Hi. I'm Dr. Lee.

Today I'll write about the details of the topic, 'how to choose the breast implant size for augmentation mammaplasty'.



Last time I mentioned breast width has supreme importance for choosing the size.
But another important factor is the breast envelope.

For some patients, it is not difficult, nor problematic, but for some patients, it is very difficult and problematic.

Let me compare it to space of a house.
The actual area of a house fits for just 4 persons to live in.
But if its space was applicated very well, there could be room for additional persons. 6 or 7.
These ideas have parallels in breast augmentation surgery - the extensibility of breast envelope.




If one's breast envelope is stretched very well, then a big size implant can be inserted easily, and the shape must be natural enough.

If one's breast envelope is very tight and tense, then a big size implant will not be available even for a big-built woman, and the shape must be unnatural.

What is breast envelope?

It is the covering tissue of the mammary tissue.
That is, skin, subcutaneous fat, muscle (pectoralis major), and fascia.

These tissues cover the underlying implant.

Breast envelope goes looser with age, less tight, more stretchy.

Other factors related to the stretchy breast envelope are  as follows ;

Number of delivery.
Massive weight loss (10~20 kg)
Big breast

Breast feeding is not yet established as the culprit of the saggy breast but could be considered as that of stretchy breast envelope.

If a breast augmentation surgery candidate is very young and has no history of delivery, the breast envelope  must be very tight.

It does not stretched well. The surgeon has to struggle to insert something under it.

If a candidate is aged or, has many children, with saggy breast then generally the implant volume could be very big. The envelope would be well stretched and the insertion process might be easy.

In these cases scar would be vague because, a bad scar is made when there is strong  tension between the opposite side of the wound.




But the size should be adequate even for these people because, if the implant is very very big, the weight of the implant must be very heavy and it can stretch the envelope too much. That condition could result in a saggier breast.


Big-built woman (wide breast width)  with  loose breast envelope, can have very big implant.

Small-built woman (narrow breast width) with tight breast envelope, should have smaller implant for natural - looking breast.

If a candidate for the surgery is small build but the breast envelope stretches well, then she can use bigger implant than expected.




That's it for today.

Thanks for reading and have a great day.

So many people are asking this question. today's posting is the answer,
When can I golf after the breast augmentation surgery?

Let's think about the muscle contraction during the golf swing.
For a right handed golfer, right triceps muscle, trapezius, and various forearm muscles would contract during the back swing. Left arm would just follow, this side muscles would not contract strongly.

Both pectoralis muscles - the directly related muscles with implants - would not contract during back swing.

During down-swing, left triceps and forearm muscles would contract and right pectoralis contract but not strongly.



Unless the golfer is a beginner, both pectoralis will never contract strongly.

So, the possibility of implant rupture by the muscle contractile power during golf swing looks slender.

But golf is not just strength.  The stretch of body can affect the postoperative breasts -  during the swinging movement, the golfer's shoulders and arms can push the implant here and there.



Thinking about it, during back-swing, the left side implant could be squashed by the left upper arm.

After the impact, during follow-thru, right side implant could be squashed by the right upper arm.

But, the pressure is not severe. The pressure severity of golf swing on the implants would not enough to affect the position of them.

One exception is saline implants which already have leakage. A lady pro golfer had taken re-operation surgery 7 years ago because of the ruptured saline bag.



I do not think the swinging power brought the intact saline bag to rupture, but the swing could allow the leakage - by other causes - just faster.

Saline bags are not as sturdy as the cohesive silicone gel bags. If  a pin-point hole on the surface had arisen, then saline would leak out, and the leakage would not stop until it is completely deflated.

But it is nearly impossible for a golf swing movement or muscle contraction for it to break nor move the cohesive gel silicone implant.


Human body makes a barrier against the silicone implant right after the operation.

The barrier is called capsule. And it takes just a few weeks for the capsule to cover all around the implant. Once the capsule completely surrounds the implant toughly, then it is very difficult to move the implant out of the original position. So you can golf roughly 1 month after the operation.

But it is different from case by case. I recommend you to return to your swing step by step.
One day half swing, and next day more than half swing, ....... and at last, if you think can do that, then full -  swing!
Don't overdo yourself, take your time.

That's it for today, Thanks for reading.
Have a great day.

Question ; I want breast augmentation with anatomical implant through the armpit. is it possible?

Answer ; It is possible. But not for every patient, not by every surgeon. It can be done for selected patients and done by qualified surgeons.




The anatomical implants are designed  to have orientation and direction. The lower part is thick and upper part is thin. That nature makes it easy to insert them through the lower part of the breast, but difficult to insert through the upper part. 




I think we had better review the  pros and cons with the incision approaches.


The operation time is delayed when the incision is armpit because, it has no visual and the endoscopy is always needed.

Both surgeons and patients are worried about the rotation problem with the anatomical implant inserted through the  armpit.

Anatomical implants have embossing on its center part, so the surgeons can just see that to confirm the position when the approach was areola or under breast line.
But when it is armpit, surgeons cannot see that.
So they just grope for the embossing of the anatomical implants.

There is no way to 'confirm' that it is not rotated.
And we don't have enough data for the rate of rotation of tear drop implants after the armpit breast augmentation surgery. (on the other hand, numerous data are available for under breast line approach surgery and the rate of rotation.)

If the breast shape is normal, not ptotic, not constricted, and no other bad condition, a qualified surgeon can do it (armpit surgery) very successfully.

So armpit anatomical implant insertion technique is possilbe, but the first choice is, under breast line incision.

That's it for today.

Thanks for reading, have a nice day.

To explain this term, 'capsular contracture', I think we have to talk about the 'capsule' - in relation with the breast augmentation surgery - first.


The human body reacts with almost any kind of foreign materials, including silicone, and as a result it makes a wall, an immune reaction.

This barrier is called capsule.



It takes a few weeks for the human tissue to form a capsule around the whole implant.

Capsule creation itself is a normal process. It must happen to everybody.

But if it is closing up the implants, then it can make a problem.

When the capsule tightens the implants, this condition is called 'contracture'.
Not everybody experiences the capsular contracture after the operation.

If it is closed up very tightly, then it can compress the implant, make the breasts deformed, and make the breasts harder and harder.

Capsular contracture is like a wound healing.

The human body would make a scar with any wound.

Some used to have a very bad and big scar, and some will not.

Unfortunately, nobody can predict whether it would happen or not, before the surgery.



Quoting a data from 'plastic and reconstructive surgery', an authoritative journal,  an expert surgeon in USA reported the occurrence of the capsular contracture had been only 0.7% from 1664 patients - breast augmentation surgery - for 7 years.

On the other hand, a report presented to FDA by Mentor and McGhan, the implant manufacturer, had the data about the  capsular contracture  rate, it  had been 9%.

So you can see how different the result is between the surgeons.

The capsular contracture is one of the main reasons for the unsatisfactory results and reoperations of the numerous breast surgery.

And both the surgeons and the patients hope to avoid it because,  it is one of the most serious problems of this surgery.



But How?  Isn't there any way to avoid it?
Definitely there is the way.

In my opinion, the means to sidestep the capsular contracture is, a trauma-free and nearly bloodless, delicate technique of surgery.
Because  the contracture is a phenomenon of a hyper-reaction against a foreign material.

But it is not easy.
A nearly trauma-free surgery can be achieved only by a well experienced, expert surgeons.

Patients could attain very fast recovery and return to normal activity very soon after this surgery.

If the patient has so much pain after the breast augmentation , get drainage so long time and have much discomfort, then it means there was much damage to the normal tissues, and  the capsular contracture rate could be higher.

So that's it for today's posting.

Thanks for reading and have a great day.