on it even more. Such a teenager when grows up to be an adult, would have more dependence on the outer looks and also suffer from outer look complex.

2. The right perception of your looks 

The way, attitude of how you look and perceive yourself is very important. You need to have a balanced perception of your looks and should be able to judge the looks in such a way.

When you have this mature perception, you will be able to talk and think about cosmetic surgery.

I believe that each individual woman has her own appealing points.
But most women do not know what it is.

The more surprising fact is that the more beautiful a person is, she does not know what her appealing points are and what her weak points are.

Those who are not confident about their looks are not confident talking about it as well.
They just hope that they could look pretty, and do not know where the real problem is.

It is concerning that many women get an expensive plastic surgery by looking at falsely made advertisement on plastic surgery in such situation.

Cosmetic surgery only makes one of many problems that I have, better.

Therefore, one must know what my positives and negatives are by taking a step backward and observing oneself. Once you have this rational attitude, you will be “ready” to get a cosmetuc surgery.

I look so bad, I need to get everything fixed.
Why do you think that our kids think in this way?

There are three things in our society’s outer look centralism that influenced our children.

Parents criticizing the looks of the children since when they are small.
Things about the outer looks that their friends tease about such as “You, pig”.
Outer look centralism in the mass media such as TV or internet.



Just like any education, the right education needs to start at home.

"My baby, you are so cute and lovely "
This might be a start, but,

"Your eyes look so pretty, I used to like people with similar eyes ever since I was young."
"Your smile makes those who see you happy." If you say such detailed word repeatedly, your children will know that you mean it.

I think these expressions are more necessary during the maturing stage. Then your children would have more confidence about their looks and those appealing points.



"Then what can I tell my kids about plastic surgery?" This is a question that you might have.

It is difficult for the parents to be the main source information on plastic surgery to the middle school girls. It’s because the parents do not know about the plastic surgery well enough. The information that the kids get from the internet is very much comparable to what the parents have.

It is necessary that the mothers get on line and start studying about beauty surgery as well. This will help maintain subjects to talk about with the kids.

Sense of one’s identity needs to be formed,
And one should know her own appealing points,
Then, she needs to have self confidence,

in order to have an accurate, balanced, objective thinking about one’s outer looks. I think that the responsibility of the parents is the most important factor.

Today, I talked about why the teenagers need cosmetic surgery education. This is something that I felt strong about as I consulted many middle school girls these days. I hope that my thinking has been agreed by most of you, readers.

Thank you very much. Have a nice day.