Breast Surgery To Know List 4.
Deciding on the Breast implant size

There are many posts on how we can decide on the size of the breast implants. Today, I would like to summarize the core contents with this post.




Before the doctor would see the patient and say “You would need xxx cc.” This was about 7 to 8 years ago.
But today, this process is different. There are several stages on how we go about in choosing the right breast implant size.

We usually use the below 3 stages.
 
1. Upper body measurement
2. Implant fitting (T-shirt test)
3. Sizing while conducting surgery

I will go in detail for each one of them.

1. Need to get upper body measurements in the first consultation with the surgeon

You need to take different measurements but the most important one is the width of the original breast.
The average width size of those patients (those in 20’s ~ 40’s) who come to have breast augmentation surgery is about 11 cm. If the upper frame is big then this width size is big. If the upper frame is small then the width is small also.
The greater then growth amount in the breast, the wider the width is. So if the original breast is small then the width is small as well.




The width of the implant depends on the width of the breast. So if the width of your breast is about 11 cm, we would choose an implant with width of 11 cm or less.





But there is another part of the body that is as important as the width of the breast. It is the extensibility of the breast tissue
There are those who have elastic skin, tissue, muscle, fat that surround the implant, and there are those with less elastic parts of the body.

The younger the patient is, before giving birth, the skin on the breast does not stretch out as the skin is less elastic.
As you get older, and give births, the skin becomes easily stretches therefore, losing the skin elasticity.

If the skin is tight and does not stretch easily, then it is difficult to use wide implant.

In opposite, if the skin stretches easily, then a larger width implant can be used.





Therefore, we decide on the size of the implant by measuring the upper body, i.e. the width of the breast and the skin elasticity.

This is preliminary, and is not the final decision.

2. Implant fitting (T-shirt test)

 
How big should the implant be in order to make my breast bigger? A question as such can be answered easily by fitting the implant just as you try different clothes when you want to buy one.

The size of the breast is very subjective and also the satisfaction survey of breast surgery is very subjective as well. So, it is important to check the breast size after the surgery although she knows how much cc implant has been used. If the patient is not satisfied, then this is not a meaningful event for the patient.
Let’s imagine that you are buying a dress.
There are those who think that size 44 is too big.
There are those who think that size 66 is too tight and small.






This is the same with the size of the breast implants. There are those who think that 200cc is too big and those who think that 400cc is too small.

The subjective feeling in choosing the size of the breast implant depends on the size of the upper body, not the absolute number in the size of the implant (cc).

It is not always the case that the size of breast implant chosen at the first stage of upper body measurement would be the same as the size that the patient wants.

So the surgeon prepares the implant that is recommended size and another with the size that the patient wants. There are many variables during the breast augmentation surgery and the size might look differently while having the surgery.

3. Sizing while conducting the breast augmentation surgery

Final decision making is done during the breast augmentation surgery. The measurement size and the patient wanted size are just references sizes for the implant.
During the breast augmentation surgery, we make look for the implant and fit in the implant imitation to measure again which size is the most appropriate one. We call this, sizing.

If the diameter of the breast is about 10.5 cm, and the patient wanted 270cc implant however the recommended size was 290cc, we would prepare all implants from 250cc to 300cc before the start of the surgery.

During the surgery while we test different sizes and decide that 290cc is appropriate, we fit in the 290cc implant into the breast.

In opposite, if there is enough room for the implant but the skin does not stretch so that the 270cc implant cannot fit it, then we used 250cc~260cc implant for the surgery.





There are some patients who visit various clinics but decide on the one that will use the implant with the size that the patient wants.

But, this could lead to trouble in the future. The young patients are too focused in wanting larger breast compared to what the body can take therefore, demand more volume rather than what is appropriate for the body.

We cannot decide on the size of the implant with just the first interview with the surgeon.
As we have stated earlier, there are many stages that are involved in deciding the size of the implant and the final decision is made in the surgery room.

A patient’s opinion is a consideration factor, and the surgeon cannot do everything that the patient requests or demands........
Doing what the patient demands may lead to future problems such as refilling, being able to feel the implant, damage to the implant, unnatural look, etc.




Today we shared the fourth post on the ‘To know list of the breast surgery’ that covered details on how the size of the implant is decided.
Thank you for reading.

Have a great day.

Breast Augmentation Surgery To Know List 3.
What types of breast implant are there?

I would like to present a simple description of the different types of implant for the breast augmentation surgery. There are many of those who are curious about this but it is not easy to distinguish the different types because there are too many.

First, we can divide into two types of saline solution type and cohesive gel.
This can be further divided into smooth type and textured type.
There is a smooth / textured in saline solution type, and smooth /textured in cohesive gel type. Also, we divide the cohesive type to round type and water drop type.

Types of Saline-filled Breast Implants

Types of Cohesive gel Breast Implants

The water drop type cohesive gel breast implants does not have smooth type, it consists only of the textured type. (Saline solution has water drop type as well but we do not import that in Korea)

Saline-filled breast implants is used primarily for re-surgery therefore it is not used in the usual 1st breast augmentation surgery that has the objective of beauty. So we will discuss about the cohesive breast implant today.

Cohesive gel Breast Implants

Therefore, we will talk about 3 types; Round smooth type, Round textured type, and finally Water drop type implant.

1. Round smooth type breast implant

Cohesive gel breast implant is made by filling the gel into the smooth surfaced layer. This type of implant is soft and is bendable.
Many say that the smooth type implant feels better than the textured implant but this is because the smooth type has a thin layer. Also, if the implant goes into the body, it is difficult to feel the difference between the smooth type and the textured type.

Round smooth type Breast Implant

The smooth type feels very thin and weak so many think that the implant might tear when put into the body. The biggest problem with the smooth type breast implant is that there is not friction between the layer and the body so we do not know where the implant would locate itself.
The layer is rather slippery so if the implant is not exactly placed in the room provided for it, the implant may shift to another location.

2. Round textured type Breast implant

Smooth type lead to different forms after the surgery, and so in order to prevent this, textured type implant was developed. The skin would grow into the textured implant therefore limiting the thickness in the epithelium however this was a failure. Different forms were made with the textured implant as well. Also, there was no difference in possibility of having different forms for both smooth and textured type if the implant was placed under the muscle.

Round Textured type Breast Implant

Then why do we use the textured type? It is used to stop the misplacement or the shifting of the implant to another location. Smooth type has smooth layers making it easy to move about to another location and also leading to deformation of the implant.
However, the textured type has rougher surface so it does not move about easily. I usually recommend the textured breast implant. There is no assurance that the implant will stay at the location that I intended.

3. Water drop type Breast implant

All water drop type breast implant have textured surface / layer.
Water drop type was made so that it would look natural on the body.
There are many of those who do not know about this properly but the water drop shaped cohesive gel breast implant was produced and sold at the same time as the round type cohesive gel breast implant. It is false that the water drop type is an improvement over the round type.

Water drop type Breast implant

The origin of water drop type breast implant is Natrelle Style 410. It was first sold in 1993 and was the first product of its kind.
This is the strongest of its kind as a cohesive implant, meaning that it is very safe. This is both the advantage and disadvantage of Style 410. It is very strong so it does not lose its form. Also it can fill up the volume properly.

On the other hand, since this is the strongest of its kind, it is very difficult to place it into the body. Also, the final feeling is not as good on a thin person. Recently there have been side effects of seroma and double capsule in the Natrelle product reported by the doctors.





So Natrelle develops a lower model Soft Touch in Style 410 lineup.
There is higher level of cohesiveness, and so it became easier to put in the implant. However, the safety level decreased as much as well.

The tight gel leads to longer formation of the breast and also improves on the sagging breast by uplifting it properly. But those who are young may feel dissatisfied with using this type as it feels less smooth.

There is no right answer in how you choose the implant. There are pros and cons according to different situations.





If you want satisfaction right now, you might want a soft breast implant, however, if you are looking long term, you might want to have a stronger breast implant.

However, there are many doctors and patients who say that Style 410 is too strong.
So other companies such as Mentor, Silimed, Nagor, Arion, Polytech, Sebine decide to make a softer implant than Style 410 and a tighter one compared to other round cohesive gel products.




If we compare the tightness and the softness of the imported implants, we could rank them as, Polytech being the softness, Silimed, Sebin, and Mentor at a similar level, and style 410 being the strongest.


I will prepare another post on the differences between the brands. Today, we differentiated various types of implants into three types and talked about the basics.

There is no absolute correct answer on how to choose the appropriate breast implant. This depends on the body, preference, age, financial status, and the doctor as well. One cannot say which implant is better than another.

Thank you for reading.

Have a great day.

Lateral Canthoplasty that avoids the skin sticking back together

Asian people have eyes that are narrow, lower, and the eyelids are thicker compared to the Westerners. Such differences with the Asians lead to them wanting double eyelid surgery or blepharoplasty.

If the width of the eyes are short, and if epicanthoplasty is not enough, then, at times, we go with lateral canthoplasty as well.
There are many patients who worry that the separation from the lateral canthoplasty does not last making the skin come together again, and ask questions regarding the procedures that do not result on the re-surgery or the skin sticking back together again

So today, the post will have contents regarding the lateral canthoplasty that does not result in the skin coming together after the surgery.

[Lateral canthoplasty that avoids the skin sticking back] 

Many patients consider having lateral canthoplasty if they have narrow eyes or have sharp out corner eyes. These patients have concerns about the detached outer part of the eye sticking back after the surgery.

In Kies-U, we consider re-locating the (*)lateral canthus for conducting lateral canthoplasty.
(*) lateral canthus: Point where the upper and lower eyelids meet

Before and after Lateral Canthoplasty

Relocating the lateral canthus is a little radical method compared to the lateral canthoplasty. However, this is a very good method regarding the fact that there are many patients who are not completely satisfied with the result of the lateral canthoplasty. Also it is used as a part of the re-surgery.

[Differences from the standard lateral canthoplasty]

Originally, the first lateral canthoplasty introduced was targeted on the Western patients.




Westerners tend to have thin skin layer, and the eyelids do not cover much of the eye ball therefore we do a lot of geometric type design on the eyes and cut off then reattach the skin.

However, this technique is not applicable to the Asians who have thick eyelids as such technique would result in many scars and outer part sticking back together after some time.

Lateral canthoplasty that does not result in outer part sticking back together again involves not the removal of the skin but relocating near the periost to avoid scars and greatly reduce the possibility of the outer skin sticking back.

Procedure of lateral canthoplasty

[Who needs the lateral canthoplasty?]

There are many who ask "Can I get lateral canthoplasty?”.
Anyone and everyone can get lateral canthoplasty but the result of the surgery differs from person to person according to the sharpness of the eyes and the tightness of the skin around the eyes.

If the skin around the eyes are tight, then it becomes difficult to pull and fix the skin around the lateral canthus.
Also, we do not recommend lateral canthoplasty to those who have Western looking eyes.
The surgery is effective to those who have Asian looking eyes.

Lateral canthoplasty, lowering the outer part of the eye

[Problems with lateral canthoplasty]

The biggest problem with the lateral canthoplasty with the outer part that does not stick back is the conjunctiva edema.

Originally, the surgery exposed the conjunctiva so that it becomes a part of the eye making the eye look a little swollen and different from how the eye had looked before.

Also the eyelashes are removed as much as the incision so the eye may look unnatural, however, this can be avoided if the incision is done at an appropriate length.

Most important aspect of the overall approach is to interview with the surgeon and then make a final decision.

Today, we shared about the lateral canthoplasty. I hope the contents help you understand better about this topic.

Thank you very much.

Breast augmentation Surgery To Know List 2. 

Is the silicon implant safe to use?

Today’s post is on the safety of the silicone gel implant. There are many of those who are highly interested in this topic therefore; I will go over the details briefly.
 

1. Is there any relationship between the silicone gel breast implant and breast cancer? 

Since 1992, many plastic surgeons, and other scientists studied and gathered data on the safety and effectiveness of the breast implants.

The 7 years of work was put into a book, "Safety of Silicone Breast Implants", published in 1999;. (Washington DC, National Academy Press)

This book was complete through much effort not only from the plastic surgeons but with the efforts from other scientists as well. The book has a reputation for being one of the most scientific and reliable book of its kind. It also meant that silicone breast implant is safe.





Another acknowledged medical journal, New England Journal of Medicine, in its 1995 332nd edition, announced a finding by Dr. Guerrero, who studied the relationship between silicone breast implants and Autoimmune Diseases on 87,000 patients. The result showed a proof that the silicone breast implant does not cause any body illness.

Such reliable scientific findings were published continuously, and since then, many people in Europe and South America used silicone implants. The implants were restricted only in US and Korea.

FDA restriction of the silicone breast implant was set only for the beauty surgery temporarily. So if the surgeon thought that it was necessary, then he/she could make a request to the FDA so that the patient can use the breast implant.

But in Korea, the importing of the implants was banned. Korea bench-marked the restriction from the FDA and made the implant banned from the country without any logical reasoning.





In 2006, FDA finally approved the use of silicone implants and Korea Food and Drug Administration did the same copying the exact standards from the FDA. The importing and the usage of the silicone breast implants were opened up since 2007. In 2012, there was an approval in the import, distribution, and usage of cohesive gel breast implant such as water drop type.

Silicone gel breast implant is safe. There is no proof that the silicone gel breast implant causes breast cancer or other Autoimmune Diseases such as lupus, and rheumatism. The public news and opinions without any justification caused moratorium that restricted medical development.

2. Why do we use the silicone? Is there no substitute? 

Silicone is chemically a safe substance. There is a long history of using silicone in the medical industry and there have been many successful cases in the usage.

Silicone can be made in many different forms, and can be easily put into the body. The cost is relatively low as well.

But this does not mean that there is only good in silicone. The biggest problem with the silicone is the structural look. If the silicone implant goes into the body, the body starts to become immune to it. This happens to every person except for those who have problem with immune system like AIDS. If this immune activity becomes rigorous, then the skin that surrounds the silicone becomes thick and hard causing bad structural look and touch.

There have been many studies related to such problem with the silicone. In Europe, there has been a history of using polyurethane instead of the silicone. This implant has near to 0% of causing structural problem.

However, polyurethane cannot be imported to Korea. There is a complex reason for it.

3. What happens if the silicone gel breast implant burst? 

There still are some contents on the blogs and homepages of some individuals that if the silicone gel breast implant bursts, the silicone gel leaks and goes into the blood or lymph circulation causing various types of sickness.

These contents do not have any logical ground. There are some people who think that if they eat snakes, their body becomes more flexible. However, science should not be based on likelihood. There must be a solid reasoning behind any explanation. Also, there are no proofs or facts that the silicone gel goes into the circulation and that the silicone causes any illness.

There is still some coherence in the leaked silicone gel so the gel stays together. Also, the gel remains in the epithelium so there is no possibility that it enters the circulation.





If the silicone gel gets damaged, then the shape of the implant changes slowly causing the shape of the breast to change over time. If this change is observed, then it is recommended to take MRI or ultrasound test to get a confirmation on the damage and them replacing the old implant with a new one. Silicone gel breast implant does not get damages as easily as the saline type.

Today’s post was answering if the silicone breast implant is safe or not. I hope the post helped you out. Thank you very much. Have a nice day.

When I meet patients for breast surgery, there are many frequently asked questions and there are some facts that the patients do not know well enough. I would like to post on these one by one.

Also, I would like to set facts straight, especially those wrong information on the internet.
If any of you have had thought about having a breast augmentation surgery even once, I am sure that you will be able to have more structured knowledge and have good interviews with the surgeons.

Breast Surgery To Know List 1. Knowing your body

The most important part of your body in breast augmentation surgery is the shape of your upper body.
When you interview with the doctor regarding the breast augmentation surgery, the whole process is a matching process that includes the implant and your upper body.
At times you may think that since “I am tall, I need a large implant.” However, the height of a person and the implant does not have any relationship.

First of all, we need to analyze the upper body then decide on the type and volume of the breast implant. Also, we need to go over some precautions before the surgery.




First thing that we check is the breast and the cortical organization – mainly how much of the subcutaneous fat and mammary glands you have.
In putting this in easier terms, we look at how thin you are, how much fat you have, and how big is your current breasts.

This is the most important factor in having a breast augmentation surgery. If the fat that surrounds your upper body is thick, then one will not be able to make out that you have an implant and there is less possibility of after-effects as well.

In opposite, if you have less fat then, one will be able to make out that you have had an implant. Also, there would be bad side-effects.

There is a paradoxical aspect here.
If you have thick upper body that means that you have a large breast. If you are a person with such body, then you might not need a breast surgery.
However, if your upper body is thin, then you would have small breasts, and may need a breast implant, but, this implant may not be good for you.




There are some people who say that “the rich get richer” and “the poor get even more poor” about plastic surgery. In some aspects, this applies to breast augmentation surgery as well. If you have a large breast then it is advantageous to have a larger implant. If you have small breasts, it is less advantageous for you to have large implants.
Those with asymmetric breasts need to be aware of this.

If your left breast is larger than the right, then a larger implant will go on the right and a smaller on the left.
However, in reality, a larger implant can be put into the larger breast (left) but the smaller breast (right) will not be able to take in a large sized implant.
An implant goes into a very closed and tight space therefore, the implant can be folded, or look unnatural.




A lot of the patients set a larger breast as a standard and think that “I might have to put this big implant.” In such case, a much larger implant needs to be used for the smaller breast.

If you want to lessen the possibility of side-effects then, you must consider the smaller breast as the standard one. First, you need to decide on the implant size of the smaller breast, then decide on the larger breast so that the two breasts look more natural and to minimize the side-effects.

Next, we need to consider the bones of the upper body.


Bones on the upper body are important because it becomes the framework of how your fat/skin is laid out. Therefore, it is important to see how the overall frame is shaped.
If the both ribs are shaped inwards, so that the breastbone sticks out, we call this a bird chest. The problem with the bird chest is that if we out in the implants, there is a high pressure in the center of the body therefore, the implants can be forced outwards looking far apart.

The number 2 ~ 4 ribs stick out so the upper body may look very thick.




If the breastbone is too low, we call this funnel chest.
The implants in a funnel chest act differently than the ones in the bird chest. The implants mover towards the center and make your breasts too large causing a problem.

As you can see, the cause of the asymmetric breasts is the shape and size of the ribs.

The surgery procedure will differ according to the shape of the upper body bones therefore it is important to check on the upper frame.


Third, we need to check on the location and the location and the placement (proportion) of the nipples.

This is one of the most common factors that I check when I analyze the breasts or upper body shape.
The core objective is to look at the upper body proportion.

All beauty surgeries are successful if the upper body proportion is good. The surgery becomes more difficult if the upper body proportion is bad.

Let’s call the middle inward part of the two collarbones, #1, and call the nipples on both your breasts #2 and #3. When you link the three points, you will be able to see a triangle.




If this shape is close to an equilateral triangle, then we can say that you have a good proportion.
If the triangle looks like an isosceles with tall height, then you might be having sagging breasts.
In such case, we need to select appropriate implant and plan the surgery accordingly.

If the triangle is wide, then the breasts are far apart, so we need to have surgery that will place the nipples closer or recommend short type implant such as water drop implant.

Fourth, we need to consider the skin elasticity of that which surrounds the breasts.

The size of the implants depends on the skin elasticity. If the skin is elastic then we can use a larger sized implant. In opposite, if the skin is less elastic then it becomes difficult to use a large sized implant.

Usually, as you age, or after you give birth, you skin becomes more elastic. Those in 20’s and 20’s would have tighter skin.


Today’s post was the first one for “Breast Augmentation Surgery – To know list”. If you have any questions, please feel free to ask me.

Thank you for reading. Have a great day.