Breast augmentation Korea
Today I would like to share 3rd posting on matching implant and tissue structure.



We have shared that in order for the breast augmentation to be successful, the foreign substance (implant) has to match properly with the body, and that size and form stability are important.

Today, I would like to share about the implant filling and the shell type. All are important but there are no accurate information on them.
Silicone implant is consisted of exterior (shell) and the interior (gel).
The shell has filling inside it. If the shell can be composed of max 250cc gel and has such amount, we call this 100% filled. In reality, most products are not 100% filled.



280cc shell is filled about 95% which is 266cc. Such product would have volume of 266cc marked on the package, not 280.

Almost all round type implants are produced such way. Why is that?
As the implant gets filled up to 100%, it becomes more form stable and strong. For stability means that the implant is able to maintain its shape no matter where and how it is positioned. Such problems could follow.

- If the disc shape is maintained when standing, upper block would look worse
- If the disc shape is maintained when lying down, the breast would look unnatural because there is no gravity pulling it down
- The breast would feel hard rather than soft
The manufacturers consider such factors and therefore produce products that are no 100% filled. Less than 100% filling leads to,
- Upper block cannot be found when standing
- Breast lean towards the outside when lying down, looking natural
- Feels soft when you touch the breast



However, such less filled implants have problems. Let’s look at some of them.
If the implant is not completely filled, one part might more gel than the other. There is no balanced distribution. Such could lead to wrinkling of the shell. The wrinkle from outside looks wavy and you can feel it when you touch it. We call this rippling. More accurately, it is called underfill rippling.

If there is much friction on the rippled part due to much movement, there could be some damage to the shell. This leads to high possibility of damage.
If you have ridden bicycle a lot, then you might know this. If you do not fill up the air in the tire and ride the bike, you might experience more flat tires. If you fill up the air, then there is less chance of you getting a flat tire.



The breast skin loses elasticity after giving birth and/or breast feeding. Loss of skin elasticity leads to sagging breasts. If underfilled implant is used on such breast, the breast would look like it had lost more elasticity than before.
Using underfilled implant on the patient with sudden weight loss or skin aging would not be good also.

The advantage and disadvantage of 100% filled implant, i.e. form stable implant is exactly the opposite. Fully filled implant feels hard and not smooth. The gel disperses less when the implant leans onto one side. But the durability is good therefore there is less chance of collapse and although the skin loses elasticity, the implant can maintain the shape of the breast. Such form stable implant is more effective in correcting tuberous breast as well.

If the disc shaped implant is filled as much as possible, and if the round type implant is filled as such, the implant would shape like a ball. This is why the round type implants are not 100% filled.

Most of the implants imported are underfilled ones. Micro textured implant from Sebbin, Motiva, Bellagel are introduced as 100% filled implants but the shells can extend easily therefore they are not form stable implants.

Micro textured implants have smooth exterior skin therefore although there is much filling, the implant is not form stable.



If you want close to complete filling and form stability then the best implant would be anatomical type. When the anatomical implant is filled 100%, it does not become round like a ball. The anatomical shape is maintained looking natural.
This is why 100% filled implants are mostly anatomical implants. Under filled implants are mostly round types.

Then, which implant is good to use? This may be the question that you want answered.

Like the title of the post, I wanted to express that the matching of the implant and the body is important. The answer to the question is that the implant selected must be in consideration with the status of the patient’s breast.


If the breast skin is very tight and you do not want large volume, you can use less form stable implant that avoid upper block. Round type implant would be recommended to you.

But if you have tight skin and want large volume, using the round type implant would lead to upper block. Although the implant is under filled there are much skin tissue covering the implant. Therefore, in such case, anatomical implant would be recommended.
If you have sagging breasts with loss of elasticity, or if you have tuberous breasts, then anatomical implant would be good for you. In rare cases, form stable round type implant would be recommended (this is very rare in Korea).



If you have good shaped original breast with good balance and skin status but want to make the breasts larger, then you can use any type of implants for cosmetic purposes. Smooth, textured, round, micro texture, anatomical, polyurethane, all would lead to satisfying shape of the breast.

Today we shared about how much implant shell is filled with gel. I hoped you understood this core concept in understanding what the implant is.
Thank you and have a great day.


Breast augmentation Korea KIES-U

About Form stability

[breast augmentation Korea]
The two key words that I share while I talk to the patients or write on this blog are “form stability” and “dual plane”.

Form stability of an implant is one of the core concepts in forecasting how the breast augmentation result would be. But, to most patients, this term would be very new to them.


Most of the information on the internet is about how the breast feels after the breast augmentation. The information is rather one dimensional.
The information is one the result such as soft implant, hard implant, implant that spreads easily while lying, and implant that feels natural.

No matter how soft the implant is when you lay it on top of the table but you feel that the breasts sag a lot after the augmentation, would you be happy with the result?

Although you were attracted to the fact that the implant balance shifts downwards and feels natural when lying down, you might suffer from rippling effect. Would you be satisfied with this?



There are some conditions that need to be met when using implants in breast augmentation.

Can we correct and control the shape of the breast as we want?
Will there be no complications or failure in the long term?

These are a few.
There are basic must-haves such as form stability and position stability in order to satisfy these conditions.
Breast augmentation has a lot of variables.
FDA statistics show that 20% of all breast augmentation leads to reconstruction due to dissatisfaction and complications. The reason for this is due to the loss of control.
We can expect any outcome if there are different results or some satisfying or dissatisfying results.

We cannot say that this was a successful surgery.

It may be impossible, but we need to estimate the outcome and control the process to result in a successful surgery. Also, there must be minimum level of complications and no reconstruction in the long term.

Of course, all these factors do not just depend on the implant itself. The surgeon needs to study the body properly, plan out the whole process properly, apply the appropriate plane method / desquamation method, efficiently close the wound with least amount of bleeding when inserting the implant, and conduct post-augmentation check-ups with proper management.

It is correct to say that the surgeon needs to select the implant that matches perfectly with the patient.




Stating which implant is the best or better than others is just a marketing tool.
All implants have their purposes in usage that determine the outcome.
It’s like selecting the right ingredients for a delicious meal.

We cannot use the same hot sauce for a pizza and soup. We need to select the right implant for a particular situation in order to derive the best result possible.
There is no one implant that leads to a successful outcome 100% of the time. The success is made by the surgeon and the implant is just one of the tools used.

One would be able to estimate and control the result with least complication by using a 'good implant'. But there is not just one implant that satisfies all these conditions.
The doctors selects the best implant possible and matches that with the patient’s body in order to achieve that goal.

The implant that we use currently is called a ‘cohesive gel’ implant

The terms such as micro texture, smooth, and macro texture are words that describe the shell of the implant. The substance inside the implant is all cohesive gel.
‘Cohesive’ means well integrated.

Many patients ask how micro textured or silk surface is. But there is no one who asks what cohesive gel is.

Why do the manufacturers use cohesive gel?

They use it because it does not leak out like the water does if there is some damage to the implant.

But more importantly, it is because of ‘form stability’.
The ability to maintain the form makes it easier for us to estimate how the shape would be and also helps us to correct the shape if necessary. Also, it helps to fill the upper block of the breast for a long period of time.

It helps to maintain the shape/form although the implant collapses. We call such characteristic form or shape stability.

But if the gel is formed similar to water, the one dimensional feeling can be good.
The state has to be close to water if you want the implant to feel more soft.

I don’t know if you would remember my writing on how using liquid silicone, illegally, can result in the best outcome possible if there is no complication. The more liquid it becomes, the gel becomes very soft and wavy leading to a very good sense of touch.

But if the implant collapses, the shape disappears as well. Your breasts would end up looking weird.

If you have breasts that need to be corrected such as sagging breasts, such result would be meaningless. You will not be able to change the shape of the breasts properly and the shape of the implant would also change.

You will suffer from complications such as rippling. Upper volume of the breast would not be filled and the gel would all move downwards.

Cohesive gel came into the market in order to be a substitute for such liquid silicone. Gel is sticky and feels a lot stronger than liquid silicone. It is more close to solid than liquid. The difference is from touching a white cream with your hand to touching rubber ball. This is the difference of liquid and solid.

The reason why "cohesive gel" was made by the manufacturers is to avoid any shape related problems due to implant collapse, less filling of the upper volume and others although the patients want the breasts to feel soft.

This is why cohesive gel was born. The cohesive implant is classified by how much cohesive the implant is. The more cohesive the implant is, we call the implant form stable. The less cohesive the implant is, we call the implant less form stable.

The most form stable implant that we use today is Allergan’s Style 410. It is an anatomical implant and is sold the most around the globe.



Form stable implants feel strong and hard. It also maintains the shape the longest and the upper breast do not loose volume as you age. The best part is that you can correct the shape of the breast easily. It is best for those patients with very short distance between the nipple and inframammary fold or the distance between the clavicle and the nipple.

The gel does not leak easily when the implant collapses and the shape is maintained for a very long time. There will not be any rippling of the implant as well.
I will share more on the details in the future but there are critics on Style 410 with the rough texturing that causes double capsuling, seroma, and lymph nodes making the doctors avoid this product.

Then which cohesive gel implant has the least form stability?
It is Mentor/Allergan smooth round type implant.

The gel’s elastomer is very thin and the shell is about 90% filled which means there is more possibility of implant collapse or folding.

The inner density level is very low therefore it feels more like water.
The implant feels very soft and wavy.

Also the implant shifts one sided when you lie down towards one side. This might feel natural to you but if you have less elastic skin or much fat then such outcome would be less welcoming.

Luckily, there are many implants that we can choose from and there are many spectrum that we can choose in between.

Bellagel, EuroSilicone, PolyTech and Cervin have micro textured cohesive gel implants that have just an average level of cohesiveness.

The implants are near to 100% filled.

The implants do not feel like gel but the shell’s elastomer elasticity is high which makes the implants feel somewhat good when you touch them.

Such implants have less texturing so they do not stick properly to the skin wall. So the implants might not be able to maintain their positions inside but move about so such implants cannot be made as anatomical type. (All micro texturing implants are round type)

I have stated previously that in principle, the implant has to match the tissue structure of the breast. It is best to select an implant that matches with the shape of the breast and helps balance the growth of the breast skin.

If you are young and before pregnancy (In the 20’s), have tight skin and somewhat good breast shape and volume, the best solution might be just to make the volume larger and maintain the shape.

If such is the case then the form stability of the implant is not important. You can use any implant that you like. We would recommend smooth, round type or micro textured implant.



If you gave birth, have less elastic skin, and upper volume is less filled then it is important to change the shape of the breast to make the breast look balanced. The implant must not collapse therefore we must use form stable one. Such implant would change the shape of the breast and provide much volume. Most of the form stable implants imported to our country are anatomical types.

We need to choose an implant that matches the patient’s breast characteristics, and the state of the breast skin tissue.

In summary,

If my breast is tight and hard, then I would need soft implant
If my breast is less elastic then I would need tight implant
This would balance out the breasts. Implants are used as a complement to the human body and what we use depends on how our bodies are.

We will share more in the next post. Thank you for reading.
 

KIES-U Plastic surgery Korea
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
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Does transaxillary incision always hurt? Does inframammary incision not hurt?

Many patients want inframammary fold incision because they want to recover quickly. Some say that they do not feel much pain so they want to avoid transaxillary incision.
We cannot say that this is completely false but as you think about it, it is not correct to say that the approach method, incision, is the only cause of pain in breast augmentation.



The conclusion is that pain is not caused simply by just one factor.

There are many factors combined that lead to pain after the breast augmentation. The incision spot may be the least important factor of pain.
Then what is the most important factor? I have summarized this into a diagram as below. These factors are the ones that lead to pain after the breast augmentation.


 
Going into the explanation, the pain caused after the breast augmentation takes place when implant with much volume goes into the body and takes up some space. The surrounding skin pressures the implant and the pain receptors feel this pressure. This is the origin of the pain. People have different level of pain receptors in sensitivity, location, density, etc. The most sensitive ones are near the bones. The skin feels much pain as well but anesthesia helps relieve the pain. The pressure goes through epithelium, muscles and to the bone leading to much pain.

This is why there is more pain if the implant is located above the pectoralis muscle and almost no pain if the implant is positioned above the muscle. This is more important than the incision spot.

More pressure leads to bigger impact on the pain receptors, therefore that larger the implant is, there will be more pain. If the skin surrounding the implant put much pressure, there would be more pain as well. The implant puts pressure on the clavicle resulting in pain which means that the size or the tightness of the implant can result as such.

So if you want quick recovery, then it is wiser to use small sized implants rather than thinking about the incision spot.

It is also important that the surgeon carefully operates without causing much tissue damage. If there is much trauma on the bone or if there is much bleeding, the tissue cells will swell up. The pressure from the swelling will stimulate the pain receptors. Therefore it is important that the surgery is complete with least amount of tissue damage and bleeding for quicker recovery.

Finally, that last important factor is the individual differences.
Pain is a subjective matter. The doctor is just another third party in the patient’s perception. The doctor just hears about the pain that the patient is feeling, he/she cannot feel the same pain therefore the doctor’s information on the pain are all abstractive.

Internal medicine and neurology department use pain scale. They want to make the subjective matter measurable.




Personally, I do not think that the level of pain can be differentiated into different level. This is why we say that there is individual difference. Same level of stimulant will be felt differently from one person to another. One person might have more pain receptor in stimulating spot and the other may not have much pain receptor. There is no way that we can know this until we poke someone. In same aspect, we cannot know if someone will suffer from pain unless we conduct the surgery.

Although we do not have the exact measurement, we have much gathered data through experience and come up with a method that could result in least amount of pain. First, you should not be greedy regarding the size of the implant but choose a size that is most appropriate for the body. Those in 20’s or are in stage before pregnancy have very tight skin so these patients must be more careful.  If you have much volume or fat already in the original breasts then having the plane above the pectoralis muscle is recommended. Also the surgeon must concentrate and be careful so that he/she does not damage the tissue cells.

Does axillary incision hurt? Not, always. Then does the inframammary incision not hurt? It does not. The factors shared above are more important when considering pain. There might be little differences but this is a general tendency.

This is all for today. Thank you for reading.

[KIES-U Breast augmentation Korea]
This applies to all foreign substances that are put into the human body, but it is very important to know that the breast implant used in breast augmentation matches well with the body or not.

The success of breast augmentation depends on the implant therefore; the implant must match the body.

The implant makes my body look better and this means that the implant must be fitting for a certain individual. Therefore, stating that the implant matches the body is very important, and we call this implant – tissue structure dynamics.



There are 2 concepts to breast augmentation

Making the breasts larger + Filling up the breast volume appropriately

Breast augmentation requires filling up the volume to make the cup size bigger and this is not everything.

We need to consider the tissue structure and conduct the surgery appropriately. In doing so, we would be able to avoid any complications and maintain the beautiful shape for a long period of time.

We tend to think about many things when we put on our clothes. We choose the clothes that are fitting to our body. But, we also want our body to fit into the clothes that we like. We use correcting inner wear or even lose some weight in order to wear such clothes.

We need to consider the breast tissue structure and conduct the breast augmentation accordingly, but at times, in order to get the result that we want, we force a change in the tissue structure.

If your original breasts have ideal shape but not much volume, there is no reason to put on much stress on the tissue structure. The shapes does not need to change therefore just inserting the implant would be good enough for the volume.

We wouldn’t need to consider many things in such case. This case would be similar for a woman with great body shape wearing a dress, pants or anything.

But this is not the case all the time. There are cases such as asymmetric breasts, contour or bird chest, sagging breasts, etc where you need breast correction to solve the problems.

This would be similar to wearing clothes that have some attractive points that would cover up certain parts of the body.



Let’s say that you have one breast that is sagging a lot and the other is normal. What implant would be good for you?

It is not right to think that an implant that is currently the most widely used would be fitting for you. Breast augmentation is not as simple as you think.

Sagging breasts means that there is no upper filling in the breasts but there is much volume in the bottom part of the breast. If the breast status is the opposite, then you would need to fill up the bottom part.

We would need to apply dual plane for the sagging breast and insert the implant filling the upper volume. The implant must hold up the upper breast shape properly therefore the implant must be a form stable one. You would not need such implant if you already have much upper volume in the original breast. You would need to use an implant that stretches downwards.

The type of the implant, size, and other factors must be considered in order to select an implant that matches your body. Also we would need to know what happens when the implant and the tissue cells come together.

Selecting the size of the implant

Everyone would think cautiously about the size of the implant.
We need to think about this with some common sense.

If you use a very big implant, it would look awkward and it would be recognizable as well.
In opposite, if you use a small one, then there would be no reason for you to get the breast augmentation done.



Most people think that “the more is better”. Those with small original breasts would be more interested in the size. This is like a little chubby person wanting to wear tight clothes.

Although the expected outcome of the surgery is good, we should avoid it if we know that the skin tissue could be damaged or something that cannot be fixed could happen.
Selecting the implant size just through subjective reasoning of the patient and the doctor could lead to a harming situation.

Large implant puts on much pressure on the skin tissue and the bone that the implant is positioned on and this could lead to some unexpected negative results.

- Breast skin layer becomes thin and the breast tissue cells contract
- This results in small volume in few years
- The implant line becomes visible
- Clavicle erodes making the bones sink

If such activity takes place, there is no way we can correct it therefore it is important that we try to avoid such situation from the beginning.

Then what is an appropriate size of the implant that would not damage the tissue cells and end up with the best shape possible.
This is the main focus point.



If your body is big enough, you can use large sized implant.
If your body is small, then you need to use small sized implant.

Everyone can know this.

But, how can we judge if our body is small or big?
There are women who are 170cm tall but have narrow shoulders and thorax.
Such patients cannot use large sized implants.

There are those who are small in height but have wide shoulders and large thorax. Such patients would need to use large sized implants.

The size of the implant would match with the size of the body in such cases.
We do not stick the implant on the outside, but insert it into the body.

Therefore, it is important to know how much the skin surrounding and covering the implant can stretch out.

If you are wearing a dress that does not stretch much then you would need to wear bigger size. But if you wear something that stretches very well then you might be able to wear a smaller sized dress.

If your skin stretches easily then you can use large sized implant. But if your skin is the opposite, then you will not be able to use a large sized implant.


In conclusion, there are two factors that determine the volume of the implant.

- Diameter of the breast
- Expansibility of the breast skin

Height, weight and other physical structure are not important.
Putting in something big to make the breast bigger is not important. The implant needs to fill up the volume properly and improve the look of the breasts. The weakness that you have in your breasts must be corrected and possibilities of any complications must be minimized simultaneously. These are all factors that we need to consider when we say that the implant matches well with the tissue cells. This is the key point.

We will share more on this topic in the future. Thank you for reading.


[KIES-U Breast augmentation Korea]
Contact Us: +82-10-2687-4790
WhatsApp: +821026874790
E-mail: kiesu0202@gmail.com
Web site: www.kiesu.com
YouTube: www.youtube.com/kiesu0202

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.