What is tuberous breast?

It is difficult to find a severe case of tuberous breast but there are times that I get to meet patients with minor case of tuberous breast.

Breast augmentation Korea KIES-U

I think that there are about 5% of patients with a minor case of tuberous breast.

Name and definition

Tuberous breast is a congenital abnormality.
It can be formed on just one breast or both.
During the maturity stage, you breast do not develop completely therefore forming this unique shape.

There is no confirmed reason as to why this is caused but we believe that there is relativity with the disability in accumulating collagen.




In US, about 1 to 5% of breast augmentation patients are found to have this problem but there is no prevalence rate of the whole population. Not all of these patients come all the time to have the problem fixed.

It has many names. Some call it tuberous breast and others call it constricted breast.
It is also known as tuberous breast deformity, tubular breast, snoopy share breast, and herniated breast.

Characteristics of the shape

Large and thick areola
Far distance between the two breasts
Breast hypolasia
Sagging breasts
High inflammatory fold
Narrow breast width

These are some characteristics.



This also influences one’s ability to breast feed a child. In a worst case, one’s breast might not have developed enough to breast feed a child.
However, there is no influence on pregnancy or giving birth.

Treatment

Tissue expansion method and breast augmentation techniques can help correct the breasts.

Surgery is more complex than a normal breast augmentation. Highly trained plastic surgeon needs to conduct the procedure.

I have felt that the characteristics of those with tuberous breasts are as the following, in our country.

Nipple – Short distance from the inflammatory fold, and very straight
Tight breast cortical organization
Sticking out nipple, areola
Overall, the breast is small
Two breasts are wide apart



There needs to be more know-how than just a basic breast augmentation.

The implant needs to be strong and very stable in shape therefore the implant requires to have high filling rate and high agglutinability of the silicone gel. Water drop type is more effective than the round type.

I would recommend Allergan Style 410, Mentor CPG, and SiliMed.

These implants are used to make the lower part of the breast from begin tight to loose making the breast look aesthetically pleasing for a longer period of time.




Some might think that implant going into the upper part of the pectoral muscle might have more aesthetically pleasing results but most of the patients do not have thick enough skin tissue therefore the implant is located under the pectoral muscle. Double plane surgery that helps out those with thin layer of skin tissue can lead to satisfying results.

It is better to release the lower breast tissue so that it is dispersed to make a good looking share for a severe case of tuberous breast. This procedure is more complex and requires more time.

Today we looked at the details of tuberous breast.

Thank you for reading, have a great day.

Korean made cohesive gel implant, Bellagel, and Motiva from Costa Rica 

Today I would like to introduce new implants that might be certified and distributed in our country this year.
One is made in Korea, Bellagel, and the other is from a company with HQ in Costa Rica called Motiva.





Currently there are 5 implants that are distributed and sold at our country.
Mentor from US was not a large company but it was acquired by a multinational company, Johnson and Johnson leading to a wide international distribution of its goods.






Allergan also from US was called Mcgan before and named its product Natrelle..
Mcgan implants also have long history as Mentor implants do. It produced silicone products and was acquired by many other companies in the past. Recently, it was acquired by Allergan that produces Botox. Currently it does not use the name Mcgan but uses the name Natrelle from Allergan.

Silimed’s Mentor was started in Brazil and is a top 3 company globally after Mentor and Allergan. In order to expand its presence in US, it moved the HQ from Brazil to US. Since, it has used the name, Sientra, simultaneously.

In 2012, Mentor received FDA certification on anatomical silicone gel implants before Allergan could leading to an upset over various US companies.





These are multinational companies. The rest are rather small sized.
There are various silicone gel companies in France such as, EuroSilicone, Arion, Sebbin, etc. Sebbin products are imported to Korea.




Polytech from Germany is also imported to Korea. Polytech is famous for its polyurethane coated skin (capsular contracture free) but this is not certified in Korea therefore only the silicone gel type implants are imported.





All these 5 implants are high quality ones but have their advantages and disadvantages. It is not true that a particular brand might provide continuous good result but another might not.

Getting a good result from surgery is like pressing on one side of the balloon that leads to bulking of the other side. If you focus on just one side of a problem, another side might have a new one.

I do not prefer a particular brand over another. I select and match an implant according to the body shape, and chest of the patient.



When the patients ask “which brand is good?”, I always give the same answer that one should choose the implant according to the condition of the breasts.

Local implant is produced by Hans Biomed and the developing time was about 12 years. Hans Bio is in KOSDAQ and is financially stable.

Bellagel is not in the market yet, but has been exported to Latin America and other countries for the past 2~3 years.

I have high expectation for Bellagel in that since the HQ and the manufacturing plant are in Korea, the company would be able to communicate a lot with the doctors that might help with the development of the product.




Also all of the products imported to our country have been from the western countries therefore it was not perfectly fitting to Koreans or other Asians. Now, more fitting implants can be produced on the basis of data of Korean patient bodies.
There would not be other problems such as A/S or stock due to different demand in size.

However, one concern is that the implant is put into the body for the lifetime therefore a doctor needs to have long enough experience with the product to recommend and use it. But, nobody has any experience with Bellagel.
The history of the product is rather short, therefore, require more time to be applied on the patients.




Motiva from Costa Rica is under the veil. We do not have any information on when the product was developed, which doctors have used it, and what the advantages or disadvantages are. I am not sure such a product needs to be certified at our country.
I think that some clinics would promote this product by stating that it has an indicator on the product therefore one can know right away if there is something wrong with the product.

But as stated earlier, Motiva is an implant that needs to be in the body for a lifetime, therefore, it requires much time and experience to know the advantages and disadvantages of the product.

It takes more than a day or two for the doctors to try different methods, apply the implant to a patient, gather structure data, to find out the advantages and improvement points.

If you say that this is a product from Costa Rica, that you have not used it in the past but recommend it to the patient, do you think that the patient would like to try it?
I would not. It would be difficult for me to recommend such a product.




Today we posted on cohesive gel implant Bellagel from Korea dna Motiva from Costa Rica. Thank you for reading.
Have a great day.

Do teardrop(anatomical) type implant rotate (turn upside-down)? 

I would like to quote findings of Prof. Heden from Karolinska University in Stockholm, Sweden.

"From 1995 to 2009 we implanted close to 12,000 (minimum of 6,000 patients) AHCSI implants (teardrop type implants)........ Infections were caused in 1.7%, seroma in 0.6% of the cases. Infections are found mainly in the combined mastopexy augmentations.

Rotations have been seen in the teardrop type implant at 0.42% but have been an uncommon complication."

Scott L. spear, Surgery of the Breast. principles and Art. 3rd ed. 2011. pp.1344




Prof. Heden is one of the most well-known experts in teardrop type implants. He perceives a technique in making accurate desquamating location for teardrop type implant to be very important. This means that if the “teardrop type implant pocket” is made in the correct position, there is no possibility of rotation.

Let’s refer to Prof. Elizabeth Hall Findlay as well.
Prof. Findlay is another expert in breast augmentation who has been in the field all her life time. Prof. Findlay found double capsule and late seroma, and studied them.

Breast augmentation Korea

When strong texture implant gets physical exterior trauma, late seroma is formed after a year of the breast augmentation. In this case, the breast would swell up severely and after an emergency surgery that involved removing the seroma, one found that there was a double capsule at the point where there was a water buildup.

Much seroma would stop the implant sticking on the surrounding tissue. Therefore, the teardrop type has higher possibility of rotation.
But, late seroma is not common. Infection, hematoma, trauma, or breast cancer would lead to such a problem.


If there is much space, then the implant would rotate. If the pocket fits the implant well, then the implant cannot change its shape or position. But, round type would still rotate.

Breast augmentation Korea

If the implant sticks properly onto the surrounding skin, it would not rotate easily. All implants are textured so that they do not move about. If there isn’t good texturing, or the implant is from some bad company, or if there is much blood around the implant, then the implant may rotate.

What is the problem in moving about frequently?
We looked at Prof. Findlay’s findings above that late seroma is caused when there is a trauma on the aggressively textured implant. This can cause the rotation or the movement but this is really uncommon.

If the breast with an implant gets a lot of trauma or physical irritation, the implant loses its stickiness therefore causing seroma or hematoma that leads to the rotation or the movement.

Breast augmentation Korea

There are some cases abroad where the husband touched the wife’s breasts too aggressively that has led to seroma formation and reconstruction. The doctor found that there was a rotation in such case.

But other than this, if the woman does not do any UFC like activity, or if she is not a stunt woman, there shouldn’t be any trauma that causes such problem.

Although there is much movement of the pectoral muscle, if the implant pocket is made properly and if the stickiness is appropriate, there shouldn’t be any problems of rotating or moving about of the implants.

Once the silicone implant gets inside the body, a strong and tense barricade is formed around the silicone exterior. This is due to the immune reaction of the body, therefore, one cannot avoid it. This barricade is the epithelium. The epithelium surrounds the implant in 2 to 3 weeks. This epithelium that surrounds the implant is very strong and tough. Therefore, it is meaningless to massage the breast after this epithelium is formed in 2 to 3 weeks of the breast augmentation. Massaging would not avoid the epithelium.
The width of the epithelium would influence how much pocket space is formed for the implant and the textured surface of the implant sticks to this epithelium. Therefore, one should not conduct any rigorous activity but restrain body movement for 2 to 3 weeks after the breast augmentation. Rigorous activity can obstruct the stickiness causing possibility of the implant rotation.

Breast augmentation Korea

There are many patients who are concerned about the rotation of the teardrop type implants before the breast augmentation.
But, if everything goes, well, the rotation would not happen.

First, the doctor’s technique in desquamating the pocket that fits the implant perfectly is most important.
 Pocket that matches the implant needs to be formed to order to avoid rotation or the movement of the implant.

Second, one must avoid any repetitive trauma on the augmented breasts. This is not any trauma but one that may separate the implant and the skin tissue..

Third, one must restrict body movement / activity 2~3 weeks of recovery. Basic normal activities and stretching are fine, however, one should avoid any activity that requires a lot of strength so that the implant positions and sticks properly.

Today, we looked at the cause and solution to how one can avoid implant rotation. I hope that the contents have helped you.

Have a great day.

Recent finding on the risk factors of capsular contracture (breast augmentation) 

There was an announcement regarding a finding on the capsular contracture risk factors by Dr. Grant Stevens and 34 others and so I would like to post on that.

When there is a medical finding and announcement, there must be a reasonable number of samples to derive statistics. Also, there should be an appropriate time period that the experiment was conducted.

Therefore, major announcement such as this one, does not come out easily. There are many experts who debate on this finding, showing how important this journal article is.



There were 34 doctors and 2560 breast augmentation patients involved in this research. The data was gathered over a period of 5 years.

Only one type of implant, Sientra (known as SiliMed in Korea) was used, and the main objective was to find out the difference in the capsular contracture incidence rate between the textured type and the smooth type.

The incidence rate of these 2560 patients over 5 years was 7.6%. Some doctors experienced the incidence rate of less than 2% and some over 17% therefore the deviation was rather large.

The risk factors that lead to capsular contracture found from this experiment are

Surface of the implant; Smooth type has higher incidence rate

Incision part; Breast aureole has higher incidence rate than the inframammary fold

Plane; Subglandular has higher incidence rate than subpectoral

Hermatoma and seroma formation leads to higher possibility of capsular contracture

There are other minor ones such as massage, correction bra, size, etc.



Former findings showed that subpectoral had similar incidence rate whether the implant is textured or smooth, but higher incidence rate for subglandular breast augmentation.
But, the current experiments showed that whether it is subpectoral or subglandular, the textured type leads to lower possibility of capsular contracture.
Also, there was a statistical finding that the subpectoral leads to lower possibility as well.



Another finding was that massaging after the breast augmentation causes more cases of capsular contracture.

Massaging was popular in 1970’s and it was perceived that massaging minimizes the possibility of capsular contracture but there weren’t any findings that massaging influences capsular contracture in any way.

Massaging leading to lower possibility of capsular contracture is something of old and should be completely removed today.

The summary of the report is that in order to reduce the capsular contracture, one should use the textured implant, place it under the pectoralis muscle, and conduct inframammary fold incision.

There aren’t convincing contents about the implant size and the usage of the correction bra. Also, the experiment only used the Sientra (SiliMed) implants therefore, there needs to be more supplementary findings or data.




This is all for today.
Thank you for reading.

[Breast Surgery Korea KIES-U]

Breast augmentation is the most popular beauty surgery in the world today.
In 2010, there were 318,000 cases of breast augmentation in US alone.



Image that shows the possibility of capsular contracture according to different incision areas. Reference: 2012 Aesthetic surgery journal vol. 32, Doctor Jacobson


The most concerning side effect after the breast augmentation is the capsular contracture. There is no confirmed reason as to why this capsular contracture is caused or formed but there are many doctors who perceive that the exterior pollutant that penetrates into the body is the cause.




Prof. Jeffrey M Jacobson, Prof. Scott Spear and others from Georgetown University in D.C. has studied results from experimenting 197 samples from 2003 to 2009.
Prof. Jacobson and his team built a hypothesis that staphylococcus on the human skin leads to high possibility of capsular contracture.

They perceived that the staphylococcus that lives in sweating parts of the body such as the armpit touches the implant as it is put into the breast leading to higher possibility of the capsular contracture. They also believed that staphylococcus infected the implant in the same way when the incision is done on the areola.

After many comparisons and analysis, the incidence rate of capsular contracture due to armpit incision was found to be the highest at 6.4%, followed by breast aureole at 2.4% and inframammary fold at 0.5%.



This result was found to be statistically significant by Prof. Jacobson’s team.

The finding was that the possibility of capsular contracture by armpit incision is 13 times more likely than the inframammary fold incision. 

Capsular contracture is not as simple as to be only explained by germs polluting the implant. How the patient desquamates the implant pocket, how severe is the bleeding, is the implant textured, etc are all variables that may lead to capsular contracture.

However, I think that this finding, inframammary fold incision leading to least possibility of capsular contracture, is a meaningful one.

Toda, we looked at the findings by Georgetown University research team regarding the different incision parts and the incidence rate of the capsular contracture.

Have a great weekend. Thank you.