Breast augmentation – Inframammary fold (Incision and scar)

Anatomical implants are mostly used in breast augmentation today.



Whether you do anatomical augmentation or not, you would choose the type (round cohesive gel or anatomical cohesive gel) and the size of the implant before the breast augmentation. Next you would need to choose on the part for the incision. This is one area that you would think about a lot. I would like to share on this point to help you out.

I would like to refer to very prestigious contents. The two references below are authored by world renowned Dr. Spear and Dr. Tebbetts.



There are two competing goals in breast augmentation; providing comfortable access to the breast, while placing the incision in the most inconspicuous location possible and less exposure of scar. For many surgeons, it is the inframammary fold approach that provides the best balance between these two aspects of incision location. (Surgery of the breast, Scott L. Spear. 2006 Lippincott Williams & Wilkins)




The inframammary approach for breast augmentation is the most widely used incision location for breast augmentation. …. Reasons for popularity of the inframammary approach include direct vision for optimal control, minimal tissue trauma, and minimal bleeding. … Each of these reasons directly impacts patient outcome short and long term. (Augmentation Mammaplasty, John B. Tebbetts, 2010, Elsevier Inc.)

As you can read in the contents above, most surgeons around the world are already aware that the inframammary fold incision for breast augmentation leads to least complication and other problems providing best results. Inframammary fold approach is the most popular one in US, EU, South America.
Also, inframammary fold approach has been getting a lot of attention after the certification and sales of anatomical implants.
It is ideal that inframammary incision is done for the anatomical implants.

However, this approach is not comfortable by many surgeons in Korea. This is because many young patients preferred the axillary crease approach. I have had interest in inframammary fold and have applied it for a long time. I would like to post on some of the strong points of inframammary fold incision.

Below is the summary of different incision methods.






1) Axillary crease



Incision on the axillary crease means that the incision is done far away from the breasts therefore, it is recommended to those who are sensitive about having a scar on their breasts. However, there is no visual so we need to use the endoscope (long surgery time) and the distance from the input to the breast is long, meaning that there is that much more change of damaging the tissue of the entrance path. There can be pain after the surgery due to this cause. There are many nerve and vessel stimulants in the armpit therefore there can be some related symptoms caused. Also, it is not easy to put in form stable anatomical implant through the axillary crease and we need to study more on the possibility of implant rotation.



2) Areola



One thing that worry the patients about the areola incision is that the breast feeding may be disabled because of the areola incision. There is no such problem if an experienced surgeon performs the procedure.
Areola incision is a very good method for most breast augmentation including sagging breast and combination of 2 or more surgical methods.
However, there is a concerning point in which the incision on the breast may lead to tissue penetration causing trauma.

Also, as the implant is put in, the implant can come in touch with skin tissue cell that might lead to infection, inflammation, and even capsular contracture.
If the diameter of the areola is big enough, there would not be much problem with using the anatomical implant for areola incision method.



3) Inframammary fold 



The reason that inframammary fold incision does not cause pain is because it can be desquamated quickly. Also, it has a clear vision therefore the procedure is quick. Pain and complications are caused when there is not much visual and if one needs to damage the skin tissue.
Inframammary fold has best visual compared to any other methods and so it is the safest method as well. There is less trauma and less invasiveness.
Also, desquamation is easy and one can stop bleeding near to 100%. It is the easiest method when using the anatomical implant.
The scar can be covered by the breast skin therefore the scar is not easily visible.



4) Belly button



Belly button method leads to least pain and least visible scar that is far away from the breast. However, it is impossible to use cohesive gel silicone implant for this case. Only the saline bag type can be used. Of course, anatomically shaped cohesive gel implant cannot be used also.

 
Today, we looked at globally used breast augmentation incision method of inframammary fold.

I think that this method will be applied more and more with the usage of anatomical implant.
Also, many doctors believe that it is the safest incision method that can be applied.

Thank you. Have a great day.

Form stable implant

There are many who do not understand what form stable implant is.
Today, I would like to share about what a form stable implant is.



Form stable implant is one that does not change its shape irregularly but stays in uniform shape.

What is form stability?

The gel has high cohesiveness and density. As the filling rate, volume of gel compared to exterior skin, approaches 100%, the exterior shape remains stable.




 
Advantages of form stable implant

1) Durability (Low possibility of collapse or leakage)
2) Low possibility of capsular contracture (Theoretically; not clinically proved)
3) Low possibility of rippling
4) Good for filling up the volume in the upper breast
5) Low possibility of breast parenchyma contraction (Need more clinical data)
6) The gel does not leak although there is damage on the exterior skin

Disadvantages of form stable implant

1) Requires high technique for surgery
2) Costly
3) Large incision for the implant
4) Patients feel that it is not as soft
5) Not good for those who want large sized implants



The important point here is that there is no absolutely form stable implant made by the manufacturers today.
Anatomical implants are said to be rather stable in form or shape in our country.
The most representative product is anatomical implant from Allerga, Style 410. There are other such as CPG (Contour profile gel) by Mentor, and anatomical implant from SiliMed.

Truform2 from Allergan Inspira is a round type implant but it has a high fill rate therefore provides high form stability but not as much as Style 410.




Implants that have weak form stability are,
Mentor round type implants (Mentor MemoryGel)
Soft touch products in Allergan anatomical implant
Polytech silicone gel products

Such variety of implants are produced by the companies and it is difficult to know each one of them.
If you feel that you need a form stable implant, you need to think and consult with your doctor on whether you want highly stabled or lowly stabled implant.

In most cases, the form stable implants are recommended for,
Sagging breasts
Tuberous breast
Constricted breast
Low volume in upper breast
Other factors such as when your original breast needs big make over

Thank you for reading. Have a good day.

Is it anatomical implant surgery? Or a breast augmentation? 

I have stated in the past that the anatomical implant breast surgery is not a breast augmentation surgery but is a cosmetic surgery.

However, when I talk to my patients, many of them do not know what the difference between the anatomical implant and the round type implant is when used for the breast surgery.

Making your breasts larger is something of old. These days, breast surgery is to make breasts that match well with your beautifully shapes body. My post today is to elaborate on this.
This is not easy to understand. However, if you read the contents slowly and carefully, you will get a hold on it.



In order to understand this, you would need to know why the word ‘cohesive’ is used for the cohesive gel.
At first, Mentor named it cohesive gel, Memory gel.
It meant that the implant remembered or memorized its original shape when manufactured.
The implant needs cohesiveness in order to maintain its original shape. The company made a silicone material with adhesiveness and density.



The reason for developing cohesive and sticky gel is to prevent spillage of internal substance in the body if the implant collapses. The idea behind how much cohesiveness is necessary, is different for each manufacturers.

Anatomical implants have high level of cohesiveness (Highly cohesive silicone gel). In oppose, the round type implant has average level of cohesiveness (Classic cohesive silicone gel).

Many people know that the type of cohesive gel implants can be divided into anatomical and round type.
But before considering whether the implant is anatomical or round, it is important to know the level of cohesiveness.



Silicone gel with high cohesiveness; Tightly closed therefore does not leak and maintain its original shape.

We looked into the following images before, but let’s refer to them again. The images are from a book written by Dr. Hammond.






The above image is one with low cohesiveness, i.e. MRI result of breast augmentation with round type implant.
The picture below is an implant with high level of cohesiveness. It is a MRI of a breast with anatomical implant.

The round type implant does not remember its original shape! The pressure from the surrounding skin and the gravity pulling the implant down make the implant rumple. We call it a round type implant but it does not remain round inside the body.
Therefore, if you use the round type implant with low level of cohesiveness, your breast becomes larger but the shape does not change.

But if you look at the bottom image, you will be able to see that the anatomical implant with very tight inner substance maintains its shape resisting the surrounding environment.
Anatomical implant maintains its shape making your original breast change its shape also. Your augmented breasts become anatomical, i.e. the shape that you want them to be.

This is the core point of the anatomical breast cosmetic surgery.

If your original breasts are beautiful, but you want them just to be larger, then you can use the round type to get the result that you want. You do not need to consider anatomical type. But if your original breasts do not look beautiful and you want to make them look better with larger volume, then you need to use the anatomical type!



You will be able to understand better with the aid of these images. The photo below shows the usage of very big round type implant because the patient was greedy about the size.



375cc implant was used. You may think that there is good enough volume but I am sure that most of the patients do not want their breasts to be like that.


Anatomical implant – Before surgery, 1 week after, 2 months after the surgery (left to right)

When you use the anatomical implant, your breasts shape differently as time passes by. You will be able to overcome the initial problem and have new beautiful looking breasts. Of course, you will have larger volume as well.

Today’s keyword was ‘Cohesiveness’. Anatomical implant with high level of cohesiveness make the breasts look more natural with larger volume. Round type implant with low level of cohesiveness just makes your original breasts larger.

Therefore, there is not much difference in the result using the round type implant. The implant itself is very simple and you just need to choose the size that you want.
But anatomical implant results differently according to who you are. The implant that you choose determines the final outcome therefore the selection process becomes really important. There are so many more types of anatomical implant than the round type implants.

One needs to judge which manufacturer’s implant and the type fits best with the particular patient in order to get the best result from the breast cosmetic surgery. The role of the doctor / surgeon becomes that much more important.

This is all for today. Thanks a lot.

When can I start to exercise after the breast augmentation surgery? (Breast augmentation recovery) 

Today, I would like to share about the recovery from breast augmentation surgery, i.e. when you can start exercising after the breast augmentation.



First, the type of exercise is important.
Second, one needs to consider the difference in the outcome of the surgery for each patients.

The first week of recovery from the breast augmentation surgery is quick and active. The body reacts to the implant that is in the body all of a sudden, and the implant pocket begins to heal therefore, this period is unstable.
It is recommended that you avoid heavy activities or exercises and just do daily chores.



Strong capsule, epithelium, is formed around the implant after 3 weeks.
There can be difference in the thickness but this epithelium is formed in all bodies with silicone.

If this epithelium becomes too thick, it can be the cause of the capsular contracture, but this epithelium also helps implant to maintain its position stable within the body. There are two sides to the coin.

Therefore, you will be able to do just about any exercise after three weeks.
Normal muscle movements do no shift the implant to a different position.



You can exercise on the running machines, you can enjoy cycling, weigh training, and yoga. After a month, the epithelium becomes stronger therefore even massaging the breasts would not lead the implant to shift or move to another position.

Therefore, I tell my patients that it takes about a month to enjoy normal exercises.
But you need to be a little loose about this time period.

Your body knows what is best for you. If you want to swim after the breast augmentation, you might do a little warm up. If you feel ok, then you can swim more the next day but if you don’t feel good, then you should stop at that moment. You need to feel your body and control the pace of your recovery so that at the end, you can get back to your original condition..




I conducted breast augmentation on a professional body builder. We communicated a lot and I am aware that it took 2 months for her to do the normal body building exercises that she did before the surgery.

Professional body builders can resist the heavy weight but normal female patients cannot.
 
So it takes less time for a normal patient to get back to normal condition.
Today, we looked at the time period of exercising after the breast augmentation. I hope that this post has helped you out.

Thank you and have a great day.

How long does it take to have natural feel after breast augmentation?

Q. How long does it take to have natural feel so that my husband or boyfriend cannot know the difference?

A. This is not a comfortable question to ask but is one that many are curious about. Today, I would like to answer this question.

Let’s look at that natural feel after the breast augmentation.





Many patients just consider the feel of the silicone implant.
So they think that it is best to use soft silicone implant so that their husbands or boyfriends to not recognize the difference.
The feel after the breast augmentation comes from the original breast tissue. The implant is below it. Therefore it is like touching a bread covered up with cloths.



If you want to know exactly what that breast is, then the cloth covering it needs to be thinner.
If the cloth is very thick, then you will not be able to know what is under it.

Now comes an important point.
If your skin is very thin or you have a thin body, then a person with small breasts who used large implants cannot cover up the fact that she got a breast augmentation surgery even after a long time.
There is a high possibility that people can feel the difference.
But, if you had thick skin layer, or were a little fat than normal person, there is a high possibility that people cannot feel the difference.



Also there is no proportional relation between time of recovery and the feel of your breasts.
Your breasts might feel unnatural due to the swelling in the first 2 to 3 weeks of recovery. They will feel natural after the swelling goes down but if you use a very large implants, your skin layer gets thinner therefore, your breasts might not feel natural after 6 months to a year.
(But, there is a proportional relation between the shape of the breast and the time or recovery)




So if you need to avoid sexual life due to the recovery from the breast augmentation, it is recommended that you avoid having sex in the first two weeks. It would be very concerning to touch the breast in the first few days of the recovery.

It’s been about 2 months since I got the breast augmentation. If everything goes fine, I would not need to worry about my husband or whoever touching my breasts.
Today, I posted on the answer for how long it takes for the augmented breasts to feel natural.

Thank you for reading. Have a great day.