Uneven breasts; how to correct them
There are patients who have a complex with uneven breasts as much as those who do with small or sagging breasts. Today I would like to share about the uneven breasts.

People think of uneven breasts as breasts with different volume size but there is a lot more to this. Let’s look at them one by one.

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1. Uneven thorax
2. Different location or inframammary fold or nipples
3. Different degree of sagging
4. Different original shapes of two breasts
5. Uneven breasts caused by breast cancer surgery or other treatments
6. Uneven breasts caused by breast augmentation, contraction, correction

There are the main factors of uneven breasts

1. If you have two sides uneven thorax then you have uneven breasts by default. This is because left and right sides of your body are uneven naturally.
You need to understand this properly. All human being and all living things do not have perfectly even two sides of the body. Only the mannequins and dolls have perfect even two sides of the body. Your face, hands, and legs are all uneven.




As you can see in the image above, the left and right lungs look differently. The heart is not in the middle but is little closed to the left. The main artery and the main vein are also positioned towards one side.
 
This is why the ribs that protect the inner parts of the body look differently as well. The left ribs that protect the heart usually stick outwards more that the right ones.
This is why about 90% of the people think that their left chest sticks out more than the right. But there is not that much difference to say that both sides are uneven. However, we tend to use different size implants in order to make the two volumes the same.

From my experience in consulting with the patients, about half of them know that they have uneven breasts and the other half does not.



2. There are very rare amount of people who have the two inframammary folds lined up in a straight line. This means that one inframammary fold tends to be positioned higher than the other. Therefore, the nipples are located at different level of position as well.

From my experience,  the distance between the nipple and the inframammary fold is about 1 cm or less. We can say that this much distance is within the error range therefore, we do not need to focus on the cosmetic beauty regarding it. But if the distance is greater, then you might have to consider getting a correction done.
You can consider areola movement and implant surgery simultaneously. We can correct the location of both areola and nipples and make the inframammary folds line up straight as well.
 
3. It is common to see different degree of sagging as well. One breast may sag when you are going through puberty, but this usually happens after breast feeding as mothers cannot balance out the breast feeding evenly on both sides.
It is natural for the bigger breast to sag more after giving birth. The loss of volume is noticeable as well. Using implants on both the breasts cannot solve this problem. The sagging needs to be corrected so they are even therefore we need to conduct breast augmentation on the more sagging breast simultaneously with correction.
Many think that breast augmentation just involves putting in of the implant. But they do not know how the sagging breasts are corrected. We can design the correction in a shape of concentric circle and move the location of the areola and the nipple. We can gather or pull up the derma from the bottom part of the breast to correct the sagging. There are many techniques as such.
We can also apply different level of lifting to make the breasts even. At times only one implant is used for a particular side and we conduct correction on the other.

 
4. Two sides with different shapes mean that one side is conical and the other is sagging. Or one side might have the areola and the nipple located away to the left of right side of your breast, and the other in the middle of the other breast. This happens because you are born with uneven thorax.

We can move the location of areola and the nipple more towards the middle of the breast or we can make the implant pocket size different on each breast or even use different types of implants. We can apply dual plane on one side and under/above pectoralis muscle method on the other.

Reference from an essay in Brazilian Plastic Surgery Journal

5. We must consider many methods for uncorrected breast after breast cancer surgery or one that needs correction for unevenness. We can change the skin flap, or can use implant by estimating how much fat can be regenerated. We could also add fat transplant.

Reference from an essay in Brazilian Plastic Surgery Journal

 
6. There are times when you get uneven breast because of some cosmetic surgery or your uneven breast may look worse after the surgery. You need to compare your breasts before and after the surgery properly so that you can know the cause of the unevenness and find exactly what needs to be done to correct this.

You might need to have different planes on each sides for the implants. You have might to consider relocating the position of the areola and the nipple. You could consider fat transplant or you might even have to replace the old implants. You need to think about all these addtional alternatives.

Lastly, uneven breasts is a problem that most women have therefore you should not think that only you have this particular problem. Every person has uneven two sides of the body. You breasts are to look good with cosmetic surgery and not to look even on both sides.

This is all for today. Thank you for reading.

Sociology of plastic surgery

Langlois and others conducted an experiment on 3 month old babies by giving them 2 pictures and observing which they like more. Although these babies could not speak, they look at the picture of the one that the adults judged to be more attractive.

Couple of years ago, there was a TV program that tested which teacher the kindergarteners liked more, a pretty looking teacher and the ones who is not. The kids concentrated more in the class thought by the teacher who was more attractive and they thought her to be more professional.

Based on such experiments and information, we can think that the want for beauty is gained through learning and also something that is innate.



A human’s stand towards beauty is both longing and a desire, and at the same time something that is artistically wanted for.
Sophisticated, noble, smooth, attractive, lovable, enticing, etc, words such as these show how much us human being long for beauty.

In this regard, our society too is very and overly interested in plastic surgery. The plastic surgery in Korea is very famous throughout Asia.

I always think about how our country has become so famous in plastic surgery globally in its technique and culture. I would like to share about this today.

 


Plastic surgery is a behavior that is highly related to a person’s needs and wants towards beauty.

We all have our want of beauty but we are in a culture where we cannot be open about it. Things have changed a lot, but not this.
If a celebrity has a plastic surgery, this becomes a gossip but he/she and the management make it untrue or are hesitant to talk about it.
This is because many people criticize the person who look better through plastic surgery. This is especially so with mid and old aged men who are the backbone of our society.
This shows that neo-confucianism perspectives still remain as a part of our society. Such culture can bring out absolutely different perspective of plastic surgery.

These mid and old aged men set priority on the root and are trapped within the idea that “although she got pretty because of the plastic surgery, the root does not go away.” In opposite, young ladies are too concerned about looking good and they want to look good through whatever way possible.

As such, we can see two opposing views regarding plastic surgery according to social class and age.
 


We need to talk about this as well.

This happened couple of years ago. An announcer in KBS came out on TV and looked as if she gained more weight than before. The viewers criticized her by saying “how can she come out TV looking like that?” There was a lot of criticism that our country was too much focused on appearance.

Ability, skill, and experience should be more important than appearance but we are too focused only in the appearance. So there are many critics that say that our society not only judges ability but also beauty.

I had a conversation with the head of announcer academy. I asked him if he could know that the student could become an announcer just based on the looks. He answered that the student needs to be “Pretty, Being pretty is good enough. You can’t be selected if you are not.”
Beauty can be more important for visual area… but I still had some questions. This is maybe why our society is too appearance oriented.

But in overall, I don’t think that our society is that much appearance oriented. There are times that we spend much focus on the beauty but it is not the most important factor.

In Brazil, South America, it is known that 18 year old teenage girls go to the banks to get loans. They want to get cosmetic surgery on the hips and breasts. The girls here, when they become legally adults, do not go for a drink or have a date night with their boyfriends. They get money to get a cosmetic surgery.

Our country is perceived to have many who want cosmetic surgery but it is not comparable to Brazil. It is not perceived that majority of the society is focused in cosmetic surgery.

I don’t think that the problem lies because we are too centered in beauty, but the problem is because we are obsessed by it. This is highly influenced by the marketing activities of cosmetic surgery clinics as well.


There is a famous portrait named “Gangnam Beauty”. I think that many of you have seen it. There are number of ladies with same faces in this portrait.


Those from the rural areas when visiting Gangnam say one common thing, “all women in Gangnam look the same.” I don’t think that they all look the same based on my 10 year stay here in Kangnam.

There is a trend toward a standardized beauty in cosmetic surgery.

But this trend changes little by little with time.

The number of cosmetic surgery clinics in Kangnam are reduced with time as well unknowingly. People are starting to be aware that cosmetic surgery if resulting in bad outcome can lead to a loss of personality and attractiveness.

There was a TV show called Let@# that was on air until last year. It was one of the most effective means of promoting cosmetic surgery clinic of which the topic that the viewers were mostly interested in was bimaxillary surgery.

At one time, bimaxillary surgery was The Cosmetic Surgery.

The actual name for bimaxillary surgery is bimaxillary concurrent surgery. Tooth correction is carried out simultaneously therefore careful decision making is necessary. Many viewers thought that their faces could become smaller through bimaxillary surgery and invested much money just by watching the TV program.


These people have suffered from many complications after the surgery. The doctors did not ask or judge anything but just received money as they conducted the surgery. This has led to various complications and side effects resulting in legal claims and suits. There were some celebrities who came on TV crying and saying that there are at difficult times.

As people saw these things, they became to realize that cosmetic surgery is not something that can be done lightly. They also realized that bimaxillary surgery did not make their faces smaller. They also because aware that following others who look pretty and getting a cosmetic surgery is a dangerous thing to do.

In the past there was a standardized beauty, but today, consumers are aware that beauty does not come down from heaven just with money.


Complication of bimaxillary surgery… “Hospital to pay KRW 60 million”
There was a judgement that if there is not sufficient information of bimaxillary surgery then the hospital must be responsible for the complications that arise. On the 18th, Seoul district court ruled that the hospital must compensate for the complications caused through bimaxillary surgery. The ruling also included that “plastic surgery is not an emergency one, therefore the result can be different from what the patient expects, Therefore, the hospital needs to share about the treatment methods, improvements in detail to the patients”. “Also it should be noted that B did not provide enough information.” It was added that “B seemed careless and also damaged some parts by forcing this surgery.” “However, the surgery itself has some dangers therefore, B’s responsibility is limited to 60%.” “B must provide punitive damage of KRW 61 million to the patient.” A visited B’s hospital in 2007 for bimaxillary surgery but A did not see any positive effects but only got more complications that led to trial in court.



The Korean cosmetic surgery market grew with much focus on beauty. There was no individualism and personal standards. Just common beauty was required that led to much problems. But I think that today, we have different standards of beauty and there no one specific standard.

This is a time of change and I knew that this time would come soon enough.

Beauty cannot be judged instantly. Beauty at first sight only is a thing of a past. Beauty is something continuous and attractively felt. “You become more attracted to it as you see more of it” is the new perception now.

Thank you for reading. More of the related contents will be shared in the near future.
Have a great day.

Breast revision surgery - What You Should Know

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I would like to share about things to consider in #breastrevision surgery


1. Is the revision surgery really necessary?

2. Can the problem be solved?

3. Have you done enough to prevent the recurrence from happening?.

4. Should the implant be replaced?

5. Is there enough communication between the patient and the doctor?


Let’s go into the details, one by one.

1. Is the revision surgery really necessary?

 In case of capsular contracture, the first thing you need to decide is if the capsular contracture is one that needs correction. You need to be very subjective in this case.
"Doctor, I think that my breast became hard." This is not enough to do the revision surgery.



Capsular contracture is caused when the body reacts to the outer substances by twisting and contracting. I think that we need to differentiate between the tightness and the hardness.

In the early stages after the surgery, the tightness in your breasts feels like when you are wearing a tight pair of clothes. The clothes needs to cover that fat that you have gained therefore you will feel a little tight. But if you wear that clothes for a long time, the clothes itself would stretch out. When that clothes become loose, you will feel comfortable.



The same applies for breast implant. At first, it feels tight and hard. The duration of this process differs from one person to another.
This is why the doctor’s judgement on the condition of the patient is very important.
As such we need to answer the following questions to move on further.

“Is it ok for the patient if she does not get the revision surgery”
“What would happen to her if she does not the breast revision surgery?”
“Will she get better? Or worse?”
“Will the revision surgery make her feel better?”
“What is the recurrence rate after the revision surgery?”

Such questions need to be answered with experience and subjective reasoning. This is not easy.

2. Can the problem be solved? 

If the problem is with the capsular contracture, then you should only fix the capsular contracture problem. Other problems should be 2nd or 3rd priority.

If the capsule is too thick then we need to remove it. If the patient is thin, then removing the capsule would make you feel the implant more easily when you touch the breasts and your breasts could be more exposed to outer substance.

This is what makes breast revision surgery difficult. But the core problem is to fix the main problem that led to breast revision surgery therefore, we need to be clear about this.

3. Have you done enough to prevent the recurrence from happening?

Many of those who suffer capsular contracture ask this question. “What do I do if it recurred?”

There is no doctor who can say never to this question.
Recurrence can happen. But we need to do everything we can in order to prevent recurrence from happening.

When the implant collapses, we need to know why that happened and get the breast revision surgery done. Id the damage was done while inputting the implant then we need to change the input procedure to that which is different from the first time. We need to use other equipment as well.



There are implants with higher possibility of collapse.
The thinner the skin of the implant, the higher the chance of it tearing. So it is better to replace the old implant with one that has thicker skin.
We need to do things differently in the breast revision surgery surgery compared to the first one in order to decrease the chances of recurrence.

4. Should the implant be replaced? 

One of the reasons or environmental factor for capsular contracture is the fact that the implant got exposed to the body of the patient so it is better to change the implant as well.

At times we remove the capsule but leave the implant as it is. But this is not normal. The capsule is caused due to the metabolism of the body therefore we can change the implant to same type but new or to a totally new type one.

When the implant gets damaged, the replacement would be better if it is thicker, has better recharge rate, and is smaller in size.
 

5. Is there enough communication between the patient and the doctor? 

Most of the breast revision surgery are conducted because there is a problem. The patient wanting to have this problem cared, is really concerned and worried. Today, the hospitals become really defensive as the patients can take the civil matters to court. (Today, minor problems are taken seriously as a claim)

However, there must be enough communication in this sensitive time.
There must be a conversation on the reason and origin of the problem, whether we need to solve the problem or not, whether we need to conduct breast revision surgery or not. the timing of the breast revision surgery, and what is expected after the breast revision surgery. All these are important.

If there is no communication, there would not be an understanding.
If there is no communication, then only the concerns will grow.
The patient must fully open up about the concerns and discomforts. If there is no trust from the patient that leads to hiding of the facts, the doctor and the nurses cannot provide much help.



Breast revision surgery can be a problem of medical technique or academical knowledge.

However, the most important thing is to listen to the patient, be concerned and have much conversation for better understanding.

Thank you for reading and have a great day.



 KIES-U Breast augmentation in Korea www.kiesu.com | whatsapp +82-10-2687-4790

Possibility of breast implant rupture vs MRI, is it necessary?

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The US FDA approved silicone gel implant sales in 2006 for the purpose of breast correction and augmentation. It also provided guideline that there should be MRI test once every 2 years starting from the third year of breast augmentation.


There is no change to this guideline.
Of course such is necessary, if there is a damage to the implant and the patient needs some treatment. but there are those who oppose this.



Today, I would like to introduce a data of an experiment that Teresa Wang M.D and other from Sloan-Kettering Cancer center in NY conducted with 383 patients.

There was a tracking study in this hospital for 10 years starting from 1999 on the patients with correction surgery. MRI was tested and data was gathered to see if the implants have been ruptured or not. 963 MRI were conducted over 53 months (4 years and 5 months).

The result showed that the damage rate was 1.9% through MRI and the false positive rate is 8.4%.

The statistical findings showed that the rupture rate of implant within the 3~5 years was 0% and 2.3% for 7 years. 15.1% for within 10 years.

The rupture rate of the implants is very low therefore all the high costs and time needed by the patients for MRI test (in the first 5~6 years) are a burden. Therefore, the authors conclude with a question of whether the MRI inspection is really necessary.


There are opinions that MRI is unnecessary for those patients without any complications for 7 years after breast augmentation.

Since the first day that the cohesive gel has been imported until now, I have never seen a patient taking a MRI test because she was worried about the implant rupture.



It is not saying that these patients are not interested in their bodies. It is just that they did not have any problems or discomforts therefore this expensive MRI (MRI is not reimbursed and costs about $500 or more) is not tested by many.

Also there are other findings, that the silicone when leaked from the implant, does not get dissolved within the body and it does not cause any complication or illness.
Is this guideline of getting tests once every 2 years really meaningful?

FDA should remove or edit this guideline not only because of this finding from Teresa Wang.

I think that it is more realistic to consult with the doctor 10 years after the breast augmentation. If there is any problem, then one can use ultrasonic test that is less costly to find out the problem. I think this is more realistic and better scientifically for the patient compared to the MRI.



Thank you for reading. Have a great day.




Breast augmentation Korea KIES-U | www.kiesu.com | +82-2-3452-0202 
 

Breast augmentation Korea issues 

There was a news from SBS stating that the silicone from a collapsed implant flew into a baby’s mouth while the mother was breastfeeding her baby.
There are many of those who are concerned and curious about this when planning on breast augmentation.



Journalism is always different from science. “Accusing the fact” is journalism and this is also its role, but there is no science to it. There is no one scientific sentence that catches your attention. One needs to see many numbers and contemplate on it to get a step closer to the scientific truth. So, I get discomforts whenever I see such news article.

There are many feeds on naver under this article. “You should have removed the silicone before giving birth.” “How can you feed your child a silicone?” “All of you should be careful if you had breast augmentation.. this is awful.” “Why do something on your body, when you should not do anything on it.” About 80% of the contents were about criticizing the mother.’

The reason why I talk about the scientific truth is because, if you know the reality, then you cannot criticize the mother.


There are many aged, old male users who criticized the mother on the internet and these users are writing some cruel words to the victim.

It is like when I am driving my car to work, I stop at the light for a min or so. A truck driven by someone who is really sleepy crashes into the back of my car and I get hurt. People them criticize me by saying “why not take public transportation to work and get your body spoilt?” This is very absurd.

I am sure that the reporter did not want something like this to be the outcome. But the result turned away as such because the article was focused on the implant, not the doctor or the hospital where the surgery took place.



One of the most common surgeries held around the world today is the breast augmentation. A lot of breast augmentations are done in US, Europe and in South America. There has never been a case or a journal or a content in a textbook that describes on the silicone gel from the implant leaking into the baby through breast feeding. This is the very first case in the world.

Then one must talk about the surgeon and the hospital. But the article only concentrates on the implant and this somehow leads to the criticizing of the mother. This is sad.
When the reporter writes such an article, he/she wants to attract the attention of the readers. There has always been some activity that involves putting in a substance into the body in medical history. If a patient got a surgery that led to complications, such simple article would not be attractive enough. But if it involves something that is real common such as the implant, people would be talking about the problems that arise and this story would be big in the news.

Let’s look at the new again. If the substances in the implant are to go into the baby’s mouth, there are 3 certain conditions related to it.

1. The implant shell must be damaged
2. The silicones must leak outside the capsule
3. Silicone must dissolve into the liquid in the breast

Condition 1 is likely to happen. The statistics from Chosun Ilbo (3600 complication, 66% damaged within 4 years) is not accurate so it is not this common.

In order for condition 2 to happen, the implant must be damaged before the capsule is formed. It takes about 2~3 weeks for the capsule to be formed on a normal person, therefore it is highly unlikely that the damaged implant has been used during the surgery.
The implant gets damaged due to the purpose act of the inexperienced surgeon who wants to put in the implant no matter what.

The silicone from the damage implant disperses everywhere in order for it to penetrate into the liquid in the breast. The silicone cannot penetrate once the capsule is formed.

There is an another problem. Silicone gel is a combination of large molecules. Each one of the molecule that form the silicone is large. If this is to penetrate and leak from the breast, the substance must enter the cell. Not just one or two cells but a lot of the cells in order to see the light.

This is impossible if you study the cell biology.
In 1993, FDA opened a commission to study what influence the silicone from the implant has on the body (cancer, metabolism, etc). The commission warned the manufacturers to stop the sales and required clinical datas. (This has been stopped since 2006)



In 1999, well know scholars of biology and medication/toxin gathered to publish a journal named “Safety of silicone breast implants”. We can conclude that this book proves the safety of silicone implants.  

(The value of this book is that the authors are not plastic surgery specialists. Those who do not have any interest in selling breast implants have gathered to publish this book therefore the contents are more reliable.)



"It is difficult for silicone to directly disperse into the breast cells. There is no such happening on the women who breast feeds as well.." This is stated in pg 11 of this book. But, the first case came out in our country.

In 1996, Lugowski and others compared the density of silicone of a person with implant and a person without one. The density of silicone on a person with the implant was 0.0637ug/ml, and the density of a person without the implant was 0.061. There is no significant difference between the two.

Same results followed in number of experiments conducted later. The density of silicone does not increase due to the silicone breast implants. There is no difference between a person with breast augmentation and those without one.

There are millions of experiments with same results.

Let’s refer to a more recent experiment.

In 2003, there was an essay written by Holmich M.D and others. It states, “there is no absolute difference in the bodies of the women with normal implant and collapsed implant in regards to disease, complications, and protein.



It means that although the implant collapses, there is no influence on the body, and you do not get any illness. There are many experiments supporting this as well.

"Damaged implants are relatively harmless, and they do not lead to any other further damage even with time."

There is only one reason for what happened with the incident report on the 12th. In order for this to happen, the cells must be damaged a lot leading to trauma. Also, the implant should be damaged when inserting.
So basically this says that there is a path formed for the silicone to go into the cells.
It is like a fistula being formed. Originally there should not be a path, but the path is formed somehow.

I don’t think there is a possibility that the path is formed automatically and the gel within the capsule came out through that path into the breasts.



All the experiments until today had the hypothesis that the silicone from the implant breaks up, penetrates into the body cells and the blood, travelling throughout the body and reaching the breast cells, and finally coming out through the mother’s milk. The silicone molecule has been tested for density to see how different it is from the normal one.

But the new yesterday said that the silicone that came out could be seen easily visually. This is not what we have been known about. This is not possible unless there is a highway through the silicone and the nipple.

This is repeating itself, but I would like to answer the question what many ask over and over again.

"There is no evidence that there is more silicone in the body of a mother with breast augmentation and that without when breastfeeding.."  It is the same. There are so many evidences and this is the scientific truth. Many scientists have proved this and this is what we can call fact.

SBS news report can be judged as medical accident.

FDA reevaluating the safety of the implant, canceling the permit if there is a problem, enforcing much more on the regulation… are distracting the audience from the fact and getting the mother criticized.

The hands of the surgeon are important.
Not the product.

The patient trusts the doctor, not the product.

I would like to share one last thing before I finish off.

What happens if you eat the silicone. I heard that if the silicones gets in the body, it cannot be removed. This is a big thing. What should I do?

Is silicone really a toxic?

Is silicone really bad for your body if it gets into the body once or even repeatedly?

Semple and others studied on the density of the silicone on the women with implants and those without. The result was 0.0555 ug/ml, and  0.0511.

This is really a little amount and one that cannot be found with basic equipments.

The silicone in the milk for the babies is 0.7. The formula for all those products for the babies in the marts are 4.40.

I was raised with not only mother’s milk but by milk powder and formula as well. There is a very rare number of babies that grow up with just the mother’s milk. What I want to say is that, there are many processed food with silicone when being produced. There are silicone in cow fodder, and even in bubble inhibitor of milk as well. There are silicone in milk package also.

In this industrialized age, we are exposed to silicone in various ways. (1986. Adler and Berlyne)

I am sure that all of you know what the baby milk bottle and etc are made out of.

It is silicone.

Methyl simethicone, nylicon are treatment for baby intestine, stomach behavior. These are silicone as well.
Let me provide you with a summary.

1. Silicone accident was not caused because of its safety but can be looked as a medical accident.

2. There have been many experiments on the silicone gel implant in many countries for many years. The common result in all those experiments is that the “silicone implant is safe”. We must trust this.

3. There is no difference in the density of silicone in the body of the woman with implant, and those without an implant in the breast milk. (This is a fact)




I am quite upset that the news is all about “can silicone be trusted?”
If there is some proper reference from a specialist, there would be more focus on medical accident.
That mother should not be criticized but be cared for and we should pray that the baby stays healthy.

This is all for today. Thank you.