Taking care after the breast augmentation surgery 

There are many patients who ask me what to do after the breast augmentation surgery and so I would like to answer this question today with this post.

A surgery must be done perfect so that the patient does not have to do much after-surgery management.

But the body is complex and different from one person to another and also some implants might have problems even before using. There are many variables so it would be good to know that you need to carefully take care of your body after the surgery.

1. Breast augmentation after care massage

Before, we used to think that massaging was a “must”.
Massaging was only for those body parts that used implants, especially the breasts. The main objective of massaging was to make the breast more soft.



Massaging in other words could be described as enlarging the non-surgical epithelium.
This would be to push the implant from the outside so that the epithelium opens up in order to make the implant move more easily.

But, epithelium is not something that is bad, and it is necessary for the implant to be secure at its original position and also it is something unavoidable.
Also, enlarging non-surgical epithelium is disregarded today.
If you look at the textbook of breast surgery, you would not find any details on massaging. This is not necessary any more.
I, too, do not provide massaging to my patients unless there is some special case.

2. Removing stiches, dressing 

Where ever the incision was, there is an entrance of the implant and this entrance needs to be closed properly and dressed properly as well.

It is good to close the incision from the outside, but the trend today, is to use the thread that dissolves inside the derma and use adhesive gel on the outside.
We cannot say which is the better method of the two because each has its own advantages.

I usually put sutures because I think that this is the most comfortable method for the patient.

Do not forget that there are no differences in the wound or scar with the two different methods. Scar is not an important factor in deciding which method to apply.
Putting sutures is to make the patient more comfortable. It would save the patient coming to the hospital and allow her to shower freely.
Sometime we apply taping so that the implant places itself properly and securely. This taping loses stickiness after 3 to 4 days so we remove the taping after so many days.

3. Compression garments breast augmentation

Corrector bras are used commonly in order to secure the position / location of the implant during the earlier stages after the breast surgery.
The important thing is that the implant does not move about to different location but maintains the appropriate position. You do not need to use the corrector bra.

But some special cases require you to use the corrector bra. If you have bird chest or have problem with the thorax, you might be required to use the corrector bra.

4. Managing scars 

The epithelium is formed 48 hours after the stitching leading to water tight closing. The recovery from the scar takes about 3 to 6 months.
If you look at the scar for a month, some might see red swelling.
If this is you, it would be better to leave it as it is.
This red look might change its color to brown after 3~6 months.




The tissue around the scar generates leading to scar remodeling. This takes about 2 to 3 years. There are many procedures that we can take during this period for better recovery.
I will add more details regarding this in the future posting.

5. Ultrasound 

There are many things that we check for when doing the ultrasound test on the breasts.
If there is blood between the implant and the skin?
If there is any other seroma?
How thick is the epithelium? Is it very thick and white? (Capsular contracture)
Is there any problem with the implant? (leak, damage)
Is the implant properly positioned? (Rotation, change of position)
The good thing about the ultrasound is that the patient feels no pain and she can do this test any time she wants.



Ultrasound test is subjective and it cannot accurately make out if there is a damage on the implant.
You need to do MRI to see if there is a damage on the implant but this is too expensive therefore, many patients take ultrasound tests.

 6. High frequency 

High frequency is used to send heat to the deeper layers below the epidermis. It is used to control the pain.
This is used in orthopedics for physical treatment. High frequency sends heat making the blood circulation better and makes the breast with implant feel better as well. If a patient feels pain after the surgery, we apply the high frequency as well.




There is no preparation necessary for high frequency therefore it is comfortable and frequently requested by the patients. If there is no problem with the recovery then you would not need this.

We have looked into few measures that you can take after the breast surgery. A patient might require some treatment but the doctor needs to check on the status of the patient and decide what to do.
Thank you for reading.

Breast implant placement : Under and over the muscle or Dual Plane

If you are aware about the breast implant placement, then you know just about 90% of what the breast implant that we use for the breast surgery is.

When I talk to many patients, they ask,

“How large (cc) implant do you use?”
“Do you use the round type or the tear-shaped?”
“What is the incision location?”

But rarely do they ask about the placement of the breast implant.

If someone does ask about the plane, she would not ask about the differences in the plane and why such differences exist.

I have always been wondering how to communicate this to the patients easily and clearly.

So, I decided to draw an image.

Below is the explanation.



 


As you can see above, if the breast implant is located over the muscle, you are able to feel the implant. This can be easily felt with the thin patients relatively more so than those who are not thin.

Then why do we put the implant over the muscle? There are many advantages. The implant, itself, pushes up the fat so the breast looks bigger and prettier. Also there is no pressure from the pectoralis, so the implant would not be moved to another location.




We usually put the implant under the muscle for the thin patients. You would not be able to feel the implant in this way however, the muscle tends to push on the implant. As time passes, there are few cases where the implant moves up and changes the location.



Dual plane surgery takes on the advantage of the over muscle and under muscle surgeries. We cut off the muscular fiber and put the implant at the top of bottom of it.



In doing so, this would lead to the separation of the pectoralis. Some people worry that this causes no movement of the arm.
A body builder had the same surgery. She was able to lift weights after the surgery without any problmes. You do not have to worry about the muscle functioning.




Dual plane breast augmentation causes no pushover of the implant, and you cannot feel it either.

I hope this has helped you understand what the whole process it. Dual plane breast augmentation has least number of side-effects and is a very good method.

If you know about this, then you know almost everything about breast surgery. This is the most important part of the breast augmentation surgery.

Thank you for reading. Have a great day.

Textured silicone breast implant use in primary augmentation 

Academical findings do not stay fixed but the details are changed as new findings and results come out. So the doctors pay careful attention to the new findings.
The doctors who do not study would not provide outmost result to the patients.
Also, science is something that “you might think correct, but can be mistaken”.
Medicine is a part of science.

Below is an article, released on January 2015, on “Textured silicone breast implant use in primary augmentation core data update and review"





It is stated that in 2013, there were about 290,000 breast augmentations done in US. This figure comes from American Society of Plastic Surgeons, so maybe the actual number may be greater. One of the most popular plastic surgeries around the world is breast augmentation.

The most common side-effects of breast augmentation are
Contracture, moving location, refilling, seroma, etc

Why is a contracture?

There are various reasons but the most commonly stated one is that the strain around the skin and the breast tissue comes in contact with the implant and this contaminated implant causes infection within the pocket.

How does textured implant minimize the contracture?

In theory, the texture physically breaks down the epithelium tissue, leading to the breakdown of the collagen fibers and reducing the epithelium. This is what we currently understand. 
(But using textured does not mean that you are completely free from the contracture)

What can you do if there is a contracture? 

The most effective method would be to cut off the epithelium. The epithelium incision would reduce the muscle tension so the cell that makes the epithelium would not grow and therefore not survive. 

Does the appearance of the textured implants differ according to different products?

Yes, they are different. The most widely used on is Allergan’s textured salt loss technique which leads to deeper and more textured surface.
Mentor’s textured uses imprinting technique which makes the surface little thinner and smooth. 

Does the anatomical type lead to less contracture?

Yes. The 5th generation tear-drop type implants have strong exterior with strong agglutinability on the inside therefore, it causes tension with the breast tissue and sticks together more firmly leading to lower possibility of contracture.

There are many who thinks that the tear-drop implant feels better.

Tear-drop type implant feels better because the implant / breast / epithelium all move together naturally. 

But the smooth type implant is relatively more separated from the epithelium therefore when you touch it the implant seems to be separated from the skin. 

(This comment does not apply to all patients. This applies more to those patients who gave birth) 




Some say the refilling is more common with textured type

There is still not much reference for this. We are short of data on this. 
The type of the implant do not matter, but thinner patients have higher possibility of refilling than those who are not.
Also there are some who say that more texture implants lead to more refilling than the smoother ones.


Then which type shall I use? Textured or smooth?

It is said that textured minimizes contracture and also limits rotation and movement of the implant. However, there is a higher possibility of seroma and more texture it is, there is higher chance of refilling as well.

I tend to use the textured implant more.

As a surgeon, it is more relaxing for me to use an implant that does not move or rotate easily.

Today, we share a little about the textured implants.

Thank you for reading.

Q) Is there no problem with breast feeding after the breast augmentation?

The answer to this question is that there is no problem.
In addition, let’s look at some of the important facts that you need to know in breast augmentation.

Breast augmentation can be divided into two.

First is the ‘Subglandular’ – Above the pectoralis major muscle
Second is the ‘Subpectoral’ – Under the pectoralis major muscle





We call this ‘surface’.
There are surfaces above the muscle and below the muscle.
All the breast augmentations are depended on where the implant is put in.
This is why the surface is so important. Everything changes according to what surface is selected.

Then, which surface is closely located to the breast tissue that makes the breast milk.
It is the surface above the muscle.
You might think that the breast milk may not be good if the silicone touches the tissue.

But, if the implant is put in below the muscle, the implant would not interact with the breast tissue. This would have no effect on the breast milk.

If the silicone is put above the muscle, the epithelium forms after two weeks.
This epithelium completely separates the implant and the breast parenchyma.



So one can know that the silicon does not interact with the breast milk tissue.
There are many people who think that the silicone causes harm to the body. Of course, there aren’t all good things about the silicone.

However, the silicone is chemically stable substance. Also it is completely separated from the body therefore, it does not cause any harm to the body. Also there is no relation with cancer either.

The implant itself does not pollute or harm the tissue. This is a verified fact.
But, what if the surgeon is not experienced enough and causes harm to the breast tissue?

The breast tissue can recover but if the damage is severe then the amount of breast milk can be reduced and there may be limitation on it.

How can this happen?

Implant through the armpit and under the muscle does not cause any trauma to the breast tissue.
But, implant through the armpit but above the muscle can/


Incision on the areola has the highest possibility of the trauma. This happens often with the surgeon with not much experience.

Subpectoral has the lowest possibility of breast tissue trauma. The incision is visible to the eyes therefore, it is safe.
So this is the best method that does not cause any damage to the breast tissue.

This is just a principle in the breast augmentation.
But the surgery depends fully on the surgeon and his/her experience.
There are times when there is no damage to the breast tissue although the areola incision is performed.

Subpectoral is the safest method that does not damage the breast tissue.  Also is the surgeon is much experienced, there would not be any problem on the breast milk. Breast augmentation does not have any effect on the breast milk.

This is all for today,
Thank you very much for reading.

Breast Augmentation For Older Women [KIES-U Korea]

Q. I am kind of old, but can I get a breast augmentation?

A. Age is not important. The health status is.

This is a commonly asked question.
There are many who are about 50 years or older, and think that they have problems with the breasts. These women think “Am I too old to have a breast augmentation?”

In our country, there are many women who want their breast size to be larger in order to show their body appeal through swimwear. So there are many in 20’s ~ 30’s who are relatively interested in the breast correction.




But in the western countries, where there is more number of those having breast augmentation, the main patients are those aged 35 ~ 50 years old.

Most of them want the breasts to look prettier after pregnancy or diets. Also, there are some who think of the breast augmentation as antiaging surgery.




There are very few of those in our country who think that the breast augmentation is an antiaging one. The most important objective of the breast augmentation is that the implant goes into the breast in order to improve the shape of the breasts to make them more elastic and look younger.

It is not only to make the breasts look larger.

The oldest patient that I had was 65 years old.
She needed a revision surgery because the saline bag implant that she had from her previous surgery needed replacement.

She asked me whether it was better to remove the implant or replace it. My answer to her was that the old implant was fine before, there would not be much problem replacing the old ones.

So this patient replaced the old ones with the cohesive gel implants with the concern of the breasts collapsing without the implants.

Is age important? If a patient who is older than 65 years old wants breast augmentation, we must first check if she has any problems with her body.
She might have diabetes, heart problems, cancer, lung disease, etc. In such case, it would be difficult to have the breast augmentation

But, if the woman does not have any illness and wants the breast correction, she will not be able to give it up.

Health status is more important than age

If a woman in her 30’s has a severe illness, then I would recommend her to rethink about the breast augmentation. If she is in her 60’s but is healthy, then I would recommend the breast augmentation.

Most of the aged patients who come to our clinic have problems with the previous surgery (most come due to the implant rupture).

If there are not problems with the tests prior to the correction and the general anesthesia, then we go ahead with the replacement surgery. Also, the result of this is similarly good to that of those patients who are younger.

Is there any pain or inconvenience for the aged patients?

No, in fact, they recover with better conditions.

The younger you are, the tighter the skin and the tissue are therefore the implant is compressed and there is much friction. However, those who are older have loose skin and tissue.

KIES-U Korea Real-Time Operation Monitoring system

So, there is not compression on the implant.
The patients recover comfortably.

There are many aged patients who do revision surgeries, and there are many who have the first surgeries as well. Also most of the surgeries are inferior breast crease.

Thank you for reading this post.