What do I need to do if my breasts sag after breast implant augmentation?

Some of you might be getting married or are planning to give birth before breast augmentation. Today, I would like to share about what to do in case your breasts sag after breast augmentation due to aging or giving birth / breastfeeding.

One thing that you should recognize is that not one same pattern applies to everyone. The things that can happen to you after breast augmentation varies from one person to another. Therefore, I would like to share some different types and what you can do with you face such problems.

1) Losing skin elasticity

This is when you breasts look like that they lost volume in the upper side, and sag a little. This is not complete sagging but the breast skin has lost some elasticity..
There are those who require a change to a larger implant in such case. The larger implant would pull on the skin making the skin tighter. This makes the breast skin more elastic.




If you have used small size implant more so than what should have been used considering your physical body, it could be better to increase the size of the changing implant. But in general, your skin is thin and weak therefore, larger implant used could only lead to more sagging of the breast.

If the size of the implant was appropriate in the first surgery, it is better to maintain that size in the surgeries after. If you do increase the size of the implant, then it is recommended that you use form stable implant.

The 5th generation silicone gel, i.e. form stable implant was introduced 5 years ago in our country. All of those patients who got breast augmentation before that time used unstable implants. Such implants are not helpful in avoiding the sagging therefore it is better to replace such implants for better shape and elasticity.
One thing that you should keep in mind when changing to larger implants is that there is more possibility of suffering capsular contracture.



I have experienced this many times and I think this is what happens in the re-surgeries. If the original implants did not cause any problems then it means that the implants have no effect on the surroundings., that the implant matched well with the breasts. But if the new set of implants come into the body, the body may react by attacking rather than adapting. Therefore, such activity could end up in capsular contracture in some cases.
Also, you would have to make the size of the pocket larger for the larger implant. We cannot take this lightly and just make the pocket larger. We must remove the capsule as much as possible. For such reasons, I recommend areola or inframammary fold incision rather than the axillary incision for re-surgeries.

2) Low degree of capsular contracture holding up the implant at the upper part and the skin losing some elasticity (fake sagging)

If you have a severe case of capsular contracture, then you would have visited the hospital before you came in for the problem of sagging breasts. If you have low degree of capsular contracture, you tend to stay as you are. (You might not even think that you have capsular contracture) The implant is caught up by the capsular contracture and when you give birth and sagging is caused, an elephant shape is caused because the upper breast only has implant and the lower breast is only composed of your breast tissue.



This is not real sagging but a fake sagging of the breasts. The nipples are facing downwards and the implants are captured at the upper part of your breasts.

Patients think that they have the upper bulge in the breast after giving birth or breastfeeding. Such problem can be solved by opening up the capsule. You would not need general anesthesia in some cases.


But if you have a severe case of capsular contracture then you might need re-surgery that requires shifting of the implant to lower spot or applying dual plane procedure. This would require general anesthesia.

3) Severe case of capsular contracture

If you have a severe case of breast sagging then this would require correction (breast lifting). But the problem is that there already are implants in your breasts. We need to decide on what to do with these implants.

At times, we just remove the implants and conduct the correction surgery. This would apply to those patients who had large original breasts or have had the implants for a very long time. Some might perceive the implants to be bad for them due to many pregnancies or even some might want to remove the implants due to the complications that they have suffered.



Such cases would result in rather simple correction surgeries. But if the implants have been in the body for a long time, these implants make the breast tissue cells contract and thin. Such outcome could limit what we can do during the correction surgery.

But most of the patients want to continue to use the original implants or even use larger ones for re-surgeries. This is a problem. The more severe the lifting surgery is, the blood circulation to your skin and areola/nipple gets cut off. Lifting requires desquamation of much tissue cells and replacement therefore there are a lot of bleeding. Such activity limits the blood supply into the nipple.

Therefore, if we have to replace the implants and correct the sagging breasts, we need to forego some greed on trying to do too much lifting. We should correct the breasts to only some degree, not perfect. But, if you want aggressive correction done, then we need to do the lifting first then place the implants back into the breasts after much time.

The new implants should be form stable implants and we need to remove the capsule as much as possible. Also, we need to use the suction drain.


It is better to do as little incision as possible when conducting the correction for sagging breasts. It is better to do the incision around the areola rather than conducting vertical incision of inverted T incision.

There is nothing dangerous about conducting correction surgery and using the implant in the very first breast augmentation. This is conducted with normal, usual state of blood circulation/supply. But the environment changes in the re-surgery. The implants have made the breast skin thinner and the blood circulation is already somewhat damaged.

Therefore conducting surgery could limit the blood circulation and leading to complications.

The correction should not be too aggressive and if the sagging is very much severe, then the whole process can be conducted in two procedures.

How to prevent bleeding during breast augmentation

Surgery is an act of open reduction in order to treat the patient. Internal medicine does not involve any bleeding but surgery does. This is how we differentiate the two.



This is why bleeding is always associated with surgery. If there is no blood, this is not a surgery, it would be physical therapy, internal treatment, etc.There is some contraction to 'no bleeding' in a surgery. It is rather important to think about 'how to minimize bleeding' in a surgery...Breast augmentation requires  using of implant and in order to put in this implant, we need to conduct incision. Bleeding is caused in this incision as well. But breast augmentation does not lead to much bleeding. Breast augmentation, therefore, does not cause much bleeding in its procedure.



But then, there are many doctors who fall into this trap.
There is not much bleeding during the surgery, but the patients come back to the hospital because of the much bleeding caused.
Implant is not a part of your body, and it plays independently inside the body. if there is bleeding near the body part, the body tends to suck in the blood back in. However, if there is bleeding near the implant, the implant cannot do so. Such blood gathers and solidifies at one side of the implant.

Blood gathers on the bottom side forming hematoma that then pushed the implant upwards.


All the doctors who conducted breast augmentation have experienced this. This is why they all contemplate about how to stop bleeding and forming of hematoma after the breast augmentation.

Some doctors spray blood coagulant around the implant and close up the incision. Some also spray medication that contracts the blood vessels. There is not just one method on how to avoid bleeding. The doctor must consider the bleeding problem before the surgery starts.

Most young people have elastic muscle and fascia tissue cells. The blood wall that penetrates the muscle is also elastic. This is why it does not get damaged easily during the surgery.  But older people have less elastic muscle and blood wall. Little damage on these parts in order to gain more visibility during the surgery, leads to bleeding. The blood flows little by little and this makes it more difficult to stop the bleeding. But, if there is bleeding in elastic cells, it is quicker to stop this bleeding and also the doctor can recognize the bleeding rather quickly which makes the treatment quicker as well.



We need to be more careful of those with less elastic tissue cells and also be more careful in pressurizing for bleeding. There are certain know-hows that come with experience to minimize the bleeding. Also the relationship between the volume of the implant and the size of the pocket is important. If the pocket is larger than the implant volume, there would be less pressure effect providing more space for the hermatoma to form. The ideal match would be the pocket size equaling the implant volume. Pressure bandage or pressure bra must be used after the breast augmentation and there must be pressure from all sides.


If there is more pressure on one spot than the other, the blood will gather on the spot with less pressure. Hemovac drain cannot stop the bleeding. It only helps to dispose the blood if the bleeding occurs. If the blood vessels look weak and if there is a chance of delayed bleeding, then the doctor should place the hemovac drain. There are some advertising on the internet that reads we do not use hemovac drain because we are skillful. This basically is neglecting basic principle of open reduction, surgery. It is not good to use hemovac drain every time, but it is a problem if you don't use it when you have to.

All patients feel fear when facing a surgery. It is only natural to feel scared that something is cutting through their bodies. (It is scary to open your mouth in the dentist also) There are other fears that build up as well such as "What if I don't wake up after the anesthesia? What if things go wrong during the surgery? What if it hurts a lot?"  Bleeding cannot be avoided in a surgery therefore treating that bleeding is very important in a surgery in order to avoid all the problems. Bleeding causes inflammation, inconvenience and consumes more time in healing. However, there is no surgery that can avoid bleeding but we can minimize it as much as possible.

This is all for today. Thank you very much.

Conditions for resulting in successful breast surgery - Plastic surgery Korea KIES-U

I have read a newspaper article regarding underwear company that released statistics on underwear sizes for women that came up through a project.
It was unexpected that there were more Korean women in the 20's who had size C cup than A cup.
.

This new statistics is radically different than the one from the past. Also the fact that those in 20's had larger cup size compared to older adults had led to a conclusion that the breast augmentation surgery has become popular.

Breast augmentation has become this popular but there are studies on the satisfaction, recorrection, and complications that can arise from entities in US and EU. It is difficult to find such statistics in our country but we have identical breast augmentation methods to that of US and EU therefore, I think that the problems and complications that arise in the two parts of the world can also be applied to those patients in Korea.

The satisfaction rate after the breast augmentation is rather high. People are satisfied with the results but there are some claims due to minor problems.

Most of the complaints are about the size, asymmetric breasts, and sense of touch. It is mostly satisfactory, but there are some things that could have been better. Such findings are shown a lot in cosmetic surgery magazines and they can be found at our country as well.

The most common complication is not the capsular contracture but the mispositioning of the implant, and being able to feel the implant. I would like to share what things we can consider in order to have non-regretful breast augmentation surgery that leads to pretty looking but no pain of whatsoever.



First, you need to know your body.
You need to have interest in your body and try to find accurate information about it. Such people are on 1 out of 10. Other 9 of those patients are more aware of the advertising products. This can be found easily with younger women. The shape of the breast, bird chest, etc meaning your bone structure must be considered. If you have center of the chest sticking out, you would need to think that the breasts might look too much separated apart when the implants get in. If you have a bone sticking out at the top part of the breasts, then breast augmentation may lead to upper block sticking out. In such case, you might have to consider anatomical implant which not too large size in order to minimize any complaints that you have after the augmentation.



Subcutaneous fat i.e. the thickness of the soft tissue. ; If you have much fat on the upper body, your body lines would not be clearly visible after the surgery. There are complaints related with this also. If you have much fat in the upper body, your soft tissue is thick therefore, when the implant is put in, there is a less chance of rippling and you being able to feel it. So it might be better if you use larger sized implants.

In opposite, if you do not have much fat in the upper body, you would have great body line after the breast augmentation but you could also suffer from rippling, being able to touch the implant, unnatural looking breast line and other problems if you use large sized implants. If you are one of such, then it might be better to get rid of that greed for larger size.



Second, you need to be clear about your goals.
There are many patients who do not know why they want to get the breast augmentation done. It is rather meaningless if you just think that making them bigger is good enough. There are certain values that each patient wants from the breast augmentation. At times, these values coincide one another.

Perfect shape
Natural feeling
Large size
Correcting sagginess
Correcting structure
Correcting shape

 

These are some goals that you might want to solve. You need to prioritize the list and let the doctor know about it. It is important to share such values wanted to the doctor.

Third, you should select an implant that has been verified.
It is difficult to select an implant from variety of the products that we have in Korea today. About 6 years ago, say in 2011, there were only 2 products that we could select from. There are about 8 manufacturers now that is leading to some problems. In order for the doctors to recommend which implant is good and say which is not, we need to use the products for about 5~10 years.



But in reality it is different. "This product was released last year. It is new." Such statements are worrisome.

When a new car comes out, people go on a test drive and wait for the reviews to come out. Saying that something is new for a product that is to be put into your body, cannot be an advertisement. This fact should be something that disqualifies the product from your choice. It only seems that the new product should be tested on your body. The doctors can only recommend those implants that have been in the market over time with much researches and results published. If you narrow down the choices in such a way, there isn't many that you can choose from.

Fourth, you need to trust the medical personnel and depend on them with the surgery.
It is important that you ask difficult questions, share ideas and question about the treatment to the doctors. There are some accurate and specific facts that the patients must be aware of as the overall procedure takes place. Also, it is not wise to be 100% reliant on the doctor. However, you should not leave a perception that you "do not trust the doctor." It is because the doctor will take that he/she must take all the blame for even a very minor problem therefore would think their way out of it from the planning stages.

If you want the best possible result for the patient, there are many things to make decisions on before the surgery and at times the doctor needs to be forceful about those decisions. Therefore if the  patient does not trust the doctor, the doctor would self-defend as much as possible.

"I told you that this method would have been better. Why didn't this patient agree to my decision?" can be a statement made by the doctor.

In oppose, "This patient trusted the medical personnel and also communicated a lot. So, I did my best to come up with the best result possible." The medical personnel with such thought would perform better on the patient.

Today, I shared about few things that you could consider before  breast augmentation. Hope the details have helped you.

Thanks a lot.

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.