There are many types of breast reduction. Breast augmentation is differentiated by incision spot and the location of the implant, but breast reductions changes the shape of the breasts completely therefore there must be numerous types of the surgery.
I would like to start off by sharing on the simplest method. It is the fat removal surgery(Liposuction).



First, you need to think about if the breast is only composed of fat. There isn’t only fat in the breasts. There is skin tissue that produces the mother’s milk and there is the fat tissue.

If you need fat removal (liposuction), this means that you have much fat on the breasts. If you do not have much fat, there would be no need for fat removal (liposuction) at all.
Let’s say that you have large sized breasts. Do you need fat removal or not? How can we tell this? If you are thin, then you would not have much fat. Let’s say that you are thin but have large breasts. This is a very rare case. Most patients with much fat tend to have large breasts.

If you are young, have much fat and large sized breasts or if you gained weight all of a sudden and your breasts became large, then fat removal (liposuction) would be a good recommendation.

The good reason for removal (liposuction) on young patients is that is that their skin has much elasticity therefore, if the components get reduced the skin reduces as well and become very tight. If there is no skin elasticity, the skin would sag.
As you get older, the skin tissues disappear and the fat gets formed. This naturally would make you good for removal (liposuction). If you are old and have large breasts, there is a high change that you have lost skin elasticity. If we only apply fat removal and nothing else on older patient, then there is a high possibility that your breasts would not look pretty.

So if you are one who completed breast feeding and have sagging breasts, fat removal (liposuction) would not be enough but you would also need to reduce the skin.



We could conduct both at the same time or set-up a different date for the skin reduction.
Whether the fat removal (liposuction) is helpful or not depends on the patient’s age, pregnancy, weight gain, fat ratio, etc. If these are not enough, then we can conduct ultrasonic test. Ultrasonic tests can let us know the amount of fat in the breasts.
This decision method would be as below in the image.

If you want fat graft and have large breasts,



Then, how do we conduct skin reduction?
Skin reduction is similar to designing normal breast reduction. The only difference is that in normal breast reduction, we remove the breast fat and skin tissue together reducing the weight of the breasts. But the fat removal (liposuction) involves removing the fat first then measuring the skin tissue left and deciding what to do.
We call this complex fat removal (liposuction) breast reduction. One of the best options that we have in reducing the large sized breasts is fat graft.
Normal fat removal (liposuction) on young patients (aged in 20~30’s) with much fat or much breast skin tissue can end up with good results.




Older women (in their 40’s) who have less elastic skin must get complex fat removal and breast reduction together.
We need to consider such characteristics of the patients in order to apply different method to most effective breast reduction.

Today, we shared about fat removal and breast reduction.
Thank you for reading.


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About breast reduction

Today, I would like to share about breast reduction and things to consider.



1. What problems lead you to take the breast reduction surgery?

For most patients, the breast reduction is needed for cosmetic reasons and also for functional reasons that help with the daily problems.
Most young women want breast reduction for cosmetic reasons, because they do not want to be criticized for the breasts that they have.

For older women, they feel pain on the neck, back and other parts of the body. They feel like they are carrying something really heavy.
Breast augmentation and breast reductions belong to two separate categories.
Breast augmentation is 100% cosmetic surgery. Breast reduction involves daily problems that the patients have.



There are more older women than younger ones for breast reduction. As you get older, fat tends to build up in the body. After pregnancy and breast feeding, the skin tend to sag therefore if you have large breasts, you might want to get rid of the heavy fat completely.

There are two sides to breast reduction. One side is about young women wanting it for cosmetic reasons, and the other is older women wanting it for functional reasons. Also, the older women do not like the “weight” of the large breasts due to the inconvenience that they face daily therefore wanting the breasts to become smaller.

2. Past illness and heredity

Breast reduction is no small surgery. It is not big one also, but all the doctors conducting this surgery would say that it is somewhat big one. Why is that so?
There are much bleeding involved and there are much damage to the skin tissue. It is very difficult to design and it also results in large wounds. If you have problem with blood coagulation then you cannot get the breast reduction done. If you have high pressure, diabetes, or any past illness that do not help out in healing the wounds, then you should avoid this surgery. You need to take care of all these illness before you plan for the surgery.

There are some who think that the large breasts are hereditary.
You do not need to worry about this. The size of the breasts no only depends of heredity. There are also factors involved.

The nutrition during the maturity stage, hormone level, body weight, fat percentage, etc are all important in deciding on the size of the breasts.

3. When is the good time for breast reduction?

There are three important times on when you can get the breast reduction. First is during adolescence when the breasts start to become big. If you have too large sized breasts, with much body weight and stiff body, you would not feel comfortable around your friends.

If this becomes really bad, you might want to avoid people around you. In such time you might want to have the breast reduction. But for most patients, then wait until they are 16~18 years old when the maturing gets completed.

Second is during pregnancy. As you go through pregnancy, giving birth, and breast feeding, the breasts go through many changes. The breasts get bigger when you are pregnant. They get smaller after the breast feeding but the shapes do not go back to the original state. This varies from one person to another, but they are more cases when the breasts get bigger. But there are those whose breasts become smaller if the original breasts were very large. In some cases, the breasts loose elasticity and start to sag.

At this time, most patients talk about getting breast reduction and correction for the sagging breasts. So the surgery plan after pregnancy are mostly about reduction + sagging correction. Most young patients have good skin elasticity but they are very sensitive about the wounds. For such case, you can also consider fat graft.

Third, is related to weight change and fat. As you get older, your body loses muscles but gains more fat and weight. Your breasts also lose its original tissue and gain more fat. The breasts also lose skin elasticity. Therefore, most women have the need for breast reduction during this stage. Weight gain and aging that lead to large sized breasts could become a personal complex on women. The surgery at this stage would require to minimize the fat and reducing the breasts.

Tiredness from the age of the person and size of the breasts build up on the neck and back of older patients. Therefore much fat and skin tissue get reduced for them.

4. Does breast reduction have any influence on breast feeding?

Many might this that breast reduction involves the reduction of skin tissue and breast tissue therefore influencing the breast functionality of breast feeding. But there are reports in US that breast reduction does not have big influence that lead to stooping of breast feeding. But if there is much damage to blood vessels and other circulation function, there might be some negative effects on breast feeding.

5. How about breast cancer?
There are no evidence that breast reduction have any effect on mammogram or ultrasonic tests for breast cancer. You just need to check for breast cancer before the surgery and after the surgery as part of your routine check-up.

This is all to breast reduction. I hope the contents have helped your understanding.
Thank you.


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Composite breast augmentation Korea KIES-U Plastic surgery

Hello everyone. Today, I would like to share about composite breast augmentation.
This involves using the implant for augmentation and using fat to cover up the implant to make the breasts look more natural.

If you see the internet, you would be able to find some words on if the clinics make the patients choose between “implant and fat graft”. There is a clear classification between the two therefore if it difficult to say which is better than the other. Fat graft has longer history than implants. Czerny already conducted a successful transfer of a lipoma from the buttock to the breast in mid 1800’s. Fillers were used on the breasts from early 1900’s. The silicone implants that we use today were first developed in the 1960’s.

Fat graft is good in a way that you are using your own fat but it is difficult to know the engraftment success rate therefore, there is no unity in how the result would be. Using implant can lead to expected results but it is a foreign substance therefore your body reacts to it that could end up in complications. Therefore we can apply the two together to cover up each other’s weaknesses.

We can make a pocket and put in the implant. We can inject the fat into the breast envelope (tissue cells that cover the breast). This could be done as one stage or in two stages. I would recommend two stage procedure but most patients prefer the one stage procedure.

Then, how can the composite breast augmentation be applied?

Most patients who want breast augmentation have low level of BMI. Those patients who are thin or somewhat average tend to want the breast augmentation. If an implant is used on a very thin person, then others would recognize this easily. As the ratio of implant thickness : breast envelope thickness becomes bigger and bigger, there is a higher possibility that the implant can be seen from the outside and that there would be rippling and separated breast deformity. The breast envelope is as below.



Thin person using large sized implant would have more possibility of having the problems stated above. But, if you have large original breasts or if you use small sized implants, you would not experience such problems.



There are patients who want revision surgery due to separated breast. Also, you can see on the internet that those with separated breast have less fat between the two breasts.



An implant is a foreign substance. If the gap between the implant and the breast skin is not filled with fat, then there will be more edged look on the breasts. This leads to shadows and more artificial look of the breasts.



This unnatural look can be avoided by minimizing the size of the implant. But if the implant size is too small, then the goal of breast augmentation cannot be achieved. This is why it is better to use fat and implant together. We call this composite breast augmentation.

First, we need to exactly measure how much fat to inject after inserting the implant.
The engraftment is really important in fat graft therefore, a certain amount of fat must be injected for the engraftment rate to increase to maximum possible level. Usually about 500-700cc of fat is collected. When you remove the impurities, about 100-250cc would be left to use.

Cellular fat graft method is mandatory and the surgeon must be careful in carrying out the collection properly with no damage and no pollution on the fat. There are people with less fat in the upper body compared to the lower body (lower stomach, thigh, buttocks, etc). Those who do not have much fat in both upper and lower body cannot apply this composite breast augmentation.

The fat should not enter the implant pocket, but be injected from many direction to fill the gap between the envelope and the breast all evenly.
 


The fat used not for the purpose of making the breast look larger, but to cover up the implant for more natural work therefore the fat is injected on the margin of the implant and the boundary of the breast.

The fat used can slip downwards therefore you need to use correction bra after the augmentation. The correction bra helps hold the fat from slipping downwards.

Does the composite breast augmentation have any complications?
The most common one is the Touch-up. This means that there can be follow-up surgeries. The engraftment rate of one-stage fat is not as successful therefore we would need to inject more fat into the breast boundary after a few months.

The possibility of capsular contracture is about the same as when you only use the implant. The same applies for infection/inflammation.
More complications can be followed on the fat collected spot if you take out too much fat.

Composite breast augmentation is simple and it has many advantages. It is very effective for thin person to cover up the unnatural look that can be had from using implants. If is good to apply when you are thin but want to have large sized implant. It is also good if you want to change body line in the lower body (stomach, thigh, etc).

This is very effective if you want to correct some unnatural look on the breast or if you want to fill up the volume in some spot of the breast.

Today, we shared about composite breast augmentation. I hope you find this helpful. Thank you.

Hello everyone, today, I would like to share about cellular fat graft.

Fat graft has 100 years of history. In the early 20th Century, Eugene Hollander wanted to retain the lost sink hole type fat on the breast and conducted fat graft for the first time. (1912) Ever since, injections were used for fat graft more and more.



US had the most advancement in fat graft. The breast augmentation was very popular in US and at first, fat graft was mainly used for breast augmentation. However, the doctors realized that the injected fat did not last for a long time and turned their attention to implants.

In 1987, ASPRS announced that fat graft would influence of having breast cancer and pushed for a ban in fat graft for breast augmentation. Since then for about 20 years, there were no practices of fat graft.




In 2000, Prof. Sidney Coleman from NYU announced findings on his study on fat grafted patients. The finding was that fat graft can have enhanced prompt engraftment and there is no problem in detecting the severe case of seroma.

There were many critics that were already expected and in 2009, ASPRS retracted the ban on the fat graft for breast augmentation. ASPRS accepted Prof. Coleman’s findings.
Prof. Coleman’s fat graft gained momentum.

He became a pioneer and his technique called “Coleman technique”, which involves low pressure fat collection, centrifuging, 17 gauge thick pipe injection, became a standard for fat graft worldwide.
The official name for Coleman technique is “Structural fat graft” or “Coleman System”.



Much time passes since then. Doctors all over the world studied the effectiveness, safety of fat graft and the methodology in detail as well. There were many doctors who judged that Coleman technique was good and retained it, but there were many doctors who believed that the technique had to be changed.

Then in the early 2000’s, Plastic surgery team from Pittsburg, US finds out about ADSC. It finds out that fat is the largest storage module for stem cells. This was the most innovative turning point in fat graft technique development.

The history of fat graft is divided between before and after of this finding on stem cells. In WW1, the soldiers with facial damage used fat graft for treatment that resulted in very positive end but nobody know how that had happened.



Today, many doctors think that ADSC has expedited the growth of stem cells.
In 21st century, we accept that there are 2 large concepts to fat graft.

First is the “filling” and the second is “cell growth”. When you get fat from somewhere and inject it to another spot, the fat must be preserved in an undamaged state and engraft filling up the wrinkle or breast. There is 1 million stem cell per ml of fat and this must be preserved properly and injected. There must be both “filling” and “growth” effect achieved in this process.



Then what is the methodology? Traditional fat graft method is made with a few changes. Fat graft should not be perceived to be just for “volume up” but maintaining the state of the cell and leading to cell growth. We call this cellular fat graft. This is the biggest attractive point of fat graft compared to filler injections.

1) Fat can be collected from any part of the body; Stomach, thigh, waist, knee or elsewhere. There is no fact that fat from a certain part of the body is better than another. Fat should be collected from the body part that has the most fat.

2) Recompressed fat collection is the basic method with the usage of injection (Do not use any mechanical equipment)

3) There is no evidence that centrifuging is necessary for better engraftment. Do not enrich the fat cells but let them swell down naturally. Both the surrounding environment and the fat must be well preserved.



4) Fat collection should be done as quickly as possible. One must meet quick freezing conditions if wanting to use frozen fat. Therefore it is dangerous to use any normal freezer for such case.

5) Fat engraftment cannot be enhanced with the help of using stem cells or medication. It is important how much fat can be used and live to grow in the new spot for better engraftment.



6) Most people to not apply more than 100cc of fat on midface. About 30-40% get engrafted permanently.

Today, there are many patients who are interested in filler. The process is quick, cheap, and there are no complications followed.

But this commercial purposed filler cannot be injected too much into the body as it is a foreign substance. Also it causes some damage to the skin.

Also there is no connection between filler and cell growth. It is not effective for anti aging. You could say that it is currently in a transition period.

Fat graft involves moving fat from one part of the body to another so if there is no engraftment, the fat gets removed. Condensed substance such as filler tend to build-up together therefore cannot be removed at times.

Also, as stated previously, stem cells have the ability to reproduce damaged cells.



There are some discussions on whether fat stem cells can lead to anti-aging. We do not have the medical ability to avoid aging, but we can expect the stem cells to help in reproducing the damaged cells on the skin.

One example can be skin damage from ultraviolet. We expect that stem cells could help recover the damage skin. It may not be rejuvenating but there are certain expectations.
'Cellular fat graft' has two goals of filling up the volume and recovering the damaged skin tissue.

It is not important to control the state of the fat in some way, but it is more important to maintain its natural state without any damages for engraftment. Exact amount that can be engrafted on the face or breasts much be used and the injection needs to be quick as the fat should not be contaminated or damaged.

The main objectives of Cellular fat graft are recovering the damaged skin tissue, anti-aging through filling volume and improving the shape. Another goal is to enhance volume through high engraftment level in breasts or buttocks.

This is all for today. Thank you very much.

Some characteristics of microtextured implants

Hello everyone. Today I would like to share about the characteristics of microtextured implant along with its advantages and disadvantages.

1) What is microtextured implant?

Texturing in implant is uneven surface where the skin cell can grow into. The purpose of texturing is to avoid capsular contracture. As the tissue cells grow into the surface without any uniformity, we can avoid the development of strong and tough capsule.

The only surface that truly avoids the capsular contracture is the polyurethane. Silicone texture was made in order to do what polyurethane can achieve. You can see this in the image below.



This is an endoscope image of polyurethane structure that is complex and maze looking like. The body has its tissue cells grow into the spacing in the structure. No matter how good the texturing is on the silicone implant, it cannot be as effective as the polyurethane when the tissue cells grow. The silicone texturing has some level of smoothness therefore there is a limit to how much the tissue cell can grow into and ending up with just sticking effect.

The most representative texture surfaced implant is Allergan’s Biocell. It has the roughest surface and the depth of the texture is few hundred micrometer making the tissue cells grow into it. Other companies applied other methods in making the texturing. Mentor made Siltex texturing product but it has less rough and smoother surface compared to Biocell.

But European companies made smaller textured products. The sales were not good and they were not popular. French companies such as Sebbin, Nagor, and EuroSilicone continued to make such products. These companies made products with texturing that is 2 digit micrometer which is not comparable to Allergan or Mentor’s products.

It is difficult to make out if there are any texturing on products from Motiva and Arion. Such products rather have smooth surface instead.

Reference : SEBBIN homepage

2) Why was microtextured implant produced?

As stated in Sebbin website, the microtextured product causes less friction when inserted into the pocket. It also was produced to avoid any scar making activity and to minimize the incidence rate of capsular contracture.
But such marketing and production does not take place in France. Microtextured products are not popular in US or Europe.

There has been much variety of implant products and new products have been launched in the market for a long time. From all those new products, only 1/10 had much success in the long run. Then can microtextured implant stay in the market for a long time?

Nobody knows that answer to this question yet. We need to wait few more years in order to know this. The history of implant is very long and interesting. Once the implant gets inserted into the body, it remains in the body for a long time. When there is a class action lawsuit, the manufacturer can go out of business instantly. This is why the manufacturers focus more on safety rather than innovation.

The opposite of microtextured implant is macrotextured. It is a silicone implant with surface that has characteristics similar to that of polyurethane. Polyurethane is the only type that has success in avoiding capsular contracture, therefore macrotextured copied this concept. But as time passed, many problems started to arise.
 


World known breast augmentation specialist, Dr. Elizabeth Findlay found problems of double capsule and seroma. The largest company in the world with macrotextured implants is Allergan and this company suffered much damage. Many researchers supported by Allergan published critics to what Dr. Findlay discovered.

As times passed, Dr. Findlay’s findings did not suffer any weakness but gained more momentum with other findings that followed. There were many Me too! Me too! findings. The finding that macrotextured implant resulting in double capsule and late seroma became more firm and solid.

Also, recently there were findings that macrotextured implants were related to severe case of lymphoma. Smooth type implants gained more popularity in US and many questions on texturing products arise in EU. Microtextured products do not have much texturing therefore, are much close to the smooth type implant. With many critics focused on texturing implant, maybe there is a chance for microtextured product to gain some spot light.



3) Advantages and Disadvantages

The advantages are that it can be inserted easily, feels good when you touch it and that there is no disturbance on the skin.

We still need about 10 years to know if it causes capsular contracture less or more. There are not much sufficient data yet. Tissue cells not growing into the surface means that the implant cannot stick to the skin. There is not much difference compared to the smooth type implant in such regard. What is the collapse rate of microtextured implant? We do not have much data on this as well.

4) Then for what cases is the microtexture implant good?

I recommend form stable (round or anatomical) implant to those patients who gave birth, lost skin elasticity, or need to fill up the upper volume.
I recommend smooth round type implant to those patients who are young with tight skin and want soft feeling on the breasts.
I think that microtextured implant could be recommended for the latter as well. There is not much difference in the surfaces of the smooth round type implant and microtextured implant.

Also, the microtextured implants introduced in Korea have much viscoelasticity. So when you touch the augmented breast, there is that more feeling of stickiness which many patients prefer. But such viscoelasticity does not help avoid rippling or enhance form stability. There is no data that state viscoelasticity helps provide better feeling in the long term.

In conclusion, microtextured implants require much research in the future. When data are gathered along with many clinical testing from the doctors, we can provide you with more accurate findings.

This is all for today, thank you for reading.


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