Things to consider for breast augmentation

[KIES-U Plastic surgery Korea]



There are three ways to select the implant size.

First method is to select a size without any measurements. 

This depends largely on the preference of the patient and the doctor. Plastic surgery is referred to both art and engineering but this method is solely based on art as there are no measurements involved and the selection is done through visual method based on preference.

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Second is the dimensional analysis system method;
The patient and the doctor deliberate on the wanted results and then measure accordingly. This method is to measure the breasts so that we derive the wanted implant size and the shape.

Third method is the tissue based planning; 
This is not based on the preference of the doctor, or the requirement of the patients. We select the appropriate size range through experiments and plan the augmentation accordingly. The doctor recommends the implant size according to the width of the patient breasts, skin elasticity, distance between the nipple and lower line of the breast, etc.

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The current trend is with the tissue based planning.

According to the journals published, we observe that the highest satisfaction is gained from tissue based planning. After taking the measurements, the doctor introduces the appropriate implant size range to the patient. The patient can get a fitting test before the augmentation to see what type of final result can be derived.

The patient can choose the size from the size range provided to get the most satisfying result possible.

Just like any other plastic surgeries, breast augmentation is also an art and engineering, but it needs to be scientific as well.

Scientific decisions should not be made based on how you feel. In reality, art itself is not structural enough, and it cannot be said that it is craftsmanship like.

The selection should be made through statistical data measurements, but I think that there should be a little art too it as well.

This is one fact that everyone accepts in cosmetic surgery. The difference between the cosmetic surgery and others is that cosmetic surgery starts off with the patient’s hope that we need to respect. There are many methods that can be applied in order to respect such hope therefore, the doctor’s preference in the method and experiences are also important.

There is no one correct answer. The answer depends on the wants of the patient and the preference of the doctor.



There are many patients who ask why all the hospitals are different in their methods. The difference arises because we want to satisfy the cosmetic wants of the patients and set direction in such way. We do not focus differentiation for marketing purposes.

I have used tissue based planning from the very beginning but I think that one needs to be flexible in decision making when considering cosmetic surgeries as we center our decisions on patient needs. But there are some things that we cannot be flexible about.

Therefore, I need to invest much time in such area to make the patients understand the things that I cannot be flexible about.

Today, I shared contents with reference on Plastic and reconstructive surgery 2016 Nov publishment by Dr. William Adams from Dallas.

Thank you for reading.

Q. I was found to have Fibroadenoma in my medical examination. Can I get breast augmentation? Do I need to remove the lymph first and then get the augmentation?

A. Here is the pathological explanation on Fibroadenoma
Fibroadenoma is a benign lump that perimenopause women suffer from. It can move about easily,  is strong and smooth, but there is no pain from it.



Fibroadenoma can degrade by itself and there is a very low chance of it developing into a cancer.

Then why does it happen? We do not know the origin and there are many scholars trying to find it out. However the development and the enlargement is perceived to be caused by the female hormone.
It gets bigger during pregnancy and breastfeeding period. It also gets bigger when you receive hormone treatment and get smaller after menopause.


Is incidence rate for fibroadenoma high if I take birth control pills or get hormone treatment? The answer is no. Female hormone does not cause it and there is no heredity factor as well.

- What is the incidence rate of Fibroadenoma?
In breast biopsy, about 50% of the cases are found to have Fibroadenoma. (75% for those who are 20 or less). Also, it is higher for those who have some type of social status. (I think this is because there are more women working in countries like US so those with low social status have difficulties in getting a check-up..)



There are some abnormal historical findings on Fibroadenoma. One should be more careful in such cases so that it does not get any worse.
- Does Fibroadenoma recur after its removal?
There is a chance of recurrence. If we find one or two and remover it, there is a chance that another one or two regenerate in the future.
- Does Fibroadenoma must be removed?
There is no one answer to this question. We cannot say yes or no. If we remove the big ones, there there would be large empty space that could change the shape of the breast. Fibroadenoma can contract in size or disappear if your let it me and at times, we recommend doing nothing.

- Can breast cancer be misdiagnosed for Fibroadenoma?
It is reported that the chances of misdiagnosis is 1/700 when conducting physical examination, ultrasound test, and fine-needle aspiration biopsy. The change become greater as the patient gets older.



- How do we treat Fibroadenoma?
Many medical institutions have different treating standards for Fibroadenoma. This applies to other countries as well as Korea.
A malignant tumor is life threatening therefore one must follow the proper protocol for treatment but there is no concern that Fibroadenoma gets any worse therefore the decision on the treating method is depended on the doctor and also can be not treated at all.
If you are 35 years old or older and diagnosed with Fibroadenoma, it is good to do a follow up check once every 6 months. 
If the Fibroadenoma contracts by itself naturally, one should monitor the status until it is completely disappeared.
If there is not change until you are 35 years old, then physical removal may be necessary.
If Fibroadenoma gets any bigger while it is being monitored, one must remove it definitely. If the patient’s family has a history of breast cancer or if Fibroadenoma looks abnormal, removal is recommended as well.
- Then, should we remove Fibroadenoma before or after the breast augmentation?

Fibroadenoma is formed on the breast tissue and implant insertion in done below the pectoralis muscle so the two do not interfere with one another.



So if you are removing one or two Fibroadenoma lumps, you can get the #breastaugmentation within a week or two after the removal.
If you already had breast augmentation, then you would have to wait 2~3 months for the breast skin and tissue to become stable, and then remove the Fibroadenoma.

But if you need to remove a giant fibroadenoma or many of those, then you would need to talk to your doctor on the time of the removal surgery.

Today, I shared some contents on #Fibroadenoma. I hope that the contents have helped you out.

Thank you very much. KIES-U Plastic surgery Breast augmentation Korea

☏ KIES-U what's app +82-10-2687-4790

Q&A on breast augmentation | Plastic surgery Korea

Should you use anatomical implant or the round implant?
The answer to this differs from a doctor to a doctor and even the hospitals.
There is no 100% correct answer, so the patients think the implants are chosen based on preference.



I have used anatomical implant for the past 5 years, and used round type and saline type from earlier period. I cannot exactly say that anatomical and the round type lead to differently shaped breasts, but I can say that there is a certain situation when the anatomical type must be used.

This has been agreed by many doctors.



1. When the patient wants a natural look (and if she likes anatomical type a lot)

Dr. Bronze took x-rays of anatomical and round type implants placed above the pectoralis muscle and showed them to many doctors. The doctors who saw the photos could not find any differences between the two.

This means that the doctors cannot distinguish the anatomical implant from round implant. This is the same for me as well. I cannot know whether the patient used anatomical or not even though I conducted the procedure
At times I think that it would be better to use anatomical implants on those patients who have small orginal breasts and used round type implants for breast augmentation. The augmented breasts look unnatural.

Anyways, in most of the time, the patient gets to decide on what type of implant she wants to use. If she prefers to use the anatomical type implant, we do not necessary feel that we try to change her mind.

2. Constricted breasts ; 

I have shared on this in the past. Constricted breasts are usually when the area from the nipple to the bottom of the breast is very tightly close together.
In order to put volume onto such breasts, there must be much tension on the bottom part so that the skin in that area can stretch out easily. For this to happen, anatomical implant would be useful.


You can refer to more information on this by clicking on the link below.
http://drleebreast.blogspot.kr/2016/11/breast-augmentation-for-constricted.html

3. Thorax hypoplasty

If there is no proper or clear ratio of the upper body, and if your original breasts are not shaped right, anatomical implants would be recommended.
If you have a Poland syndrome where one side of the thorax looks lower than the other, anatomical implant with larger size can be inserted to the lower side.

4. Breast ptosis or sagging

In case of sagging of the mammary glands, what is the best implant to use when wanting to avoid Mastopexy (lifting)? An implant with stability would be good. An implant that does not collapse and maintain its form would lead to high level of satisfaction. Anatomical is more stable compared to round type, so there are many who prefer the anatomical implant. Also, if we select tall anatomical implant, it would help add more volume on the upper breast as well.



Current trend is that there is no one appropriate implant for all causes. Different implants are used for different situations. Therefore, it is wrong to say that anatomical implant is good for everything. But I have shared cases where anatomical could be more effective in usage.

Thank you for reading and have a great day.

Breast augmentation methods

Everyone dislikes scars. Many patients expect small incision but large implants for breast augmentation.


But logically, you would need a large incision spot to insert large implant. We need to have an incision spot of 4cm to insert most widely used implant size of 280~290cc.

If you are to use low to mid 300cc implant, the incision spot needs to be about 4.5~5.5cm long.



There was a patient who really could not stand any scar on her body. As her request, I made an incision about 3.5cm long to insert 300cc implant on the axillary fold.

I completed the operation but the scar was large enough to be noticed so I doubted if small incision was really beneficial or not.



If the incision is small, it gets in the way of the equipment used during the operation. Therefore, the equipment will keep on touching the skin leading to more traumas on the skin.

When we design the axillary fold incision, we tend to start at the deepest spot in the armpit. When we look at that area again after the recovery, the skin in that particular area is different from the other parts and therefore, more visible to the eyes.

The better solution would be to make the incision larger so that the equipments used such as endoscope, retractor, gauze can move about without hurting the incision spot. Also this large incision line would look more naturally like the original axillary fold therefore it would be less visible to the eyes.



This is what operation is all about. You do not need to make it big with necessary changes, but also you do not need to put much effort in minimizing the incision to make the patient feel more comfortable which could lead to worse outcome that you did not prepare for....


Let’s say that you built a building. You might think that the construction building is not too big so you don’t need to use a large safety shade and minimize the number of danger signs used. The construction could take a shorter time than average projects. But this is a dangerous thought. There are safety issues also with small construction projects.



No matter how minor the operation is, we need to carefully check on all the safety measures and equip all the safety related equipments before conducting the surgery. We should not try to minimize anything, including the incision length.

There is a pre-axillary line on your body. We start from behind the pre-axillary line and move to a deep spot found when you lift up your arm. You can find a spot where there are wrinkles and straight line. This is the incision spot.

Today, we shared on the spot and length of the incision area.
Thank you for reading.

Q&A on breast augmentation

I went to an event a couple of days ago and did a Q&A session. One question stood out to me the most.

Actually, there are a few patients who question this.

The question was this. My husband really opposes the idea of me getting a breast augmentation. Can I say that my breasts became larger because I got them treated in eastern medicine clinic, or got filler or gained weight? Can I avoid any troubles with my husband by telling him this?



The answer from me is that “it is difficult” to do so.

If your husband does not notice that you got a breast augmentation, then it means that there is no wanted outcome. There is no patient who will be satisfied with breast augmentation if one cannot notice it.

Breast augmentation requires inserting implants according to different cup sizes to make a change in the body therefore if the husband cannot notice it, it means that there isn’t any change in the body of the patient.



There are some who want to make the breasts larger but so that someone touching it feels natural.

You can make the breasts feel natural but it is difficult to make your husband not notice it. (Unless you don’t have a relationship with your husband)

Most of the patients share that they want a breast augmentation before the operation but do not share what they feel (worried about the complications) after the operation. They just say that they are highly satisfied.

There are some who want to keep it a secret from their parents.

This applies when the parents object the breast augmentation, but usually, it is not the mother that objects. The mothers understand their daughter’s complex with the breast size and can sympathize with the daughter.



But, the fathers do not. Do you want to work in a liquor store with big breasts? Why do you want to change the body that your parents gave to you? Such are the reactions from the fathers.

Fathers do not understand the complexes that the daughters have (because they have not experienced it)

Someone asked me if I would be OK with my daughter getting a breast augmentation. In truth, I know the danger with the operation procedure, anesthesia, etc so it is not easy for me to say “yes” right away.

But if I was not a doctor, I would be more careful in answering the question (Also, I do not have a daughter)

Then, how about my wife? I would think much more on this. But I think I would say yes if she really wants to get a breast augmentation.
I would conduct the breast augmentation on my wife, but I don’t think I can do it on my daughter.



There are patients who worry that their family members could notice during the recovery due to the inconvenience and pain that the patients would suffer from.

The time for recovery and pain differs a lot from one person to another. I have stated this in the past but I would like to share it again. You need to select small sized implants to have less tension and pressure that will lead to no pain and quick recovery. In such case, your family members would not notice easily. Also, your skin cannot be too tight.. Theses are the important factors.

Today, I answered a question on “will my family not notice my breast augmentation?”

Thank you for reading. Have a great day.