[Breast Surgery Korea KIES-U]

Breast augmentation is the most popular beauty surgery in the world today.
In 2010, there were 318,000 cases of breast augmentation in US alone.



Image that shows the possibility of capsular contracture according to different incision areas. Reference: 2012 Aesthetic surgery journal vol. 32, Doctor Jacobson


The most concerning side effect after the breast augmentation is the capsular contracture. There is no confirmed reason as to why this capsular contracture is caused or formed but there are many doctors who perceive that the exterior pollutant that penetrates into the body is the cause.




Prof. Jeffrey M Jacobson, Prof. Scott Spear and others from Georgetown University in D.C. has studied results from experimenting 197 samples from 2003 to 2009.
Prof. Jacobson and his team built a hypothesis that staphylococcus on the human skin leads to high possibility of capsular contracture.

They perceived that the staphylococcus that lives in sweating parts of the body such as the armpit touches the implant as it is put into the breast leading to higher possibility of the capsular contracture. They also believed that staphylococcus infected the implant in the same way when the incision is done on the areola.

After many comparisons and analysis, the incidence rate of capsular contracture due to armpit incision was found to be the highest at 6.4%, followed by breast aureole at 2.4% and inframammary fold at 0.5%.



This result was found to be statistically significant by Prof. Jacobson’s team.

The finding was that the possibility of capsular contracture by armpit incision is 13 times more likely than the inframammary fold incision. 

Capsular contracture is not as simple as to be only explained by germs polluting the implant. How the patient desquamates the implant pocket, how severe is the bleeding, is the implant textured, etc are all variables that may lead to capsular contracture.

However, I think that this finding, inframammary fold incision leading to least possibility of capsular contracture, is a meaningful one.

Toda, we looked at the findings by Georgetown University research team regarding the different incision parts and the incidence rate of the capsular contracture.

Have a great weekend. Thank you.

Breast Ptosis Surgery, KIES-U Plastic surgery Korea

How do your breasts change after you give birth or as you get older?

First, is when most of the fat on your breast drops down and the lower part of the breast stretches.

Second, is when you lose volume in the upper breast. We call this glandular ptosis.
Please refer to the image below.

Glandular ptosis that is formed after giving birth

The glandular ptosis formed after giving birth is different from the real ptosis.

In the real ptosis, the upper breast skin stretches causing the nipple to droop also.

As you get older, both your nipple and ptosis droop downwards.

Those patients who come to the clinic to talk about the ptosis do not know if they have loss of volume, glandular ptosis, or real ptosis. Let’s look at each with an aid of the images below.

1)     Normal breast

Normal breast without any ptosis

Your skin has good elasticity and your ptosis along with subcutaneous fat are all in good condition before giving birth. (Although your breasts may be small) Your nipples are always above the lower breast line. This is very important for aesthetical good look.

The 2 images below are of a patient who gave birth to two children and thought that she had a severe case of sagging breasts. The word “sagging” is rather subjective but from a doctor’s point of view, I don‘t think that there is any droopiness.

The ptosis tissue dropped down a little and there is a loss of volume on the upper breasts so basically there is less volume on the breasts. Breast augmentation would lead to positive results for her.

Loss of volume on the upper breast after giving birth

After breast augmentation through areola incision and areola reduction

 
2)     Glandular ptosis

We can see the glandular ptosis in the image below. The nipple is positioned lower than the bottom breast line.

Droopy breasts with loss of volume after giving birth (Glandular ptosis)

But the tissue on the lower breast is stretched out, and there is a loss of volume on the upper part. Therefore, much of the skin has fallen below the lower breast line. (Glandular ptosis)

You cannot put implants on the breasts with glandular ptosis as you would on the normal breasts. You must conduct biplane breast augmentation.

Biplane requires the implant to be positioned below the pectoral muscle but the lower part of the implant has to be on top of the pectoral muscle.

Biplane breast augmentation is conducted on those patients with glandular ptosis

3)     Real ptosis

Real ptosis is caused when the skin on the upper breast loses elasticity and droops downwards below the nipple – areola.

Drooping breast with loss of elasticity due to aging and giving birth (real ptosis)

You would need breast ptosis surgery in order to aesthetically fix the drooping breasts (real ptosis). Many patients already know this but breast ptosis surgery does not require implant but involves periareolar lift.

This leads to a lot of wounds / scars therefore you need to talk with your doctor and make a careful decision.

At times you can use implant for the breast ptosis surgery as well.


This may seem awkward but ….
Whenever I conduct breast ptosis surgery I feel that the beautiful looking breasts can change after giving birth meaning that a woman needs to sacrifice her beauty for a birth of a baby. If a woman does not sacrifice her beauty, no baby would be born.…..

So I try to meet my patients with drooping breasts with most respect. I think that all mothers need the utmost respect.


Thank you.

Dual plane teardrop breast augmentation 

A lot of patients in Korea get the teardrop breast augmentation but using teardrop(anatomical) type implant does not mean that your breast would look natural and beautiful.

A lot of the doctors realized this late and therefore, now, think much about how the surgery should be performed than they used to in the past.

Teardrop breast augmentation Korea

 
Also the teardrop type is 3 dimensional and it has a lot of variety therefore one must be very careful when deciding on the width, lower line, height, etc.

My personal conclusion is that the teardrop(anatomical) type implant should be used on the dual plane. If not, this implant would not look like a teardrop.

Also, Korean patients are comparably thinner than the westerners therefore need dual plane surgery when considering the volume and the upper body fat. Additionally, one needs to consider the location where the muscle needs to be divided.

When considering all those stated above, and that most Korean women prefer to use large sized implants compared to their smaller body, dual plane surgery with teardrop type implant is a must. I will call this Dual teardrop augmentation from now on.

Below are images that will help you understand the contents easily. Let’s say that I am putting in the implant above the pectoralis muscle.

Breast augmentation, implants placed above the pectorals muscle

Performing the surgery above the pectorals muscle leads to a problem of being able to feel the implant. The skin the covers the implant is really thin and also when you give strength on your arm the muscle contracts leading to the visibility and the touch-ability of the implant.

For such reasons, the breast does not look natural although you use the teardrop type implant.

Breast augmentation, Implants placed below the pectoral muscle

When the implant is put below the pectoral muscle, the implant gets pushed outwards due to the muscle contraction and with time the two breasts would look far apart.

Dual Plane Breast augmentation surgery

But if the implant is put in the dual plane such as the one in the above image, you will not be able to feel the implant, the breasts would not move apart, and you would not have any upper block on the breast. The image below is the side view.






This type of condition is severe for the oval shaped teardrop type implant as it has 3 dimensional shape when compared to round type implant. This is why you question, "I used teardrop type implant. But why do I have a severe case of upper block? Why do my breasts look far apart? 

Most patients use large size implant compared to their body and also do not perform dual plane breast augmentation.

Let’s summarize. Korean patients are usually thin and have narrow shoulders. Also the tissue that covers the implant would be very thin and tight. If a highly cohesive teardrop type cohesive gel implant is used on such body, the implant would move about even more and cause an upper block and also make the implant feel easily.

At this point of time, there is not better method than performing dual plane surgery on Korean patients who want to use large sized implants for breast augmentation.

Dual plane teardrop breast augmentation KIES-U

This is all for today. Thank you.

Propofol_ is it necessary? (IV sedation for Plastic Surgery)

There are many negative articles on the propofol these days. It has a nick name “milk injection”.

People who are addicted to propofol, hospital that black-markets the propofol, criminal activities that take place in plastic surgery clinics with the usage of propofol are some contents that are on the news. Today, I would like to share about the use of propofol that is necessary in the plastic surgery clinics.
 
What is IV sedation.....?????

I have heard that IV sedation is dangerous. Can I not do it? There are some patients who ask such question. Also there are those who ask me to put them to sleep completely so that they do not know what is going on. Let’s looks at different anesthesia methods that are used in the cosmetic surgeries.


First, local anesthesia
We do not inject the anesthesia for the whole body but for a particular part. For example if you are having an eye surgery, the anesthesia would be injected on the eyelid. This is widely used when we conduct scar / wound reduction, skin tumor removal, or such surgeries on small parts of the body.

Second, Spinal anesthesia 
This is widely used in the obstetrics. The anesthesia is injected in the spines paralyzing the lower body so that the pain cannot be felt. This is used for abdomen / thigh fat transplantation in the plastic surgery clinics.

Third, General anesthesia 
General anesthesia paralyzes central nerves therefore requires breathing tube during the surgery. Therefore, the anesthesia and intubated. One can use the ringer solution but the breathing tube is safer.

Fourth, IV(intravenous) sedation
We use the intravenous injection with sleeping drugs for anesthesia. The most representative substance used is the propofol. If there is a respiratory problem, there would be big trouble. There is no breathing tube used. therefore, one must be aware of the anesthesia usage during the surgery.



As you can see in the graph above, if you go from sleeping stage to no breathing stage, your life becomes dangerous. This is IV sedation. So if the surgery is not a major one, then is would be safe to perform the surgery during the light sleeping stage. If you think that the surgery would be too painful and you want to sleep completely then general anesthesia is recommended.
You can find many articles to well know celebrities who abuse the usage of propofol. Actually, today, one cannot discuss about the IV sedation without the propofol.

Characteristics of propofol

1. Quick and smooth
2. Long lasting effect
3. No displeasure when awake

One can easily know why propofol is sued a lot. It has a quick effect on the body, lasts long and once you are awake, you do not feel bad.

If you watch the movie, Hannibal, there is a scene where an injection is used to make a person unconscious but there is no problem with breathing. Of course, such substance does not exist today. It would take another few decades for such substance to be made. But one can say that propofol is one that is really close to this substance. Therefore it is used a lot.

There are disadvantages of propofol as well. 
1. The injection is painful
2. Too much dosage can stop breathing (Dangerous to life)
3. Anesthesia status is not stable

However good a medicine is, it can be good or bad according to the person who uses it. Drinking can kill if one drinks it too much. It can be good for the body if you drink appropriately. Propofol is similar to drinking.

There are people with misperception. Propofol is not always good for the patient. Some do not remember anything and some feel unpleasant after using it. There are those who feel good after drinking and those who do not feel good as well.

All the substances that human make act differently from one person to another. However, there is one majority opinion.

Propofol being used as a drug to feel pleasantly good is wrong. Whether you are addicted to nicotine or drug, a human being has an ability to control one self. It is dangerous to think that one can escape the reality with the help of a medication.

Propofol is perceived to be a devil’s medication but if you manage and control the
usage properly, it is something necessary and useful. Actually, all medication are like that.

Today, we looked at IV sedation and propofol.

Thank you very much.

Choosing your implant for water drop breast augmentation 

It is not easy to make a normal person who is not professionally knowledgeable in medical field to understand what a doctor wants to communicate. I get quite surprised that my patients do not understand me.

Today I look like to share something that the patients have most difficulty understanding, making it easier for you to understand. It is about selecting a water drop implant.

Water drop implant is 3 dimensional, so you can select the implant according to 3 stages.


There are those who are quick to ask “are you not going to decide on the volume (cc)?” If you think about the three stated above, you will be able to know the volume instantly.

You will be able to know what a diameter / height / thickness are with the help of the image below.





You only need 2 parameters for the round type implant because the diameter and the height is always the same.

But you need to decide on the diameter, height, and thickness for the water drop type.

First, the diameter refers to the width of the implant. The diameter of the implant should be selected first. It cannot exceed the diameter of the breast. If the diameter of the breast is 10.5cm, the diameter of the implant should be equal or less than 10.5cm. From the 3 parameters of diameter / height / thickness, the diameter should be chosen first.

Second, the height of the implant is related to the type of the implant. The one with short height would be the ‘short type’, mid height would be ‘Normal type’, and the long length would be ‘tall type’. So one would measure the upper body and if it seems long, you would select the tall type, or if it seems small, you would select the short type. The normal type is the most common one. You will be able to understand this more easily with the help of the images below.







Third, we refer to the thickness as ‘profile’. Low profile refer to the one that is really thin, Moderate profile for normal sized one, and the high profile for something that is thick. The volume of the implant depends on the thickness.

So, if you want a large sized implant with increased cup size, you would select the high profile.

If you aren’t too greedy about the up size and want something that is more natural, you can select the moderate profile. Low profile is used if you have asymmetric breasts or sagging ones.

But, there are some who are not satisfied with the new volume although they use the high profile. So there are some manufacturers who make Extra high profile, i.e. very thick implants. Extra high profile cannot be used without much thinking. It is used for those who have thick skin tissue and want large volume.



The sizing of the water drop type implant is selected according to the following order.

1. Measure the diameter of the breast then select on the diameter of the implant

2. Measure the distance from the collarbone to the nipple and the distance between one nipple to another. Decide if the upper body shape is wide or long in height. Then decide on the height of the implant

3. Ask the wanted cup size of the patient and then decide on the implant profile

This is how we select which implant to use.

Let’s try going through the three phases for an example.

Before Breast augmentation Surgery

Let’s analyze this patient.

First, the diameter of the breast is 11cm. We can use any implant with diameter of 11cm or less.

Second, the distance from the collarbone to the nipple is 17cm. if we draw a triangle, we can see a tall isosceles triangle. This means that we can use a round base type or the tall type implant.

Third, the patient does not want to increase the cup size much. The patient did not like to have big breasts originally, but as she gave birth and breast fed her child, her breasts sagged. Therefore she wanted the upper breasts to look bigger. In such case, the moderate profile would be appropriate.

This is it. We can select an implant that is 11cm in diameter, tall type and a moderate profile.

Polytech 260cc implant has a height of 12.2cm and a thickness of 3.7cm.
Natrelle 235cc implant has a height of 11.5cm and a thickness of 4cm.
SiliMed 275cc implant has a height of 12cm and a thickness of 4.2cm.
Servin 285cc implant has a height of 11.cm and a thickness of 4.6cm.

You can select one from any of the four above. But a patient should put each of the implant inside her clothes to see the volume and check on the size.
So it is better to see the actual size in person and then decide on the volume and the size. This patient liked the 260cc after the size test.

The implant has been selected and the result of the breast augmentation is as below.

Before and after Breast augmentation Korea KIES-U

The patient has a rather long chest but this is due to the sagging breast after giving birth. You can see that the upper part of the breasts have been filled up. The patient wanted more of a natural look so she was very satisfied with the result.
In summary, you need to measure the width of the breast and decide on whether to use the oval type or the round type and finally select the thickness profile according to the volume that you want.

In reality, the selection is not as simple because there are many patients with asymmetric breasts, and the tightness of the skin was to be known. There are other variables as well.

Therefore, the experience of the doctor is very important as well.

This is all for today, have a great weekend. Thank you.