(Drinking single estate, organic, pour over, sustainable, hormone free, free range, and cage free coffee)

What would you do on your vacation?  If you’re a plastic surgeon, you wake up early and hang out with someone you only know through Instagram, of course!

2 weeks ago, I was honored to finally meet Dr. Giuliano Borille in person. Interestingly, we started our “bromance” on Instagram.    He’s a plastic surgeon from Porto Alegre, Brazil, and wanted to meet me and hang out in the OR at San Francisco Surgery Center.  Really-  why would you want to see any of California when you could hang out with me, right?

Dr. Borgille and I had a blast-  especially talking about the similarities and differences about plastic surgery in the US and Brazil.  My first case this morning was a breast implant revision, and we talked a lot about breast surgery similarities and differences.

One thing I already know, but you may not, is that there are regional and geographic differences in what is considered a “normal” breast implant size.  The USA definitely goes bigger than most countries, including Brazil.  Areas of the USA with more sun exposure-  think So Cal, or the Southern US-  also tends to have larger breast implant sizes than the rest of the US.

Breast Implant Sizes, Breast Lift Procedures, and Breast Implant Placement in Brazil and the USA

For today’s case, I used a 500 cc breast implant.  Dr. Borille rarely puts in anything larger than 350 cc-  so to him, this was an interesting case!  Also, he told me that breast lifts are very popular in Brazil.


(Dr. Borille had to take a selfie with a 500 cc breast implant-  a size he never uses in Brazil)

In my opinion, breast lifts are only moderately popular in the US.  In Brazil, patients prefer to deal with breast sag with a small breast implant and a breast lift.  In the US, patients prefer to deal with breast sag with a larger breast implant, and avoid a breast lift procedure if possible.  I think this explains the difference in surgical approach.

Another item of discussion was the placement of the breast implant-  under the skin but above the muscle/”sub glandular”, under the muscle fascia/ “subfascial”, and under the muscle- typically “submuscular”, but also “dual plane”.

I have always known that under the muscle is more popular in the US for more tissue coverage of the breast implant, which helps the breast implant “feel” more natural after surgery.  If it’s just under the skin and breast tissue, but above the muscle, you have an increased risk of “rippling and wrinkling”, where you can feel the edge of the breast implant under the skin.

Well, after talking to Dr. Borgille, I confirmed what I have read about-  in Brazil, since they don’t put in very large volume breast implants, it’s easier to place the breast implant above the muscle.  You don’t have to worry as much about “rippling and wrinkling”, because the breast implant is not large enough or wide enough to cause excessive skin stretch.

Also, it’s easier to place a smaller volume breast implant under the fascia, or “subfascial” plane.  With a really large volume breast implant, it can be surgically difficult to place the implant under the fascia, depending on the patient, the size of the muscle, and the size and thickness of the breast implant.  This is a big reason why the “subfascial” placement of breast implants is more popular in Brazil, and less popular in the US.

The most common type of breast augmenation incision in both the US and Brazil is the breast fold, or IMF/ inframmary fold.  This is done to help avoid “capsular contracture” – an increased possibility with the areolar incision.  The underarm incision, or “axillary” incision, is not that popular in the US or in Brazil, because it’s harder to create a great circular pocket for the breast implants.

In both the US and Brazil, the most popular type of breast implant remains smooth, round, silicone breast implants.   In Brazil, the textured shell anatomic breast implants tend to be used in women with very little breast tissue, or in breast reconstruction-  similar to the US.

Breast Aesthetic Differences in Brazil and the USA

In the US, having a full and perky bosom is definitely an ideal body shape that women desire.  In Brazil, having perky breasts is ideal-  not necessarily having a larger size.  This explains the different breast implants, volumes, anatomic approaches, and surgical strategies in our different cultures and countries.

I also learned that Brazil requires 2 doctors for any surgical procedure.  1 doctor must be a surgeon, but the 2nd doctor can be a surgeon or anything else.  It makes sense if you have 2 plastic surgeons doing a case, because you can probably double the speed and efficiency of that procedure.  However, I’m not sure how much a pediatrician or family practice doctor with no surgical training would assist me in the operating room!

And for the non-plastic surgeons out there- yes, this blog post may be a little geeky.  However, if you know a lot about breast implants, breast augmentation, and breast lifts, you know that exchanging ideas about achieving the “best breast”  is always fun and interesting.

Do you agree or disagree with anything in this article?  Have any questions about it?  Let me know by leaving your comments below or emailing me at info@drkim.com


Check out Dr. Borille on his Instagram feed-  https://www.instagram.com/drgiulianoborille

You can also follow me on too many social media websites below for any comments.  I look forward to hearing from you!







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