Choosing the right size anatomical implant for breast augmentation

This is another frequently asked question. Today, I would like to post an answer on “How to choose the appropriate size of implant when getting a breast augmentation?”











I think that you would be able to catch the point after seeing the image above.
You might also wonder how a large sized anatomical implant is put into a body of a patient who is very thin.

What happens when an implant that is larger in width compared to the breast diameter is used? If you have a narrow thorax, you might be able to feel the implant from the outside. If you are one with funnel chest, the implants on both sides might come and stick together in the middle. This is a high possibility for skinny and thin patients.

If you have more flesh, your skin would be thick, therefore you might not feel the implant although it is larger than the diameter size of your breast. However, in such case, the implant inside your breast might be folded or squashed.

Implant being squashed means that the outer layers are folded. This would lead to implant collapse.

This is why I mentioned an example of parking spot earlier. A car is limited in terms of width, but not in height or length.






The image below shows a very thin woman with 320cc cohesive gel anatomical implant.
Being skinny is one problem, but having a tight skin is another factor that makes it difficult to use large sized implant. A round type implant at about 320cc would need a diameter that is longer than 12.5cm. But an anatomical implant that is long and thick, for example, Optimom from Polytech, a company in Germany, has 320cc in diameter of 11cm.






The patient is very thin, therefore, the breast does not look big although a 320cc implant has been used. This is breast augmentation. For some patients, 200cc might be large enough. For others, 400cc might be small.

But in order for an implant to be put into the pocket size, it is more advantageous to use an anatomical implant that is designed 3 dimensionally and has more variety of choices. It is also better in using a large volume implant.

Today, we looked at the factors in deciding the anatomical implant size for breast augmentation. Have a nice weekend.

Thank you very much.

Q. Is it alright to have sedation or intercostal nerve block (ICNB) for breast surgery? (Anesthesia methods for breast surgery)

A. Yes it is. But the most secure anesthesia is the general anesthesia.



General anesthesia that we talk about in breast surgery mostly refers to inhalational anesthesia.
General anesthesia means intravenous anesthesia and,
ICNB refers to block anesthesia.

If we divide the anesthesia methods into two;

 - General anesthesia; no pain or irritation on the body
 (Anesthesia can be administered through inhalation and intravenous) 
 One loses conscious and goes blurry in this case.



 - Topical anesthesia; No pain or irritation on a particular part of your body
 (Anesthesia can be administered through topical infiltration method and blocking method)
One is conscious in this case.

We can apply any of the methods mentioned above for breast surgeries.
But the most common one is the inhalation, i.e. general anesthesia.
It is because the patient does not feel any pain, therefore the surgery procedure is secure and convenient as there is less reaction from the thorax or muscle when operating.

The sedation that we normally talk about (intravenous anesthesia), is done through propofol. The level of conscious is rather less secure compared to the inhalation types therefore, the body might move during the operation.

 
If the body moves and if the muscles contracts often, the surgery becomes difficult therefore leading to more usage of propofol. Too much usage can lead to the buildup of the anesthesia inside the blood and cause the respiratory center of the central nervous system to lose any senses, resulting in death or brain-death.

Blocking anesthesia such as ICNB cannot be used as a topical one without the drug that reacts on the central nervous system. The drug from sedation is put in with the blocking anesthesia simultaneously.




ICNB cannot be 100% reliable that it will work until the very end of the surgery therefore, one needs to add propofol or midazolam that may lead to similar outcome.



If inhalation anesthesia is used, one does not need to additionally use propofol or midazolam what remains in the body for a long time. Also, although the patient is in a deep physical decline, she will breathe through the respiratory tube therefore, she has the lowest possibility of suffering medical accidents such as death or brain-death.


Everybody wants to ‘wake up and feel nothing’ after a surgery.
When this is achieved, one can say that the most successful anesthesia / surgery has been completed.

But in order to achieve this ‘wake up and feel nothing’, one should not promote or advertise that the anesthesia is simple.

Simple anesthesia leads to more accidents in reality.

There was a known story about a middle school girl who suffered brain-death after the eye and nose cosmetic surgery. After this event, the number of advertisement about the sedation used for breast augmentation has been reduced. Breast surgery with general anesthesia and inhalation anesthesia leads to quick surgery time, and most comfortable state for the patient after the surgery to get back to her daily life.

Has this content helped you out? Thank you. Have a great day.

Breast Implant Size to Achieve Medium C Cup?

Today, I would like to talk about the one question that most of my patients ask. In simple words, the question is,
"Can I have a C cup breast (or a full B cup)?”
 
Two problems arise if a very thin, weak lady with narrow shoulders us large sized implants for breast augmentation. The first problem is that one can feel the edge of the implant when you touch the breast. Another is that you can make out the shape of the implant.

We call this first side effect, palpability (it is also related to refilling), and the second is called upper fullness.

Anatomical implant was developed for the safety and the secureness of the implant, and not to solve the upper fullness problem. However, the patients in our country who have very thin body but want large breasts use this anatomical implants and also avoid the problem of upper fullness.

There are many who say that one’s bust need to look good. There is a Y line that connects the collarbone and the midpoint of the breasts.

Y-line that shows the breast line

This Y-line is formed better with the help and secureness of the anatomical implant as well.
If you wear a short top or swimsuit, and draw a line that connects the collarbones to the nipples, this connected line would represent a meaningful purpose of breast augmentation. This line would determine how one looks good when wearing a particular clothes and also show where the breast starts.

If the breast is large and round, similarly shapes like a bowl, then there would not be a smooth line but a line that projects out. This line has to be smooth and natural to make the breasts look glamorous.



This is a popular model, Keeley Hazell from Britain. Where does her breast start? The line from her collarbone to the nipple looks astonishing and makes her body look captivating.


 

The width of the implant should not be larger than the width of the breast
The height of the implant can be extended in order to make the volume greater (although the width is small)

If you want to make your breasts look more beautiful and fitting with any type of clothes that you wear, then those in Far East who have narrow shoulders and narrow width breasts should use the anatomical implants that are long in height.
Let’s look at one anatomical implant, Optimam from Polytech, Germany, and compare it with others.
If the width (W) of the breast is measured at about 11cm, then the width of the implant should not exceed 11 cm.
Here are the implants with width of 11 cm.

Mentor Round	W 10.9cm	225cc
Natrelle Round	W 11 cm	222cc
Polytech Round	W 11 cm	255cc
Natrelle Anatomical FM	H 11.5  W 11	235cc
Polytech Anatomical (Round)	W 11 cm	220cc
Polytech Anatomical  (Oval)	H 12.8 W 11	260cc

As you can see above, a round type implant would have a volume of 225cc, but if you choose a oval type anatomical implant, then you would have an implant with a volume of 260cc.
Let’s look at implants with width (W) of 12cm.

Mentor Round	W 12 cm	300cc
Natrelle Round	W 12 cm	290cc
Polytech Round	W 12 cm	320cc
Natrelle Anatomical FM	H 12.5 W 12	310cc
Polytech Anatomical (Round)	W 12 cm	280cc
Polytech Anatomical  (Oval)	H 13.9 W 12	330cc

The same applies for this case as well. The implant with 290cc could be replaced with one that has the volume of 330cc. This is an advantage of oval shaped anatomical implants.

Of course, one cannot just measure the width in order to determine what size implant to use. We need to consider skin elasticity, pinch test, etc and there are also many with asymmetrical breasts therefore we need to use the sizer during the procedure.

However, it is a good thing that one can have a wide variety of implants to choose from in order to achieve that C-cup goal.
 

Before and after Breast augmentation

About 5 years ago here in Korea, it was difficult to find other types of implants, other than the saline bag type. But now, there are wide variety of implants available, and there would be even more variety to choose from in the future.
But, if there are too many choices, it becomes difficult to choose one.
If you have read all the articles in this blog, then you have been open to the most updated news in the industry, therefore you can say that you are aware about the most recent information.

This is all for today. Thank you very much.

Differences between the cohesive gel products according to implant manufacturers 

Before July 2007, only the saline bag type implants were used for the breast augmentation as the cohesive gel implants were not certified prior to that date. (Cohesive gel implant could be used for reconstruction but not for cosmetic reasons)






Cohesive gel implants could be used since, but it was limited to the round types. In Korea, we could only use two brads of Mentor and Natrelle (McGann) both from US.

Mentor acquired by Johnson & Johnson, and McGann acquired by Allergan are two largest sellers of implants globally, but we cannot say that their products are the most ideal ones.
There are 7 to 8 other multinational companies making implants as well. Even I do not know which one is the best. I do not have any data that compares all these implants although countries such as Japan, China, Hong Kong, Mongolia, etc all have these 7 different brands of implants.

Polytech was certified in our country after receiving the CE certification.
Silimed, which is used as much as Mentor and Natrelle in South America including Brazil, got certified by FDA this March and is waiting for certification here in Korea. Therefore, I think that we would be able to meet many variety of breast augmentation products in our country.
Patients in our country have rather standardized body compared to those patients from western countries. Most women have under-band sizes of 70, 75, 80 and want to increase from AA or A cup to B or C cup.



So the mostly used implants in our country are round type 250, 275cc from Mentor and 253cc, 272cc, 290cc from Natrelle.
255cc and 280cc are mostly used in our country when considering unique anatomical type implant from Polytech.

I have stated in the past that although companies print same amount of volume for the implants, the volume of all these implants are all different in reality.

When I compare the three implant brands that are sold in our country, I think that Mentor’s textured implants does not have any stickiness therefore, I do not use it much.
I usually use Polytech’s round type implants of 255cc and 285cc. I will compare the two brands of same sizes.

The standards for all implants a mid-profile.

As for round type,
Natrelle implant has a diameter of 11.6cm and height of 3.6cm. Polytech 266cc implant has a diameter of 11cm and height of 3.8cm. (Mentor 250cc, 11.3 x 3.4)
Natrelle 290cc, 12cm x 3.8cm and Polytech 285cc, 11.5cm x 4cm. (Mentor 275cc, 11.7 x 3.5)
There are the implants that are commonly used by Koreans (mid-profile). As you can see, Natrelle has the longest diameter. Polytech is rather narrow and tall.






Natrelle is on the left side, and Polytech on the right.
Both have similar amount of volume but the shapes are a little different.

Korean women do not have wide chest. Those who have AA~A cup sizes have breast width of 10~11cm.
Natrelle implant might have better quality but the width is rather wide therefore, it is not easy to use 275cc implant on the patient.

Polytech’s round implant is more applicable in such terms for those Korean women who have narrow chest. When the breast augmentation with this implant is complete, the new breasts look really good.
Of course, those of you who have wide chest and shoulders do not need to worry about this.
This difference is also related to how much gel has been tightly put into the silicone implant. Polytech implants are not filled at maximum so it becomes a little fat and roundish. Mentor is not filled up as much.

Then which is better? To fill up to the maximum level or not?

According to Tebbetts (2010), filling up the volume of the implant as much as possible avoids the problems of rippling and folding therefore it is better when filling up the upper part of the breast. The less filled implant does not cause much problem after the surgery, but as the patient gets older, her upper part of the breast might look empty.

This is different for the anatomical implants. Natrelle anatomical implant (not certified yet) and Polytech anatomical implant have near identical diameter and height in the mid-profile category.



Polytech anatomical implant, 280cc, diameter of 12cm and height of 4.1cm.
Natrelle anatomical, 270cc(oval shaped), 11.5 x 4.2. In oppose to the round type, Natrelle implant might look more thicker in this case.

Today, we looked at the three brands of cohesive gel products of mid-profile.
The weather is getting hotter, but if you get the 24 hour recovery system after the breast augmentation, you would not have any problems even with this hot weather.

Thank you for reading.

Anatomical implant for breast augmentation?
KIES-U Breast augmentation Korea

Most think that this is good because the augmented breasts would look anatomical. Also patients like it because the anatomical implants avoid the upper fullness.

Breast augmentation Korea KIES-U

Actually, in order to answer this question, I need to provide explanation on the relationship between the human body and the implants. Here is the conclusion, first.

Why is the anatomical better than the round type?

It is safe and secure (Form stability)


Anatomical implants are

Maintains stability for a long period of time
There is a lot possibility of implant collapse
Has stable, uniform result in any type of body used

Some like it because the anatomical implant does not lead to upper fullness.
This is true for those patients who are really thin and do not have much shape in the original breast.
However, if you have some amount of volume, there would be not much difference, whether you use the anatomical or the round type.

When the implant goes inside a human body, it’s shape would look differently than that when you place the implant on top of a table.

All types of implants look stable when placed on the table

But, when the implant gets into the body, it does not lie down as such, but remains standing up.




When the implant stands up, the upper part of the implant squeezes down. (Textured implant squeezes less than the smooth round type implant, therefore, as a result, the upper part of your breast would be filled up more with the anatomical type when compared to the round type)

It is wrong to say that the round implant leads to upper fullness always.

But, if you have tight skin and are young and thin, you will have a greater possibility of having the upper fullness.
Your skin presses on the implant, therefore, the original shape of the implant is maintained.

Let’s look at the MRI of the implant that is standing.

Hammond, Aesthetic Breast Surgery, 2009, Saunders, Elsevier

 
This is a MRI of a patient with 322cc round smooth type cohesive gel implant. The implant is folded and wrinkled. The gravity pulls down the implant therefore, the shape is broken down. Therefore, the round type, although the implant is round shaped, cannot maintain its original shape.
This looks similar to anatomical implant because the patient’s skin tissue presses on the soft implant to make such shape.

As such, the smooth type round implant (from Mentor) seems less full. If you touch it, it is very soft. Such implant loses shape as the breast presses on it. So the shape that is made from the manufacturing plant is not implants, but the original shape of your breast is important when considering the shape after the breast augmentation.

Hammond, Aesthetic Breast Surgery, 2009, Saunders, Elsevier

This is a MRI of a patient with 280cc anatomical implant. The implant maintains its form whether the patient lies down or stands up. There is no fold on the implant as well.

Such textured anatomical implant (from Polytech) looks like it is all filled up. If feels tight and strong when you touch it. The original shape of the breast would not be important in such case as the implant would determine the final shape of the breast after the augmentation.
You will be able to see the result right away of what type of implant you have chosen after the breast augmentation.

Molding form of the anatomical implant (From Mentor).

There is a textured round type implant as well. The Polytech’s implant is filled up a lot. The implant does not lose the original shape because of the skin tissue but the implant does fold. It maintains its form better than the smooth type but not as much as the anatomical type.
Why?





Let’s summarize

If you are very thin and young (in 20’s) then, your breasts would look in the shape of the implants that you use.
If you use the anatomical type, then your breast would look anatomical. If you use the round type, then, your breasts would look round, and there would be upper fullness.
Therefore, whatever the other say about this, using the anatomical implants would make your breasts look more natural.

If you do not have much elasticity, (in 30’s, pregnant, or after giving birth), then there would not be much difference whether you use the anatomical or the smooth type. Your implant folds at the top part, just as you see in the images above.

But, if you lose elasticity in the breast in addition to this, then your breasts loses strength to hold on to the implant. The upper part of the beast would look empty. The anatomical has firm and stable shape therefore, it does not lose its shape whether your skin is elastic or not.





Some doctors perceive that the softness and the breast pressing on the implant leads to natural results therefore, recommend this to the patients.
I think that this is good for the short term, but in the mid to long term, this should not be recommended to the patients because, we saw the folds on the implant in the images above. Such folds lead to friction in the long term and makes the friction point of the implant weak. This weak point could be the reason to the damage on the implant.

Whether an implant is a round type or cohesive gel type, an implant with enough viscosity would be better in terms of durability


These are the reasons why we use the anatomical type implants.

It is good to use anatomical implants for breast augmentation.

This is all for today. Have a great day.