Implants for breast augmenation [Cohesive gel breast augmentation] 

Today I would like to write up details about frequently asked questions on cohesive gel breast augmentation. First, let’s discuss about the cohesive gel implant.


1. Can I use cohesive gel for my Breast augmentation surgery? 

Currently, anyone can use the cohesive gel. Saline bag type is used when inputted through the belly button or in some special cases.

Actually, cohesive gel is a product name. It has been developed long time ago. It refers to sticky silicon type implants.

Many companies are making silicone implants that remember or memorize the shape. Mentor and McGhan in US call these implants Memory gel or Cohesive silicone gel bag. Since then, many companies in Europe and South America have made such silicone gel implants that remember and maintain the shape.

Cohesive gel implant have become famous because it is made of silicone substance that is sticky therefore does not leak out if the exterior of the implant is damaged.

The cohesive gel implant was certified in 2007 by Korea’s MFDS and has been used ever since. However, it was used 10 years prior to Korea’s certification in Europe and South America.

Breast augmentation Korea KIES-U

2) I have heard that capsular contracture is not caused and one does not need any massage if she uses textured implants. Is this true? 

Mentor and McGhan (currently known as Allergan), both have textured and smooth type implants.

It is known that if the textured implant is put in above the pectoralis major muscle, there is a less possibility of causing capsular contracture when compared to the smooth type.
The incidence rate of capsular contracture when put below the pectoralis major muscle is similar for both textured and smooth type however, this rate is lower than that of above the pectoralis major muscle.

Surface of the textured implant seen through the electron microscope.

 However if the textured type is put above the pectoralis major muscle in a person with small breast or thin skin, one can feel the implant from the outside. So if a patient has small breasts, it is recommended that the implants, whether smooth or textured, be put in under the pectoralis major muscle.

Strong massaging on the textured implant can lead to soft tissue damage, therefore, this is not recommended. Dr. Findley, a well-known breast augmentation specialist in US, stated that Biocell texture that has rough texture when applied frictional force can lead to the formation of the seroma.

Mentor calls its textured implant, Siltex and Allergan calls its product Biocell
.
3) Is Mentor the better when compared to Allergan (Natrelle)? 

It is difficult to say which is better. Whatever seems familiar with the surgeon’s hands might be the better one to use.

Products from Mentor are produced and sold in sizes of 225cc, 250cc, 275cc, 300cc, categorized by 25cc.

Allergan makes its midrange profile in sizes of 222cc, 253cc, 272cc, 290cc, 322cc, categorized by 20cc.

All are good products but there aren’t enough evidence that prove the products in Brazil, Germany, France are better that US products that are used in Korea.

There are various types of cohesive gel, ie. Sticky silicone gel products, in neighboring countries of Japan, Hong Kong, Singapore and other 7~ countries, however it is sad to know that there are very limited number of products in Korea.

Mentor 275cc round smooth moderate profile put in from the armpit

Today we looked at what a cohesive gel implant is.

Thank you.

Can you see the implant in the x-ray after the breast augmentation? 

There are many of those who ask if one can see the silicone implant through the x-ray after the breast implantation.

The answer to this is, “Yes”. You can also see the saline bag type implant as well.

X-ray is a line that penetrates through the body, and the amount of penetrability determines the shade or shadow that comes out finally as the x-ray film.




Doctors are well aware of how the x-ray penetrates through a normal person’s body.
If there is a substance in the body, the shade looks different therefore, one can know that there is something different than that of a normal body.




But having a silicone implant in the body does not mean that there is something wrong with the body itself.

X-ray specialists receive training on how to look and examine the x-ray of those women’s chest that has implants.



It is very rare that they misjudge heart or lung disease, or trauma such as a break on the one because the implant covers those certain parts.

In case of CT, one discovers the implant coincidently as he/she looks for heart or lung illness, or clinical stage of the lung cancer.



One cannot get detailed information of the implant through the CT.

If you find that there is an implant rupture through the CT, then you would not need to get a MRI.

However, although you get positive result from CT, this does not mean that the implant is at a normal status.

If you want an accurate examination of your implant, MRI is the one that you need to take.





Many women are concerned about implants getting damaged due to the mammogram (i.e. x-ray) pressing against the chest as they get an examination for breast cancer.

The answer to this is that there is no actual problem in this. Such pressure has 0% chance of rupturing the implants. You do not need to worry about this and so you can go on and take the mammogram.

There are those who are concerned about one’s privacy being scrutinized as the implants may show up during the mammogram or ultrasound test.





But this is something that you need to compromise.

The reason is that there is nothing more important than health to any human.
One should not try to hide that there is a substance in the body from a doctor who needs to examine, find, and treat an illness.

If is necessary for you to let the doctor know that you have implants in your breasts whether you are being examined or treated by the doctor.

Also, there are many women who had breast augmentation with implants therefore, it is rather not awkward for the doctors to treat or examine a woman with implants.

This is all for today. Thank you for reading. Have a good night.

What is tuberous breast?

It is difficult to find a severe case of tuberous breast but there are times that I get to meet patients with minor case of tuberous breast.

Breast augmentation Korea KIES-U

I think that there are about 5% of patients with a minor case of tuberous breast.

Name and definition

Tuberous breast is a congenital abnormality.
It can be formed on just one breast or both.
During the maturity stage, you breast do not develop completely therefore forming this unique shape.

There is no confirmed reason as to why this is caused but we believe that there is relativity with the disability in accumulating collagen.




In US, about 1 to 5% of breast augmentation patients are found to have this problem but there is no prevalence rate of the whole population. Not all of these patients come all the time to have the problem fixed.

It has many names. Some call it tuberous breast and others call it constricted breast.
It is also known as tuberous breast deformity, tubular breast, snoopy share breast, and herniated breast.

Characteristics of the shape

Large and thick areola
Far distance between the two breasts
Breast hypolasia
Sagging breasts
High inflammatory fold
Narrow breast width

These are some characteristics.



This also influences one’s ability to breast feed a child. In a worst case, one’s breast might not have developed enough to breast feed a child.
However, there is no influence on pregnancy or giving birth.

Treatment

Tissue expansion method and breast augmentation techniques can help correct the breasts.

Surgery is more complex than a normal breast augmentation. Highly trained plastic surgeon needs to conduct the procedure.

I have felt that the characteristics of those with tuberous breasts are as the following, in our country.

Nipple – Short distance from the inflammatory fold, and very straight
Tight breast cortical organization
Sticking out nipple, areola
Overall, the breast is small
Two breasts are wide apart



There needs to be more know-how than just a basic breast augmentation.

The implant needs to be strong and very stable in shape therefore the implant requires to have high filling rate and high agglutinability of the silicone gel. Water drop type is more effective than the round type.

I would recommend Allergan Style 410, Mentor CPG, and SiliMed.

These implants are used to make the lower part of the breast from begin tight to loose making the breast look aesthetically pleasing for a longer period of time.




Some might think that implant going into the upper part of the pectoral muscle might have more aesthetically pleasing results but most of the patients do not have thick enough skin tissue therefore the implant is located under the pectoral muscle. Double plane surgery that helps out those with thin layer of skin tissue can lead to satisfying results.

It is better to release the lower breast tissue so that it is dispersed to make a good looking share for a severe case of tuberous breast. This procedure is more complex and requires more time.

Today we looked at the details of tuberous breast.

Thank you for reading, have a great day.

Korean made cohesive gel implant, Bellagel, and Motiva from Costa Rica 

Today I would like to introduce new implants that might be certified and distributed in our country this year.
One is made in Korea, Bellagel, and the other is from a company with HQ in Costa Rica called Motiva.





Currently there are 5 implants that are distributed and sold at our country.
Mentor from US was not a large company but it was acquired by a multinational company, Johnson and Johnson leading to a wide international distribution of its goods.






Allergan also from US was called Mcgan before and named its product Natrelle..
Mcgan implants also have long history as Mentor implants do. It produced silicone products and was acquired by many other companies in the past. Recently, it was acquired by Allergan that produces Botox. Currently it does not use the name Mcgan but uses the name Natrelle from Allergan.

Silimed’s Mentor was started in Brazil and is a top 3 company globally after Mentor and Allergan. In order to expand its presence in US, it moved the HQ from Brazil to US. Since, it has used the name, Sientra, simultaneously.

In 2012, Mentor received FDA certification on anatomical silicone gel implants before Allergan could leading to an upset over various US companies.





These are multinational companies. The rest are rather small sized.
There are various silicone gel companies in France such as, EuroSilicone, Arion, Sebbin, etc. Sebbin products are imported to Korea.




Polytech from Germany is also imported to Korea. Polytech is famous for its polyurethane coated skin (capsular contracture free) but this is not certified in Korea therefore only the silicone gel type implants are imported.





All these 5 implants are high quality ones but have their advantages and disadvantages. It is not true that a particular brand might provide continuous good result but another might not.

Getting a good result from surgery is like pressing on one side of the balloon that leads to bulking of the other side. If you focus on just one side of a problem, another side might have a new one.

I do not prefer a particular brand over another. I select and match an implant according to the body shape, and chest of the patient.



When the patients ask “which brand is good?”, I always give the same answer that one should choose the implant according to the condition of the breasts.

Local implant is produced by Hans Biomed and the developing time was about 12 years. Hans Bio is in KOSDAQ and is financially stable.

Bellagel is not in the market yet, but has been exported to Latin America and other countries for the past 2~3 years.

I have high expectation for Bellagel in that since the HQ and the manufacturing plant are in Korea, the company would be able to communicate a lot with the doctors that might help with the development of the product.




Also all of the products imported to our country have been from the western countries therefore it was not perfectly fitting to Koreans or other Asians. Now, more fitting implants can be produced on the basis of data of Korean patient bodies.
There would not be other problems such as A/S or stock due to different demand in size.

However, one concern is that the implant is put into the body for the lifetime therefore a doctor needs to have long enough experience with the product to recommend and use it. But, nobody has any experience with Bellagel.
The history of the product is rather short, therefore, require more time to be applied on the patients.




Motiva from Costa Rica is under the veil. We do not have any information on when the product was developed, which doctors have used it, and what the advantages or disadvantages are. I am not sure such a product needs to be certified at our country.
I think that some clinics would promote this product by stating that it has an indicator on the product therefore one can know right away if there is something wrong with the product.

But as stated earlier, Motiva is an implant that needs to be in the body for a lifetime, therefore, it requires much time and experience to know the advantages and disadvantages of the product.

It takes more than a day or two for the doctors to try different methods, apply the implant to a patient, gather structure data, to find out the advantages and improvement points.

If you say that this is a product from Costa Rica, that you have not used it in the past but recommend it to the patient, do you think that the patient would like to try it?
I would not. It would be difficult for me to recommend such a product.




Today we posted on cohesive gel implant Bellagel from Korea dna Motiva from Costa Rica. Thank you for reading.
Have a great day.

Do teardrop(anatomical) type implant rotate (turn upside-down)? 

I would like to quote findings of Prof. Heden from Karolinska University in Stockholm, Sweden.

"From 1995 to 2009 we implanted close to 12,000 (minimum of 6,000 patients) AHCSI implants (teardrop type implants)........ Infections were caused in 1.7%, seroma in 0.6% of the cases. Infections are found mainly in the combined mastopexy augmentations.

Rotations have been seen in the teardrop type implant at 0.42% but have been an uncommon complication."

Scott L. spear, Surgery of the Breast. principles and Art. 3rd ed. 2011. pp.1344




Prof. Heden is one of the most well-known experts in teardrop type implants. He perceives a technique in making accurate desquamating location for teardrop type implant to be very important. This means that if the “teardrop type implant pocket” is made in the correct position, there is no possibility of rotation.

Let’s refer to Prof. Elizabeth Hall Findlay as well.
Prof. Findlay is another expert in breast augmentation who has been in the field all her life time. Prof. Findlay found double capsule and late seroma, and studied them.

Breast augmentation Korea

When strong texture implant gets physical exterior trauma, late seroma is formed after a year of the breast augmentation. In this case, the breast would swell up severely and after an emergency surgery that involved removing the seroma, one found that there was a double capsule at the point where there was a water buildup.

Much seroma would stop the implant sticking on the surrounding tissue. Therefore, the teardrop type has higher possibility of rotation.
But, late seroma is not common. Infection, hematoma, trauma, or breast cancer would lead to such a problem.


If there is much space, then the implant would rotate. If the pocket fits the implant well, then the implant cannot change its shape or position. But, round type would still rotate.

Breast augmentation Korea

If the implant sticks properly onto the surrounding skin, it would not rotate easily. All implants are textured so that they do not move about. If there isn’t good texturing, or the implant is from some bad company, or if there is much blood around the implant, then the implant may rotate.

What is the problem in moving about frequently?
We looked at Prof. Findlay’s findings above that late seroma is caused when there is a trauma on the aggressively textured implant. This can cause the rotation or the movement but this is really uncommon.

If the breast with an implant gets a lot of trauma or physical irritation, the implant loses its stickiness therefore causing seroma or hematoma that leads to the rotation or the movement.

Breast augmentation Korea

There are some cases abroad where the husband touched the wife’s breasts too aggressively that has led to seroma formation and reconstruction. The doctor found that there was a rotation in such case.

But other than this, if the woman does not do any UFC like activity, or if she is not a stunt woman, there shouldn’t be any trauma that causes such problem.

Although there is much movement of the pectoral muscle, if the implant pocket is made properly and if the stickiness is appropriate, there shouldn’t be any problems of rotating or moving about of the implants.

Once the silicone implant gets inside the body, a strong and tense barricade is formed around the silicone exterior. This is due to the immune reaction of the body, therefore, one cannot avoid it. This barricade is the epithelium. The epithelium surrounds the implant in 2 to 3 weeks. This epithelium that surrounds the implant is very strong and tough. Therefore, it is meaningless to massage the breast after this epithelium is formed in 2 to 3 weeks of the breast augmentation. Massaging would not avoid the epithelium.
The width of the epithelium would influence how much pocket space is formed for the implant and the textured surface of the implant sticks to this epithelium. Therefore, one should not conduct any rigorous activity but restrain body movement for 2 to 3 weeks after the breast augmentation. Rigorous activity can obstruct the stickiness causing possibility of the implant rotation.

Breast augmentation Korea

There are many patients who are concerned about the rotation of the teardrop type implants before the breast augmentation.
But, if everything goes, well, the rotation would not happen.

First, the doctor’s technique in desquamating the pocket that fits the implant perfectly is most important.
 Pocket that matches the implant needs to be formed to order to avoid rotation or the movement of the implant.

Second, one must avoid any repetitive trauma on the augmented breasts. This is not any trauma but one that may separate the implant and the skin tissue..

Third, one must restrict body movement / activity 2~3 weeks of recovery. Basic normal activities and stretching are fine, however, one should avoid any activity that requires a lot of strength so that the implant positions and sticks properly.

Today, we looked at the cause and solution to how one can avoid implant rotation. I hope that the contents have helped you.

Have a great day.