Correcting asymmetric breasts

Almost everyone has asymmetric breasts.



I have come to a conclusion after more than 10 years in this field that there is a very rare amount of people with symmetric breasts. This is like a person with two eyes living in the middle of those people who all have one eye. You can think that having asymmetric breasts is rather normal. A person’s body itself is asymmetric. Also, today, we see people using PC and smartphone a lot, therefore all these people do not have straight back, neck, shoulder due to the much usage of these products. Breasts are on the upper body, therefore, the bad positions leads to worsening of asymmetric breasts.

Let’s look at some of the factors of asymmetric breasts.

1. Body frame and structure

Almost everyone has such type of asymmetric body. It is because there are different organs on the right and left side of your upper body.

The heart is positioned a little left from the center of the chest. The left and right lungs are shaped differently as well. This is why the left side is more exposed than the right.

Such exposed body frame makes people look like that they have larger left breast. Or crooked body structure - crooked back, left shoulder dropping down, crooked spine, etc - makes asymmetric breasts as well.

There are not many people who have straight formed body. As such, I have shared about the body form that we need to look at carefully in considering asymmetric breasts. The problem with this is that we cannot solve this problem by a surgery. We cannot remove rib or change the chest structure. Nobody can think that we could.

This is why I have shared that the bone structure on the left and right side of your body are different before you start to think that you have asymmetric breasts (many people do not know about this difference in the upper body)

2. Nipple and areola (including the location of inframammary fold)

The nipples and areolas on both sides cannot be positioned on the same straight line. Also, there is a pattern to this, there are more people with higher left areola, nipple. Almost all have left check exposed more than the right therefore, the left breast skin - tissue cells are tighter making the left nipple and areola positioned higher.

The inframammary fold is also higher at the breast with higher areola and nipple. The problem is correcting this. We can make the position of the areola and the nipple higher through the dual plane method. (Not too much though) The dual plane method makes the area above the pectoralis muscle larger leading to a pulling effect by the implant. The pulling makes the areola and the niplle shift upwards.



Inframammary fold asymmetry is not something to be worried about if your left chest is larger or the left inframammary fold is lower. The implant would be put into the right side making the inframammary fold lower therefore making up for the unbalance on both sides.

But it becomes difficult in the opposite case. Let’s say that you have larger left breast but the inframammary fold is higher. We need to use small sized implant but make the inframammary fold lower. We need to pull up the inframammary fold and the areola of the right breast in such case.



We need to design the right inframammary fold so that it is in balance with the left and apply dual plane so that the areola is pulled upwards. The inframammary fold will be placed lower at the same time improving on the asymmetry. We must apply inframammary fold incision in this case!!

3. Difference in the breast tissue cells

Mots patient think that their breasts are asymmetric because the breast tissue cells are different on both breasts. They think that there is different amount of fat on each breast. (Actually, the difference exists in the upper body) If there is more breast tissue on the left compared to the right, you would want to place smaller sized implant on the left, and a larger one on the right. Most patients do so. The volume of the breast is equal to the original volume and the volume of the implant. The volume of the implant does not change over time, but the original breast volume does.

A human body is not a plastic or vinyl, but has tissue cells that change, age or disappear with time. The right breast is small therefore more tense, and if the implant gets into the right breast, there would be more tension caused on the skin which might lead to contraction.

At first the volume of both breasts might look the same, but after 2 ~ 3 years, the smaller original breast would start to lose the volume. Such happening, i.e. contraction leads to the avoidance of using largely differents sized implant in correcting asymmetric breasts.

This is one of the difficulties that the surgeons face in the field. Most patients are not patient enough to wait 2~3 years to see if the correction is successful or not.

Most patients are unsatisfied with the result on the very next day, therefore command recorrection and and even make civil complaints.

The surgeons have tens of decisions to make in their head and carry out the action. The patients just see what they can and believe what they see. When the doctors becomes accustomed to this with experience, they tend to focus on instant results that the patients want. This would lead to good reviews.... 

We feel this all the time but we cannot avoid it because it is a huge problem. In the medical system at our country, it is impossible for a doctor to consider long term results and plan accordingly.
 

4. Breast ptosis

There are some patients who suffer breast ptosis before marriage. There are some who suffer it since breastfeeding.

Also aging can lead to loss of skin elasticity and the difference in the loss of elasticity on both breasts lead to asymmetric breasts.

A sudden diet in losing weight can make sagging of one breast worse than the other.

Breast ptosis leading to asymmetric breasts is different from that caused by difference in breast tissue. Most patients are aware that they have asymmetric breasts.

If the breast gland and areola/nipple are all sagging, then the lifting method must be applied. So at times we would apply the lifting method just on the sagging breast and leave the other one as it is.

What if both breasts are sagging but the degree of sagging is different on both sides. We need to apply lifting on both breasts but the degree would have to be different.

This procedure becomes difficult when both augmentation and lifting get involved.

If both breasts are sagging and are asymmetric, it becomes really difficult to know how much difference there is in the volume of the two breasts. This makes it difficult for the doctor to decide on the size of the implants. I think the best method is to decide on the size of the implant as you carry out the correction procedure. You need to apply different lifting and make the position of both breasts similar. Then, we can add more volume on the breasts and compare them so that they becomes similar as well.

If the position of the two breasts are too far apart, it is impossible to measure if the volumes are similar or not. Therefore, it is important to have both breasts at the same plane. and then compare the volume to have the best possible result.

Today, I shared some contents on asymmetric breasts. I hope it has helped you much.

This is a really difficult area and there are some things that even the doctors do not know exactly. You are really smart if you understood what I have written above. This is all for today. Thank you.

Does fat grafting have any influence on breast cancer?

If you had to remove breast tissue due to breast cancer, then you would need to have fat grafting to cover up the loss caused due to the incision of the breast tissue. This is a widely applied approach.



Fat grafting requires injecting half-liquid substance into the body, and is very simple and quick. There is no need for incision which also means that there is less chance of complications. Also, there is not much scar therefore it is widely used.
However, there was a report stating that it might lead to formation of cancer cells based on tests conducted on animals (mostly on scientific magazines).

In humans, fatty tissue cells or adipose tissue cells practically injected into the body. Even if you hear that the procedure is stem cell transplantation, you don't use pure stem cells but  extract and inject adult stem cells. However, it is impossible to conclude that the result of injection of fatty tissue in the animal experiments is directly linked with humans as the animal experiments used is stem cell transplantation..

Anyway, we need to study further on whether the fat grafted actually has any influence on the cancer redevelopment if the fat was used to replace the loss of tissue cells in breast cancer surgery.



Dr. Jean Yves Petit from Europe Cancer Center in Milan, Italy reported on the “Fat grafting after invasive breast cancer, Case control experiment” on the latest edition of Plastic and reconstructive surgery.

This experiment was conducted on 322 patients who received fat grafting as breast reconstruction surgery from 2006 ~ 2013. Also there might be some differences on how much cancers cells are left in the body in those patients who got complete incision compared to those who got partial incision, therefore, the experiments looked at the difference between the two groups as well.

The monitoring period on the average was about 4.6 years after the fat grafting. There was no differences in the recurrence in the vicinity of the previous lesion, occurrence of the opposite phase, or occurrence of the axillary and lymph nodes in the event of the transfer.

There was absolutely no evidence that the fat grafting used for reconstruction had any negative influence of the recurrence of the breast cancer therefore, Dr. Petit and others concluded and reported that fat grafting is a safe method for breast cancer reconstruction.

Fat grafting can be applied on any part of the body. It can be applied on the breasts as well.

Breast cancer incidence rate is rather high in US and EU therefore it is a threatening disease to women. It is also the most common malignant disease on women therefore I think that hospitals in our country also needs to actively conduct studies on it.

Thank you for reading. Have a great day.

The advantages and disadvantages of endoscopic-assisted breast augmentation surgery.
Today, I would like to share about what many patients are curious about, breast augmentation in Korea by endoscopes. I'm going to try to talk about the advantages and disadvantages.

KIES-U Breast augmentation Korea

1. Why do we use the endoscope?


General surgery, obstetrics, urological surgery, orthopedic surgery, and neurological surgery, all widely use the endoscope. The reason can be put as ‘minimum incision’ and ‘minimally invasive ’.

Many patients are afraid of surgery, so it would be better if we apply minimal incision and desquamation. Thus, the use of the endoscope has become widespread because this goal can be achieved through minimum trauma on the patient.

In the end, the endoscope has been used in the area of plastic surgery as well, but at least in the case of breast surgery, the purpose of the endoscope is different from that of the other.

First of all, this is not a minimum incision. And it's not even minimally invasive.
So, in breast augmentation, the use of endoscope is somewhat ambiguous. If you use breast implant, the incision size would be the same whether you use an endoscope or not. The incision can be even small without the use of the endoscope in blind operation spots (less visible places) such as the ancillary or the belly button.

It's not even minimally invasive. Breast augmentation requires putting in the implant and in order to put in this implant, we need a certain size of the opening. Whether you use the endoscope or not, the scope of the surgery is going to be the same.

Then, why do we use the endoscope? It is to know something for certain in breast augmentation surgery.

Of course, we need to conduct the surgery properly in order to reduce swelling, discomfort, and pain, but the most important thing is to see less visible places properly and accurately in order to conduct the surgery.
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There's no certain situation where you should not use the endoscope. We can have good results in breast augmentation eventhough we conduct blind operation. The reason why I use an endoscope is to check whether I have done incision and desquamation properly and to see what's happening in there. It is really important if you apply partially submuscular plane.(i.e., if you place prostheses underneath the pectoral muscles).

2. Is the use of endoscope essential?

I've been using endoscopy for seven years, but when I get asked, I can't answer it easily. There are still many people who are still in the middle of the world doing so without endowments in breast augmentation. The doctors who use endoscopy are not necessarily a majority, but rather a minority.

It cannot be said that the usage is essential. Nevertheless, I'm using an endoscope to perform surgery. After a blind surgery, I somewhat feel insecure. The surgery requires visual aid, but I have not seen anything properly therefore I feel insecure.



In fact, I don't really like the blind surgeries of all kinds of surgeries, not just breast surgery, but eye and nose surgery as well. And this is a kind of behavior that a particular surgeon might have. I think it's a good idea to see if there is nothing wrong after the surgery.
 
There is no reason to argue that the surgical procedures that have traditionally been performed without an endoscope are wrong. There needs to be studies that clearly state there is a statistically significant difference in excessive bleeding, inflammation, contracture, and other complications when using or not using the endoscope, but there is not such data.

Endoscopy is not essential. You should not criticize the surgeon who does not use the endoscope.I think this is a matter of inclination. But I use endoscope in my surgeries. Experience is important in medical science but it is also important for the surgeon to see what he/she is doing properly.

3. What are the advantages and disadvantages of endoscopic surgery?

The advantages of endoscopic surgery are
- Less trauma on the patient
- Reduce bleeding
- More visible
- Accurate desquamation

The disadvantages are
- Expensive
- Time consuming
- Difficult to react quickly on bleeding or other problems
- Difficult to perform correction or re-surgeries in certain situations

4. What's the best way to get surgery? 

You should not think that you will get the best possible result because this clinic uses endoscope. The usage depends on the surgeon’s attitude.
I use the endoscope always for axillary incision but I cannot say that other doctors who do not use endoscope are less successful than I am. We should not use such information for marketing as well.

How carefully did the doctor look at the patient? How well, how much experience do you have as a doctor is more important than the tools or implants that you use. Such do not bring about big noticeable differences in the surgery.

This is all for today. Thank you for reading.

Sagging breasts or breast ptosis is divided into two types of Nipple/areolar ptosis and Glandular ptosis..

Most patients suffer from these two types, and those with severe cases need to apply vertical incision lifting to experience positive result..



But what if the breast ptosis is not severe. Let’s say you are only suffering glandular ptosis or very small degree of it, and you are very young and still have some skin elasticity. In such case, you do not need vertical incision. You just need the lifting correction.

If you only have nipple/areola ptosis and do not have the glandular ptosis, then you would just need to fix the derma and change the location of the areola to have good result. Glandular ptosis need the lifting correction against the force  of gravity, therefore you need to use a technique that pushes up the breast to the wanted position.

Plication mastopexy that I want to share about today, is an effective method that leaves incision only around the areola causing no vertical scar and fixing the breast ptosis.




Incision must be done on the areola and we need to desquamate the outer skin and the glandular by separating the two.

Lifting will only be successful if the glandular itself is pushed upwards to the position that you want. Plication, as that of vertical incision method, is applied in push the glandular at the bottom part of the breast. We need to conduct overlapping suture on the upper part of the breast as if you are walking up the stairs.



We are actually repositioning the breast glandular in such as way that could make the breasts look better. Then we apply purse string suture and complete the procedure. This whole process is time saving.

The biggest advantage of this procedure is that it uses similar methods to that of vertical incision but it leaves no scars, and that it is time saving and less costly.



Overlapping technique results in minimum incision for lifting

The disadvantage is the you do not cut the glandular for repositioning but you only apply overlapping suture and lift up the breasts therefore this lifting effect may not last a long time. Also, we do not reduce the fat tissue so your breasts might look very flat. However, this method is a very popular no matter what the disadvantages are.

Different methods are used for breast ptosis according to the patient’s age, skin elasticity, sagging degree, breast weight, etc. Not one method can be effective for everyone.

Therefore, it is best that you talk to your surgeon to find the best method to your problem.

This is all for today. Have a great day.


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My augmented breasts do not look good after pregnancy, can breast revision surgery make them look better?

Today I would like to share about augmented breast before getting married that led to change in the shape of the breasts after pregnancy.

There are many of those patients who want to get breast augmentation revision surgery and this number has increased a lot from the past.

There are a lot of reasons for this, but mainly it is because there are many of those who get breast augmentation these days.

There is no real need for the patient to get the breast correction done because of what the patients feel about their breasts but there are some cases where you must get breast augmentation revision surgery.

Some of these cases are,

- Collapse of saline bag type implant
- You got you breast augmentation done before marriage, but your augmented breasts start to sag and change shape after giving birth
- Asymmetric breasts
- Shift of implant location
- Capsular contracture and other problems that got to do with feeling
- Rippling, etc

First, I would like to share about breast ptosis.

Sagging breast is divided into breast gland ptosis and breast skin ptosis. One is severe than the other in most cases.





Then how does the breast sagging happen with implants?

It depends on which plane the implant is in and how thick the capsule is formed. If the implant is under the pectoralis muscle like the image below with strong capsule, then the implant would be trapped when the breast gland sags leading to that dropping down look of the breast.

If there is enough capsule then such shape would not be formed. Such case can mean that implant placement below the pectoralis muscle is not good.



Below image shows the implant above the pectoralis muscle. In such case the implant sage down together with the breast gland. The breast skin becomes thinner after breastfeeding and this is why the implant is placed on top of the pectoralis muscle, but the disadvantage here is that you would be able to touch and feel the implant.


So the best solution would be to apply dual plane as the below image shows. The implant is not trapped by the muscle and the implant would not lose its natural looking shape because it does not sag down together with the breast gland. Some part of the implant would be covered by the muscle therefore, if you lose breast fat, the implant would not be felt as much.


What can you do if the breast looks weird like the image shown above? The answer is already there. Apply dual plane method and open up the capsule at the bottom. This is relocating the implant and it is much easier than you think. Areola incision or inframammary incision is recommended. The skin loses elasticity after giving birth, and this helps to limit the scar during correction surgery and also makes the scar go away easily.


If you applied dual plane or above the pectoralis muscle in the first surgery, but the breast gland and implant are sagging down too much, what can you do? In such case, we need to conduct breast ptosis correction(sagging breast surgery).

We need to gather the fat on the bottom part of the breast and lift it up together with the implant to make the breast look better.  You should remember that there is not much scar made because the skin loses elasticity after giving birth. If you have the right planning and surgical method for the correction, you would have great results at the end.



This surgery requires pullling up the breast together with the implant therefore replacing the implant is not always necessary. If you want to change the size, then you can replace the implant but in most cases you do not need to do anything to the pocket in order to perform the correction.

Today, we looked at how we can improve the breast shape and look after pregnancy.

Thank you very much and have a great day.