What is double bubble after breast augmentation?

Let’s look into one of the most common side effects of breast augmentation,
double -bubble

Today, I would like to share about one of the most common side effects in breast augmentation, double wrinkle ( double line, double bubble).

One must know the anatomy in order to understand this side effect, but this is difficult for a normal person, therefore, I would like to refer to an image below.

Normal structure of the breast

This is the normal structure of the breasts. There are some conflicts among the scholars, but the cause of the Inframammary fold is due to the Inframammary fold ligament.

But there are some with a clear Inframammary fold and one that is not so clear. If you are a patient with a clear Inframammary fold before the breast augmentation, then there is a high possibility that you would have double wrinkle after the breast augmentation.

The possibility is higher for those who have sagging breasts or large breasts.

Case of double bubble after breast augmentation

As shown in the image above, if the implant is positioned under the muscle, there is a high possibility of the double wrinkle due to the Inframammary fold ligament.

If the surgery is done above the muscle, this possibility is lower.

If you are the one who has read many articles in this blog, you might know that if the implant is positioned above the muscle, you will be able to feel it easily unless you have thick skin or the original breasts are large. There are much limitations to patients having under the muscle implant if the patients are thin.

That is why we need to conduct double plane correction.

Double plane correction leads to the implants not being felt easily and also preventing the double wrinkle.

How to prevent double bubble after breast augmentation

When the double plane surgery is conducted, most of the implant would be positioned under the pectoral muscle therefore one will not be able to feel the implant easily. And, by cutting off the inframammary ligament, one can prevent the double wrinkle.

However, this is not the only reason that leads to double wrinkle.

Capsular contracture can lead to double wrinkle, and also the position of the implant within the body can lead to double wrinkle as well.

Also, certain part of the body may become really thin during the course of the surgery, leading to double wrinkle.

It is difficult to think that the double wrinkle will be formed in each of these cases but there are various methods on how to remove the double wrinkles. Therefore, it is important that you consult the doctors in order to do so, especially those patients who are thin or have sagging breasts.

This is all for today, thank you for reading.

Today, I would like to share about a few things that came into my mind when doing a rhinoplasty. First, I would like to share a though, “curved line (known as barbie doll nose job) nose job is similar to wearing high heels.”

Why do you wear high heels?
 "High heel was invented by a woman who got kissed on her forehead.” (Christopher Molley)???
 


Very common answers to why women wear high heels could be that they want to look taller, or they want to have their legs look pretty. A body changes according to whether the woman wears high heels or not.

Second might be because of pride. All women want to look arrogant and proud. All women try high heels at least once. It is difficult to express exactly, but women have sense of superiority when wearing high heels.

The bottom layer of the high heel that touches the ground is very little, and people want to be at a higher place than others. There is a little danger when wearing high heels, but women feel beauty from the heels as well.

Third is that the curves on the high heels attract women. High heels look most sophisticated from all the products that are laid out in the shopping malls.




There is another reason to why women choose high heels. People do not know this but there is one important reason.

Other women, too, wear high heels!

For example, if your friend wears 10cm high heels and your wear flats, do you think you can walk side by side with that friend? (ㅠ_ㅠ)

In Korea, where sociality is strong, you might not want to be the only one wearing flats. This is virtually impossible.

Anyway, high heels can be a source of pride to those women who want to look edgy.
 



Then why curved line nose?

Now, let’s talk about nose (high nose). If we refer to beauty surgery textbooks, most women want to escape from psychological stress by having a nose job done.
Why do you want curved line(barbie doll) nose? The answer to this question is the same as those for the high heels.

First, high nose makes the face look smaller and solid. This solid looking nose makes the face look thinner although you have a wide face. This is same as when a woman wears 10cm high heels and looks like she has long legs and good body.

Second, high nose makes you look arrogant and proud. The part of the high heel that touches the ground is very small, and so does the curved line nose that points up high. Historians say that if Cleopatra had smaller nose, the history would be changed. Also, when we say that someone has much pride, we say that the person is “hard (high) nosed.”
Curved line nose can be an expression of a woman’s pride as well.

Third, it is figuratively most beautiful. The curves on the nose makes a woman look beautiful.




But, Rhinoplasty is supposed to solve problem on the nose, and is a high technique measure to make the nose high or low so that it is in harmony with the rest of the face.

“Curved line or barbie doll nose” is a simple term to express the shape of the nose and cannot be an answer to everything.

If you are wearing shoes and if your feet feel pain or uncomfortable, you can take off your shoes, but this is not the case for the nose.
Curved line nose just refer to the nose tip. It does not define what a beautiful looking nose is.
This, too, is not the answer for pretty looking nose.


All these are important. A nose is a three dimensional figure and can look natural or unnatural on your face.

There was a Korean drama, “On-Air”, televised few years ago, and the main actor said the following to the main actress;
"You think you are popular since many people recognize you, right? You think that you are highly popular. But the only thing that is high is your high feels.”

The main actress in the drama has a character that is in danger, and is really excited. The author must have compared the character to high heels.

I have compared high and proud looking nose to high heels. Although curved line nose is popular, I do not recommend this to everyone. Just like any other beauty surgery, rhinoplasty procedure is applied according to different type of noses.


This is all for today. Take care and thank you for reading.

Q) Are there any bad things or side-effects of having implants that are too big? 

There are many problems. I will share them one by one.

1. Over-dissection

Measuring the width (cm) of the breast and fitting the correct width of the implant would be the first stage of selecting the volume of the implant.
 


If the volume of the implant is too big, then the width is wider as well. If a wide implant is put into a narrower pocket, then the surgeon would have to dissect the side of the ribs or dissect into the mid part of the chest.

If the side of the ribs is dissected, then there is high possibility of damaging the nerves of the blood vessel. This damage would trouble the patient continuously for a long time.

But if the inner part such as the mid point of the chest is dissected (due to the bigger size of the implant) then the two implants might touch each other (Synmastia). This side-effect, if caused, would last forever.
 

2. Implant Collapse 

If the implant is put into a pocket that is narrow, the implant might collapse and lose its shape.
No matter how large an implant is, which is made of half liquid, cohesive gel, it can be forced into the pocket that is small.

Such collapsed implant would leave some space at the folded part, and the folded part would hold onto anything that is positioned. This would cause seroma, inflammation, and hematoma.

If the implant is folded, there would be much friction caused when using the arms. This friction would damage the implant exterior causing leaks.
 

3. Original breast atrophy

Let’s say that there are two women with same sized breasts. The widths are the same and the extent to how much the skin extends is the same as well.

One patient uses 290cc implant that is appropriate for her. The other uses 340cc implant that is larger than the appropriate size.

Two years have passed after the surgery. Who do you think would have bigger breasts?
This might seem like an easy question to answer but rarely does one answer the correct one. The reasons why the answer to this question is different from common sense is that the body is not like a mannequin and the body changes through time.

Silicone is located between strong ribs and smooth skin. The ribs under the implant are strong, and the skin above the implants is smooth, therefore, the skin is pressurized.
The pressure on the skin continues 365 days a year.

Let’s say that you have a bandage on your arms for 2 years. When you open up the bandage, the arm would be thinner than the other without the bandage.

This applies to the breast with the silicone implant as well. The pressurized skin would not have blood circulating therefore becoming thinner and wrinklier.
We call this atrophy.

The 340cc implant has more pressure than the 290cc one. The patient with 340cc implant may have her breasts look bigger right after the surgery, but after 2 years, there would be atrophy that causes the breasts look like those with 290cc.

The patient with 290cc would have skin that well preserved therefore, the breasts look feel more natural than the one with 340cc.

4. Unnatural appearance and feel 

If the implant is too big, then it would pressurize the skin a lot and pull the skin as well.
Let’s say that you bought a leather jacket that fits you tightly from a shopping mall. You might not be able to close the zips easily. The implant would be much like closing the zips of the jacket.

Others might think that this is too small as well. Your jacket might look all new, but if you touch it, you will feel that the jacket feels tight and rough.

This happens to the breast. The breast would look unnatural, and it would feel rough making others recognize that there is something inside the breast.
 

5. Ugly scar  

If the pocket is too small for the implant, then there has to be much stress when putting in the implant. The tools used for this input might cause damage on the skin.
When the implant goes through the entrance, there would be much stimulation and friction on the skin.

Wherever the surgery is, this type of activity would cause less circulation of blood on the scar, causing the scar to worsen.

6. Visible margin or rippling

If the implant is too big, the margin of the breast would be formed elsewhere then the place that it is to be formed. This happens to all parts of the breast. If the margin starts from a different location then it is supposed to, the breast would look unnatural.
Also, if the implant is folded and this can be seen at places where the skin is very thin, we call this “rippling”.
 
There is not one patient who does not want a large implant, but there is a limit to this. If you ignore this limit and carry on with using larger implant than the one you are supposed to use, then there would be discomfort and side-effects. Majority of these problems cannot be fixed at later stages.


Today, we looked at what happens when you use large implant that is not appropriate for you.

Thank you for reading the post. Have a great day.

Q. Is it better to use the round type or the tear drop type implant?

This is not a simple question to answer.
First, one must know the difference between the round type and the tear drop type.
Another important thing to know is the status of your breasts. One must know the status of the breasts/chest to decide on the type of the implant, therefore round type might be good for a particular patient and the tear drop type might be good for the other.




Round type implant has substance that is not tight, meaning it has less cohesiveness. So the round type changes share according to the environment it is in.

Tear drop type breast implants has substance that is tight therefore strong cohesiveness. So the tear drop type implant does not lose shape according to the environment that it is in.




So the round type implant does not remain round when inside the body but much of the weight of the shape is focused downwards (low stability of the shape).
However, the tear drop type maintains its shape when it is put inside the body (high stability of the shape).


But this characteristic changes according to the different manufacturers. Some manufacturers have round type implant that is tight and tear drop type that is not.



The secureness of the implant itself is important, but the skin elasticity of the patient is important as well.

- If the patient is young and has not been pregnant before, with small breasts, then the skin (that surrounds the implant) is tight and elastic.
In such case, whatever implant used, the implant would not lose its shape. If the round type is used, then the implant would look round, and if the tear drop type is used, then it would look like a tear drop. In this case, the breast would look natural with the tear drop type.


- If the patient is young and has enough volume in breasts, then the skin would not be too tight. In such case, it would look more natural if the tear drop type is used.
- If you are old, have been pregnant, and have large breasts, the skin would be lose and less elastic.
In such case, the secureness of the implant would be important. If the less secure implant (i.e. round type) is used, the breast would not look round but sagged. The upper part of the breast would look empty and the cleavage would be positioned lower. So, one must use more secure implant.


- If the patient is young with tight skin but the distance between the nipples are wide, the upper breast volume might be less. In such case, it is more appropriate to use the round type.
- If the distance between the nipples is short or narrow, then it is better to use the implant that focuses on the bottom part of the breasts. Tear drop type would be more appropriate in such case.
- If you need a breast augmentation re-surgery and would like to use a smaller implant than the previous one, it is better to use the round type. If the pocket is big then the tear drop type implant can get in easily.
- If you have dissected your breasts because of breast cancer or any other reason, and need to reconstruct your breasts, you would need to continuously press on the skin that surrounds the implant. In this case, the round type would be more appropriate.





So the type of the implant that you need to use differs case by case, and is not a simple question to answer. First, you need to know your body and the shape of the breast then know the differences of the various types of implants, and finally, know the differences of each brands.

Today, we looked at how to choose between the round type and tear drop type implants.

Thank you for reading.
Have a great day.

Solving "separated breast" deformity on thin women with composite breast augmentation

Today, I would like to introduce a thesis on the fat transplantation in between the breasts, especially for the thin patients.



The article is from a renown magazine, Plastic and reconstructive Surgery 135. April version. It is written by Francisco Bravo from Madrid, Spain. The name of the thesis is “Parasternal Infiltration Composite Breast Augmentation”. (You can think of this as solving the separated breast deformity of thin patients)



There were many others before Dr. Bravo, who conducted composite breast augmentation that requires using an implant along with fat transplantation.

The thinner you are, your breasts would look unnatural if you use larger implant than that is appropriate, and therefore, one uses fat as a covering tissue to make the breasts look natural.

But there is a limitation in such a method. It would be difficult to get sufficient amount of fat from a thin patient. Also the fat cannot be engrafted properly on to the implant therefore; the outcome is rather disappointing to many.

The characteristic of Dr. Bravo’s research is that you transplant fat between the breasts of a thin patient making the upper body look more beautiful.



This process does not require much fat and solve is judged to be helpful in providing solution to the ‘separated breast deformity’ of thin patients after their breast augmentation with the implants.

Fat transplantation cannot be a substitute of the implants but is helpful for the implant outline or the contour. This is more applicable to re-correction patients and thin patients.




The original breasts are important for the shape of the breasts with the implants.
Those thin patients with thin soft tissue on the breast bones complain about one being able to see the edges of the implants.

The patients think that their breasts have been “separated” far apart in such case.
But the fat transplantation  on the edges of the implants make the breasts look more natural and less separated apart.

We can see the improved results from the experiment done on the 2 groups; one with just implant and the other with implant + fat transplantation.



The amount of fat used was about 6-~140cc , an average of 117 cc, which is rather less that the amount that we usually use, 300~500cc. The fat is transplanted just under the skin.

The fat transplantation was done through the breastbone line.

I have used this method many times before, and there are other doctors who have used this method as well. But I believe that Dr. Bravo is the first person who announced such structured thesis.

Here is the summary.
Fat transplantation cannot solve all the problems that thin patients have with the breast augmentation. However, fat transplantation can be a solution to the separated breast deformity.

Thank you very much for reading.