Q. What is the name of the surgery that I am getting? Is it called breast augmentation or breast cosmetic surgery?

In truth, this is one question that I hope to be asked by my patients.
I think that this question carries the most important message for a breast surgery.
In medical terms, we call the breast surgery, ‘Augmentation mammoplasty’. This means breast enlargement cosmetic surgery.

The following definition can be found on the internet.

Definition about 'Breast augmentation' in Naver Korea

I do not like this explanation.
If I had to define this term, I would do it as the following.


"A cosmetic surgical method the makes beautiful looking and appropriate sized breasts, with an objective of setting the right beauty proportion, balance of the two breasts, and harmony with the upper body."


Proportion, Balance, Harmony

The three matters above are important to any cosmetic surgeries and the same applies to breast surgery as well.

When people consult about the breast augmentation, there is a lot of emphasis on the implants. Implants are used for the proportion and balance.

An implant is used for the beauty of the breast and not much more.
Volume is necessary for the beauty. Not the other way around.

One must know that this breast augmentation is not just to makes the sized bigger (cup siz bigger).

Let’s look at the two images below.

Breast augmentation surgery Korea

The above picture shows a patient who is about 170cm tall using 375cc round type implant.
The patient blow is about 167cm and she uses 270cc water drop type implant.

Breast augmentation Korea

Some patients think that the breasts are covered by the bra and others cannot know the difference exactly so they just want large size. But this is not a good decision. As you age, breast feed, get pregnant, the shape of breast changes. Therefore, in the long term, this would not be a good decision.

Golden ration of the breast

As you can see in the image above, the part above the nipple is the upper breast and the part below the nipple is the lower breast.

The upper and the lower parts need to have different shapes. The upper part needs to have a natural shape (beaker) and the lower part needs to have semi-circle shape. You can see the differences in the shape from the two pictures.

If you look at the image below, you would be able to recognize the golden ratio that I would like to refer to. The golden ration is known to be 1:1.618 and amazingly, this applies to breasts as well.

Breast augmentation Korea

It is not breast enlargement or breast cosmetic surgery. I think the right answer is “breast enlargement for beauty.”

The main message for today is that this is NOT "a surgery to make the breasts bigger”.


Thank you very much.

Q. Why is the capsular contracture formed?

The doctors do not know the reason as well. We think that the body reacts to outer substance and therefore causes the capsular contracture, but the incidence rate varies a lot from a doctor to another so we cannot simply say that the outer substance causes the capsular contracture.

The patient’s body is important, however, I believe that much of the responsibility is with the surgeons.



I have not seen any of my patients with double layer breast augmentation suffer capsular contracture. In such regards, I agree with Prof. Spears, in that the incidence rate gets bigger if the armpit of areola is used for the implant.

It is difficult to find significant data on the type of the implant; textured or smooth.
Therefore, if one wants to avoid capsular contracture, the surgeon, whatever implant he/she uses needs to minimize the trauma on the body and carry out the procedure in the most comfortable manner possible.

Q. How can you treat, prevent capsular contracture? 

Strong, hard massaging was a method used in the past, but this makes that patient suffer and there is no positive effect.

Removing of the epidermis leads to damage on the implant.




The capsular contracture medicine was actually used for asthma but there is no data that a patient group who used this medicine suffered less capsular contracture, so we cannot recommend this to our patients.

The most important preventing method would be for the surgeon to be gentle during the procedure causing no trauma.


This is all for today, have a great day.
Thank you.

Q. When do you need to have a breast revision surgery?

There are few reasons for the breast revision surgery

First, when the breasts become hard due to the capsular contracture.
Second, when the breasts look awkward because the location or the position of the implant changes.
Third, when there is a damage on the implant (this is common on the saline type)
Fourth, when there is inflammation, bleeding, etc.

Breast revision surgery Korea KIES-U

The most common question is on the capsular contracture. I will talk about breast revision surgery considering the capsular contracture.

The reason why the patients are scared of the capsular contracture is that the breasts look “artificial or surgically repaired.” The implants are out of the original position, the breasts become hard, and the two breasts look different from one another.

The upper part sticks outwards or the implant is pushed away from the breast. Also there is much pain or at times there may not be any pain. The two breasts do not face the same type of capsular contracture, each faces different types.

Before & after Breast revision surgery Korea KIES-U

The above image is not the worst case of the capsular contracture, but the breasts have become hard and the implant is pushed upwards.

The patient received breast augmentation through the armpit using the smooth type implants. The breasts started becoming hard after 3 months and there has been a severe upper block.

The patient received a breast revision surgery after 7 months from the first one. The original implant was takes out from the sub-pectoral part and put into sub-glandular location.

The lucky part is that the patient had some volume on the breasts even before the first surgery, so the sub-glandular part could be used for the re-surgery.

If there is not much volume in the original breasts, the implant pocket cannot be formed on the sub-glandular part therefore, we need to form double layer for the revision surgery.

The patient had sagging breasts, therefore, we selected water drop type without any hesitation, and used oval shaped 290cc implant. The patient is now satisfied.

In the next posting I will talk about 'Why is the capsular contracture formed?'
This is all for today, thank you.

Ultrasound imaging for breast surgery


Today I would like to share about the Ultrasonography after the breast augmentatioin surgery.

Although there aren’t any problems after the breast augmentation, one might be curious about if the implant is at the appropriate position and think about if there is no problem inside the breast where one cannot see.

Breast augmentation Korea KIES-U

Or, the breasts might seem thicker or there might be pain or even difference in the shape. All these changes might lead to concerns.

Ultrasonography would be very useful for such cases. There is no penetration with this test. One just uses the probe to rub on the skin and see the inside of the body and check the inside.

We refer to penetration as poking with the needle or opening up the skin but this is not something that one can do at any time. Ultrasound test is one that the patient would not feel any pain and is also a cost saving measure.

Below is a brief summary of different tests that you can do on the breasts.

 

Breast surgery Korea KIES-U

The cancer test of Mammogram, is one of the most common one that the patients take. A machine would press on the breast and takes a X-ray. Mammogram is one of the cheapest basic tests that you can take and is also one of the most effective means of detecting cancer. If there is a problem found from the mammogram, one could take the higher level test such as the MRI.


MRI is the most sensitive and accurate test that one can take. You can find the symptoms of the breast cancer at an early state and one can also differentiate the worst case from others as well. It also provides the most accurate results related to the damaging of the implants. US FDA recommends taking the MRI every 2 ~ 3 years as it gives certification of the implants.

However, this test is very expensive so there aren’t many patients who take MRI after the breast augmentation.
 

Ultrasonography is taken a lot for the breast cancer as well.
It has high sensitivity and high accurateness in finding something without any pain.
It is also cheaper than MRI. Ultrasonography also helps check problems of the patients with silicone implants / saline implants.

I usually recommend ultrasound to the patients who want re-surgeries.
Re-surgeries are usually done without knowing how the breast shape has changes after the first surgery or not know how the process has been changed. If a doctor wants to explain the current status and talk about the future plan, he/she needs to know the current status accurately. This could be done with the help of the ultrasound test.

Breast augmentation Korea KIES-U

Above is an image of a patient with a revision surgery. If you look at the right breast, you might be able to know that there is something wrong with the implant. The same result came up through the Ultrasonography.






When I first saw the image above, I through that the implant was damaged. The white color shows the surface of the implant and this white line is broken in the middle. We conducted the re-surgery to find that the implant was not damaged but flipped upside-down.

This is the bottom of the implant (what we refer to as a belly button) where the brand name was printed on.

The patient thought that the skin became really dense and though that there was a capsular contracture so she massaged the breast often.

The implant was small compared to the large pocket it was in, therefore the massaging has led to the flopping of the implant.




The above image is from the ultrasound test of a patient with a damaged implant. Usually the gel inside the implant would look black but there is a lot of density with tattered surface so I suspected damage on the implant.

I found out that there was a lot of blood around the implant from the re-surgery. The patient had an auto accident after the initial surgery and it seemed that the blood from the accident stayed around the implant.

 



The above image is the result of a seroma. Seroma can be caused by different problems including the water formed from the breaking of the tissue, or bleeding, etc. The water left over that has not been absorbed causes the seroma along with other trauma, infection, etc.

Water can exist at the earlier stages after the breast augmentation but if there is liquid after 6 months, we call this a ‘Late seroma’ or ‘Late fluid collection’. We solve this problem according to the different cause of the problem.

We do not treat the problem because there is a seroma. If there is an additional problem such as an infection from the seroma, we would do the treatment to remove any problems.

But if there is a lot of blood, then we would need to find out where the blood came out from at an earlier stage.

These kind of problems can be helped out through the ultrasound test.

If there is a capsular contracture, the membrane surrounding the implant becomes very white and thick. This can be seen through the ultrasound test as well.
However, capsular contracture can be recognized by touching the breast therefore, ultrasound is not used as to tell if there is a capsular contracture or not.
The ultrasound test is used to find out additional information on how to solve the capsular contracture.




The above image is to check whether the implant is in the right position or flipped upside-down. There is a white spot in the image and this is connected from the midpoint of the implant up until the 6 o’clock location. One can find out whether the midline of the implant is through this image. Finding out this kind of a problem is one of the biggest advantages of the ultrasound test.

Today, we looked at the various results that ultrasound tests can show before and after the breast augmentation. Has this helped?

Have a great day.

What is water-drop breast surgery? 

Breast augmentation Korea

Things to consider before breast augmentation surgery

What is a water-drop breast surgery? This might seem like a very simple question to answer but there are many who do not know exactly about it. Today I would like to share about the difference between the water drop breast surgery and one that is not.

1) The name of ‘water-drop implant’

There are many people who refer to this as water drop implant, but this is not an accurate term. We call this implant, an Anatomical shape implant.

This means that the implant is shaped as the shape of a breast. The English speaking countries refer to it as Tear drop implant as well. The term ‘Water drop’ is used in Korea mostly.

Breast augmentation Korea - water drop implant

2) When was it developed?

The water drop implant is not a new product. This was made in about 1992 by McGhan (currently known as Allergan) and Mentor.

They named is as cohesive gel by using sticky silicone gel on the implant and developed it into various types such as the one with a surface that is round shaped and another which is cohesive gel with tear drop shape that is anatomical.

So the water drop type implant that we use today is about 20 years old and is not a new product. It was certified late here in Korea.

Breast surgery Korea KIES-U

3) Which water drop implant is good to use? 

The advantage of the water drop type implant is that the outer layer of the implant is well made to maintain its shape. (Round type is also made to main the original shape but is not as effective as the water drop type) So the shape is maintained after a long time.

Another is that the upper breast volume is maintain although the patient gets older or has sagging breasts. (Round type shrinks at the top so it cannot fill up the upper breast volume effectively)

Next advantage is that if you are a thin person with less volume in the original breasts, this would lead to a more natural look of bigger breasts.
Another advantage would be that one can choose the different types of implants according to different body types. (This cannot be done with the oval shaped implant)

These are few of the biggest advantages, listed above.

Breast augmentation Korea KIES-U

4) What are some problems of water drop type implant? 

There aren’t many disadvantages of water type cohesive gel compared to the round type cohesive gel.

Water drop type implant is more stable and strong in its shape therefore it require bigger inlet so one needs to dissect the skin more. Some young patients might think that there is less volume in the upper breasts compared to what the round type can provide. Also, the price is more expensive.


5) How is the water type different from round type when having breast augmentation?

A lot of clinics have rather strong advertisements that try to communicate that there are differences in the technique, but this is not true. There is no difference in the technique or procedure with using the round type or the water drop type. Same dissection and same closing are required. The only thing one should be careful of is that the water drop implant needs to be put in in a certain direction. This is the only difference.

Some inexperienced people think that the water drop type implant requires some different method. Both round type and water drop type require same surgery method and after surgery treatment.

Breast augmentation Korea KIES-U

6) Why is water drop type expensive? (The cost of using water drop type) 

There was a big problem is huge difference in prices of the implants. All the implants are manufactured by foreign companies. There are many companies involved in various stages of importing the implants to our country. The products are manufactures in Europe, shipped to Singapore and then brought in to Korea. So this leads to big differences in the prices of the products.

But the price of the water drop implant has dropped a lot since September 2012. The usage has become popular and many companies hurried to import the implant leading to price competition. Now, you can find water drop type implant with price that is not much different from the round type.

The reasons why I tend to recommend the water drop type is because it is more advantageous for Asian patients who have tight small chest that require more safety, secureness, and durability. It is more advantageous for sagging breasts as well.

This is all for today, thank you.