How are breast implants inserted during breast augmentation?

There are many patients who ask how the implant in insert in during the breast augmentation.

Today, I would like to briefly share about this process.

If someone judges just by looking at the breast augmentation, then he/she might think that the overall process was quick. But as always, what you see from the outside is not so important as to what is happening on the inside.
If the implant is to be put in properly without any contamination, there must be some principles that the surgeon must follow.

The first is a principle on trauma.



If the surgeon gets too tough during the breast augmentation and hurts the tissue cells, the skin and the tissue cells at the entrance point do not regenerate.

The incision part must be very clean and the skin tissue, epithelium, muscle and other parts must cared for with minimum damage for the cells to regenerate at the point of entry. This will lead to normal state of inputting the implant.

If there is much damage to the skin and entry point along with bleeding, we will not be able to open the entry point properly making it difficult to put in the implant.
Careful desquamation, non-damaging surgery, and clean insertion of the implant are mandatory in breast augmentation.

Second, we need to conduct desquamation accurately in size and direction. 

If we approach from the areola then we need to desquamate between the gland and the skin layer. The desquamation must be precise and enough. This makes a tunnel for the implant to come out.

If we approach from the axillary fold, then we need to make a path above or below the pectoralis muscle. This path must be big enough as well. The tunnel that the implant passes through to get to the pocket must be accurate and big enough.

This applies the same on inframammary fold as well. This is really basic stuff but if the desquamation is not accurate or big enough, we may face hard time putting in the implant which could also lead to implant damage, skin damage, scar and failure in putting in the implant. In the long term, all this could lead to implant collapse or capsular contracture.



Third is the no-touch technique.

The most concerning part about putting in the implant is the contamination. Implant is a foreign substance to the body therefore if pathogenic virus infects the implant that stays within the body for a long time; this could lead to bad results.

One of the worst complications is the capsular contracture. Then where does this infection source come from? It can come from the surgeon’s hygiene gloves, or the blood that gets on the implant as the implants goes into the pocket from the entrance, or the surgical equipment used or even from antiseptics. Also, the implant from the manufacturing plant might not be hygienic enough.

The source of infection cannot be seen by the human eyes. There is no way if there is any infection caused during the surgery therefore it is best that the surgeons be careful during the surgery and take preventive care.



No-touch technique means that we do not touch the implant with our hands. We use funnel-like equipment for insertion and squeeze out the implant. Nowadays we do not use the funnel that much, but use latex gloves called insertion sleeve.

Also, the implant must be unwrapped just when the desquamation is complete and when the preparation for the insertion is complete. We need to minimize the time that the implant gets exposed to the air. We also need to minimize the number of touches we make on the implant once it is inserted.

All the 3 factors of minimizing trauma, accurate desquamation, and no-touch technique are all applied by the surgeons in all clinics. These must be carried out in order to minimize the possibility of implant collapsing, getting infected, rotating, or leading to capsular contracture.

This is all for today, thank you very much.

Inflammation and infection are two main adversaries of breast augmentation

Hello everyone. Today I would like to share about one of the most common theme in cosmetic surgery, the inflammation and infection with their results and further complications.

In science, we always ask “is that true?” and go through various stages in order to find out the opposite. Some people suffer because of what we try to change at present, but we cannot avoid these moments in order to find out the truth. The same applies to the medical field.

There are many surgeries that require implants. I am sure that there will be many products made in the future that could be used in the human body. Artificial tooth, ie. Implant (titanium), artificial knee, joint, artificial veins, pacemaker, etc are all these type of products. Silicone, artificial skin or ligaments and implants used to enlarge the breasts and buttocks are some common implants used today.



The reasons for using these implants are that the surgery can be quick, and we use already made products with perfect shape and features that make the overall result dramatic. It is much cheaper (due to mass production) than bone graft or cartilage transplant.

But an implant is a foreign substance. It is not made inside the body but in a manufacturing plant. People get suspicious about complications in using these products. Many complications do take place in reality.

The biggest problem in breast augmentation is the capsular contracture. We use implants for volume fulfillment but if they become hard and not smooth, there would be no meaning to using them. This is why all the doctors have been studying why capsular contracture is formed from the moment the implants are inserted.



Many studies show that the capsular contracture has been formed through contamination by germs. A lot of animal testing and clinical testing show such results.

Implants come with packaging with sterilization however we cannot say for certain that they are 100% hygienic. We also sterilize all the tools and equipment that we used during the surgery but can we say for certain that we killed all the germs? The surgeons use hygienic gloves and sterilize the operation room but there are always germs, bacteria in the air and there is no place around the world without them (except sterilization laboratory and immunity deterioration room). Therefore, there is a possibility that these germs get into and contaminate the implants and the pockets during the surgery.



If you have normal level of immunity then you can win certain level of germs that are acceptable and also recover properly. The same applies for breast augmentation patients. The human body makes the immune system active to kill and clean off the germs.

However, an implant is a foreign substance therefore it does not have the immune system. If the implant gets contaminated and there are much germs or if the surgery is too destructive and the tissue cells cannot have proper immune system, the germs will not disappear but live among the implant. These germs do not go away but make a wall for protection that leads to a thin film like structure around the implant.

We call this biofilm and this biofilm is resistant to sterilization and protects the germs therefore the germs can live for a long time causing worse level of inflammation on the body. Such inflammation works together fiboblast leading to severe case of capsular contracture. This is one of the most accepted theory.

Usually the patients cannot differentiate infection and inflammation. Infection refers to the allowing of outside germs to penetrate to the body and inflammation refers to the body reaction towards the germs.

If there is bad infection during the breast augmentation, you will have fever and also swelling on the breasts. When we say you have ‘inflammation’, it usually means that you are infected. Capsulation contracture is not a form of severe inflammation but a weak one. It is caused when there is minor inflammation that cannot be visually noticed that makes the body react with thick capsule leading to hard feeling breasts.

So what can we do to prevent such situations? Below is the 14 point plan that world known cosmetic surgeons around the world accept as capsular contracture preventing methods. I would like to clarify that massaging and taking prescription are not one of these.

1) Insert antibiotics during anesthesia
2) Avoid areola incision
3) Cover up the nipple during surgery
4) Be careful not to cause too much damage during the surgery
5) Careful hemostasis
6) Apply dual plane or form subfascial pockets
7) Use antibiotics or antiseptic solution to clean the pocket
8) Use sleeve (funnel, to avoid skin contact) to insert the implant
9) Change hygienic gloves before touching the implant
10) Reduce the time that the implant gets exposed (Unpack just before insertion)
11) Do not touch the implant a lot in order for proper placement
12) Stitch up layer upon layer
13) Avoid using drain tube (can be the cause of contamination)
14) Use antibiotics if additional surgeries are necessary
(There are some doctors who question No. 2, Avoid areola incision)

The conclusion is that the surgeon must conduct the breast augmentation properly. If there is severe case of capsular contracture after the breast augmentation, there is no reason for you to spend much money getting massages and taking medicine.



No matter how careful the experienced doctor is, he/she cannot completely avoid all the germs getting through. If the patient is unlucky, she might suffer from minor case (Grade 1~2) of capsular contracture. Such contracture does not require breast augmentation revision surgery.

There may be future implants that improve on this problem. There is a high possibility that texturing implant who disappear although it has been made to avoid the capsular contracture. There may be implant with sterilized or antibiotic coating. We expect there to be less cases of capsular contracture and inflammation once these products are in the market.

Thank you for reading.

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Some people who come for breast augmentation in our clinic (KIES-U Gangnam Plastic surgery clinic) just think that it is getting the breasts larger by spending some amount of money.

Such perception becomes more solid as they visit more clinics. When they read reviews on breast augmentation in Korea on the internet, they think that they will get the same result after the breast augmentation. Such perception can make you think that breast augmentation is something that you can easily shop for.



The first step in treatment is finding out what the problem is, but most of the patients who come to visit us(KIES-U Plastic surgery Korea) do not think so. We talk about the problems and the methods in solving the problems. Then we share some choices that could be made. This is the process of talking to the patient at first.

But, they feel offended in knowing that they have certain problems and that the doctors just point out the problems to them.

Accurate consultation, the effort for treatment can lead to worse result. Then, why does this happen?

The patients who come for breast augmentation in Korea are not confident about their breasts therefore I think that they tend to become uncomfortable if I share too much medical talk. You might be surprised at this but this is the reality.

This is different from keeping the problem that you have and visiting the doctor when the problem is at the worst state. If you do not treat illness, you might be paralyzed or die but if you do not fix unpretty looking breasts, nothing radical happens to you.

But this is my thinking all the time. Breast augmentation involves cutting and bleeding. This cannot be the same as shopping in a department store for an ear ring or bag. The doctor must share the contents that may not satisfy the patient.



Also, all bodies are different. The process of the augmentation may look alike abut they are all different. The process, method, and after treatment all must be different according to the patient. A body is not as simple as it looks.

Therefore it is important that you talk to the doctor about your body characteristics, the best method for your body, and how you can recover. If you only talk about the brand and the product, then there might be some big problems after the surgery.

'I have never heard of this before the surgery ', 'I didn’t read about his in other reviews, what is happening to me? What is wrong?”

When this happens, the patient can lose trust for the doctor and become highly unsatisfied. Therefore, whoever comes for consulting on the breast augmentation in Korea must change their perceptions.

Breast augmentation is one of many medical treatments. 

You must share the problems that you have, what kind of differences you have compared to others, your body characteristics with the specialists (along with other basic factors) and listen to the best option that the doctor will have. You need to have two-way communication in order to reflect the content on the surgery.



There is no other patient just like you.

Even the twins are different. (Only their genes are the same and they have different eating habits and so on)

You must know the difference and plan the procedure accordingly.

Long before in the clinics, the doctor would wait for there to be 3 ~ 4 patients. These patients would be gathered to one place and the doctor would share how the augmentation would take place. Then the nurses would schedule these patients.

We cannot say that this is absolutely wrong but there are many methods to breast augmentation. We cannot say that one method is the best one for all different cases. A particular method may apply to one patient but not the other. The implant is the same and so is the incision method.

Some patients have thicker fat than others, and some have more elastic skin layer that others. There are some patients who come during pregnancy and others who come after the pregnancy and breast feeding.



There are patients who removed a lump but have come for breast augmentation with the lump again. There are patients who removed some breast fat due to breast cancer that they suffered. Some have different types of shapes and some already had pretty looking breasts.

Some have severe case of bird chest but some have concave chests. Some have sagging breasts and some with breasts that are positioned real high. Some have different volumes on each side and some with different degree of sagging. Some have different locations of the nipple and some have different chest structure.
All these lead to different methods.

We consult or communicate with the patients so that we become aware of their situations and also make them understand how the surgical procedure and recovery can be carried out. This is really important. The breasts are hidden behind the clothes and are not exposed like the eyes or the nose. Therefore people are not aware of it as much as they are with the faces.

It is important to know that accurate and the best result possible can happen through clear understanding and communication.

This is all for today. I hope that the contents have helped you out.
Thank you.

Breast augmentation revision surgery, Neo plane technique

Today, I would like to share about the breast augmentation revision surgery method that I apply.

I would like to answer few questions that you may have.

1. Is there incision in breast augmentation revision surgery? 

We usually use the same incision spot as the original correction.
If we used inframammary fold, we use that for the revision. If we used areola incision at the first correction, we use the same for the second one. Same applies for the axillary incision. But the same cannot be applied for naval incision. Naval is too far away from the breast....

We need to use endoscope for axillary incision, therefore it is somewhat difficult to conduct on the second surgery. But most patients want it....


 
2. Do you have to remove the capsule? Is there a special method in KIES-U Plastic surgery Korea?

Different methods are applied for different reasons for the revision surgery. Some common reasons are capsular contracture, size exchange, implant dislocation or rotation. Such reasons lead to replacement of the implant.

If we replace the implant then we need to remove the capsule. All the textbooks on breast augmentation state this fact.

But there are some special cases when we do revision surgery on Korean patients. There are too many thin patients therefore in most of the time the implants are located below the pectoralis muscle in the first surgery. It is easy to remove the capsule if the implant is place above the pectoralis muscle but if the implant is placed below the muscle, the capsule is stuck right on the rib. There would be too much trauma on the rib if we remove all the capsule.

Therefore, most of the doctors do not completely remove all the capsule but only some part if the implant is placed below the pectoralis muscle. Axillary incision is the same because the visibility is not good enough.

In order to solve this problem, I apply the Neo plane technique. The objective of the revision surgery is for the implant to be placed at a new environment properly whatever the cause of the revision is. We need to completely dissolve the previous environment. We do not need to completely remove the capsule and but place it on the bottom and make a new plane between the pectoralis muscle and the capsule, just like the image below.



You do not remove the bottom and leave it as it is. The result would be as the below image.


We can reduce the time of the breast augmentation revision surgery in such way and also avoid unnecessary bleeding and pain.

Whatever the reason is for breast augmentation revision, the failure of the revision surgery is due to the usage of the original capsule. We cannot use the capsule with capsular contracture, but provide absolutely new environment for the breast augmentation revision surgery in order to avoid any possible problems.

3. What is a good implant for breast augmentation revision surgery?

As stated above, the main reasons for revision are capsular contracture, changing the size, rotation / change of position. Patient who got revision surgery due to capsular contracture, would not want to face capsular contracture again. In order to avoid the capsular contracture, one should use the polyurethane implant. If you have faced sever case of capsular contracture or faced it multiple times, then I would recommend Polytech’s microthane implant that is imported here to our country.


Silicone can lead to capsular contracture. You might feel normal for some time, but after 10 years, your breasts might feel tight and hard. A person who loves to eat peach but suffer allergy all of a sudden even just by touching it. Microthane can avoid rotations and misplacement also.

But this is really expensive. If you want to save as much money possible in the revision surgery, then you might have to choose the silicone implant. In such case, I would recommend you to change the type of the implant.

If you used microtexture in the first surgery and suffered capsular contracture, then you could use macrotexture in the revision surgery. If you used macrotexture in the first surgery, then you could change to the smooth type. Basically, you would use the implant with opposite effect in the second surgery. Macro, micro, smooth, etc are all silicone implants. It is impossible to go over the limitations. But, there are little differences among the products.

4. Choosing a large or small sized implant in the revision surgery, what leads to more problems? 

If you are the one who wants to use larger implants in the breast augmentation revision surgery, then you need to know that the original breast tissue contraction may come earlier than expected. As a result, you may be able to feel the implant more than you want and you may feel rippling or other complications.

If you use smaller implant, then you might suffer from rotation or misplacement because the original pocket is too big. One must remove the capsule. If you used small implant in the original surgery and then changed to a larger one, then there would not be much problem.  If you already used large implant in the original surgery and change to an even larger on, then there might be sever contraction, therefore we would not recommend this. If you used very large implant in the first surgery but want to used small sized one in the revision surgery, the surgeon needs to be very careful. If not, there would be bad problems.

5. Does the breast augmentation revision surgery cause more pain than the first? 

Usually there is less pain in the revision surgery and the recovery time is shorter.
There might be those who think that opening up the wound would hurt even more but the patients do not feel much pain in the revision surgery.

The reason for this is that the skin is already extended a lot after the first surgery so there is not much tissue to contract the implant. Therefore, this is less pain in the process. Also, you can get back to your social life really quickly.

 
All the patients who are in the second surgery must feel the same. You might be thinking that you do not want to come back to this status ever again. In order for the 2nd surgery to be successful, there needs to be good planning by the surgeon.

Approaching method, implant, technique, etc. all must be appropriate for the patient.
This is all for today. Thank you very much.

Microthane breast augmentation – Fact Check 2. Is it good for sagging breasts?

Hello, everyone. Today I would like to share about microthane, i.e. microurethane shelled implant and how it is effective on sagging breasts.

Sagging breast is caused by three dimensional shape of the breast, therefore, tissues such as Cooper’s ligament lose strength. In most of the time, when a woman gets pregnant or does breast feeding, the breasts swell causing elongation. After the pregnancy or the breast feeding is complete, the breasts lose volume and become smaller. The ligament tissue cells are not rugger therefore, they cannot go back to the original shape. This causes the original breast tissue cells to fall downwards and this is the starting point of the sagging breasts.


The original breast tissue falls downwards, but the skin tissue cells still have the original level of elasticity. We call this glandular ptosis. Such breasts would not have much upper volume but the areola is placed somewhat above the inframammary fold.

As time flies and you get older, the skin loses elasticity and the strength to hold the composition leading to a change in the shape of the breast. This is a little different from glandular ptosis in that the areola drop down below the inframammary fold and you cannot see the white part of the skin from the front side.

There are many patients who consult on what to do during the glandular ptosis stage. A lot of these patients have spent few years after the pregnancy and they have loss in upper volume of the breast with a feeling that the breasts are sagging down with a loss of volume compared to before marriage. At this stage, we need to complete a few tasks in order to recover the breast volume, regain the elasticity and fill up the upper volume.


First, we need to make sure that the implant does not collapse but stand still filling up the upper volume of the breast. Second, the breast tissue must stick to and hold the implant. If the skin loses strength, the implant would fall downwards causing the ptosis to be worse.

In order to achieve these goals and not fall back to the sagging stage, we recommend form stable implants that can be stably place on the muscle. The interface point can become loose therefore we need to provide the tightness by dual plane method.
But, there are conditions in using the form stable implants and applying the dual plane method. First, the skin elasticity must be maintained and the original breast volume should not be too big. Also, we cannot use too heavy (big) implant.


If your skin elasticity is not reliable and you want to use large sized implant, then I would recommend polyurethane to you.

When we use the polyurethane implant, it immediately sticks with the bottom (bone) perfectly. No exterior pressure or strength can change the location. It is very applicable for breast ptosis.

Microthane implant firmly holds the position as soon as it is used. This position does not change at all. The skin layer is supported by this implant therefore we can avoid breast ptosis. (Dual plane method must be applied)

As a result, this is very effective in filling up the upper volume as well. Microthane never sags downwards.

There are some who question if the textured implant that sticks to the skin leads to sagging. The textured implants do not have all the power to stick to the skin. The textured implant would slip away if you widen the pocket with your hands. Such stickiness is not enough to hold if there is much gravity.
 

What happens in the second type of breast ptosis? A case where the breast tissue and the skin all sag, i.e. natural ptosis. We need to provide solution on the skin extending. The usage of the implant cannot solve the problem. We need to cut off the skin surrounding the implant. We need to apply breast ptosis correction. Implant itself only cannot be a solution.

Let’s summarize. There are many situations where we can solve breast ptosis with the usage of microthane implants. This can be the best method for glandular ptosis where the skin does not loose elasticity 100% and you want to fill up the upper volume. This is the simplest of all methods and best method for improvement.

This is all for today. Thank you for reading.