What Technical Surgical Details Do I Consider For You During Breast Augmentation Consultation?

What technical details do I consider? There are a bunch of them. So before your breast augmentation, I need to know a lot about you. I need to know your goals, what you want to look like, your inspiration photographs or videos, and I actually need to know about your body. The anatomy’s always the same, but every patient’s different. Have you had kids before or not? Do you have loose skin? Do you have tight skin? Have you had breast augmentation or breast surgery in the past? And more. Finally, we need to know your cup size. I need to take measurements. Obviously, patients who have some breast tissue versus very little breast tissue versus a lot of breast tissue, you have a different need for different profiles and sizes of implants. You may or may not realize you may need a breast lift and that I have to take into consideration as well. In terms of these, as well as the lifestyle choices you may have had, including exercise or how much you want to exercise later, smoking and so on, I need to know a lot of details before I can come up with a very technical, specific, individualized breast augmentation surgical plan just for you. So I know this video is a little vague, but as you can tell, there are a lot of factors that go into the best plan for your best outcome.

Types of Implants

Dr. Roy Kim here with the best type of breast implant for your breast augmentation. So the generic difference really would be saline versus silicone. The envelope is the same or similar, however the filler material is different. Saline implants are empty, I filled them with saline solution, they feel a little hard, but they’re FDA approved. Silicone are pre -filled, so remember similar or same envelope, but they are filled with silicone filler material. I can’t actually add or subtract any material when I crack open the sterile box in the operating room, it is what it is. The other interesting thing about types of implants are manufacturer, of course I only use FDA approved devices, and in terms of the profile, the implants of course come in different volumes, they actually come in different widths on your chest as well as thicknesses, how far or not so far they are away from your chest. So those vital differences are sort of what comes into play with your type of breast implant that’s best for you. Remember, the anatomy is always the same, but every patient is different. If you have any further questions, please let me know.

Smooth VS Textured Shell Implants

Hi, this is Dr. Roy Kim with an explanation of a smooth versus texture shell implant. The vast majority of implants today are smooth. They’re a smooth shell or smooth envelope. Texture shell implants really are not really widely used today. The reason why is texture shell implants rarely, they can shed, there’s some reaction and so your body has a reaction to it after they’re placed and it can have a very rare type of lymphatic cancer. So, to avoid that, we’re just basically not really using texture shell implants even though technically the FDA has still approved one or two companies for their use. So this is why a smooth versus texture shell implant, the distinction is I think to patients a little nerdy, but honestly to a plastic surgeon like me, it’s a big critical difference and I would just avoid texture shell implants in general.

Shape of Breast Implants

The shape of the implant is very critical in terms of the best breast augmentation for you. So this is Dr. Roy Kim. In terms of the shape, we tend to use round implants. Why don’t we use their teardrop shape or anatomic shape implants? The ones that are sort of thinner at the top and thicker at the bottom. The reason why is they used to make smooth envelope teardrop shape, anatomic shape implants. They would rotate. So in other words, it’s not a good look if you have the thicker top at the top of your breast, closer to the collar bone, and the thinner part lower close to your rib cage. That’s a weird look. So manufacturers came up with textured shell implants. So same shape, but the envelope has a textured shell, sort of a slightly rough, pebbly surface. That way your body would be able to latch on to the little hills and valleys of the textured shell implant and it wouldn’t rotate. It wouldn’t turn upside down. It would look a more normal shape and stay that position where it’s thinner at the top, closer to your collar bone, and thicker at the bottom, closer to your rib cage. Well, over the past couple of years, we’ve discovered that rarely it’s associated with a very rare type of lymphatic cancer. So this is why textured shell implants are out. We don’t use them. One manufacturer had to pull them from the market. The other manufacturers, hey, they’re still FDA approved, but nobody really uses them today and I definitely avoid using them at all costs. So the other interesting sort of opinion I have is round implants can look very natural if you’re very critical and careful about how you place them. So in general, if it’s a round implant, if it turns upside down, if it alters the position, nobody really cares because it’s round. It’s going to be the same diameter, same shape, whether it’s upside down or right side up or to the left or to the right. It’s just round. You can make it look more like a teardrop shape implant with careful selection of the correct implant, the correct sort of silicone gel or filler material inside, and of course, coming up with the perfect pocket, my maneuver and my technique so that you end up with a more natural look. The other hint generically is that the thicker the implant, the more unnatural it’s going to look. So if you have more artificial cleavage, it’s going to be a thicker implant like moving away from your chest Just very thick more prominent and that artificial cleavage does not look natural I think it’s one thing if you have natural breasts or even natural looking breasts with breast implants and You wear a cleavage inducing bra, then yes You can choose where do you have lots of cleavage or you can choose not to have lots of cleavage If you’re not wearing a bra and there’s always cleavage that’s sort of a visual tell -tale sign that that patient that person does not have Natural looking breasts so for your breast augmentation if you want to have a more natural look You want to pick an implant that’s not as thick if you want a more unnatural or artificial look you actually want to pick an implant that’s a little thicker that has a more robust profile and Is a little further away from your rib cage going like in this direction? So I hope this answers this question if you have any other questions, please let me know

Placement of Implants

Dr. Roy Kim here with placement of implant for breast augmentation. So what I think most patients want to know is, okay, it has to go underneath the breast tissue, but where exactly does it go? The biggest anatomic landmarks are skin, breast tissue, and muscle. Classically, the most common way of doing it today is under the muscle. Now, without getting too nerdy, yes, it’s under the pectoralis muscle, and yes, it’s partially covered or majority covered, but at the edges, sort of near the underarm, there’s not much of a pectoralis muscle, so technically it’s underneath breast tissue. It’s called dual -plane, or two planes, to confuse the crap out of everybody, but that is what is meant by under -muscle or dual -plane placement. Nobody really puts it truly above the muscle, or very few people do. The reason for that is there’s definitely an increased risk of scar tissue formation around the shell of the implant, that’s known as capsular contracture. Studies have shown that, and the reason why is that there’s sort of direct communication with the milk ducks in the areola. It is still done, but technically if you look at all the nerdy plastic surgery papers, there’s an increased risk of that scar tissue formation, which is why typically we don’t do it that way. There is a different way, of course. It’s above the muscle, but under the fascia, so that’s called subfascial placement. So the fascia is sort of like that white, stringy, or sometimes whitish, cleerish material that you see on meat. The human body’s no different, so over the pectoralis muscle, there’s fascia on top of it. I can lift up the fascia, create a perfect pocket or circular pocket, and then put the implant technically above the muscle, but underneath the fascia. I do do this, however not all the time. It has an advantage of still being very natural looking, and it also helps prevent movement of the muscle, and there’s a lower risk of capsular contracture, because technically it’s not in contact with as many bacteria from the milk docs. There’s a problem with it, I think, in many patients, at least in the West or the United States. If you put in a larger implant, my very strong opinion is that it’s stretching the fascia and it may actually tear it. Subfascial techniques were really done a lot in Brazil, where the size, the thickness, the overall volume of the implant is a lot lower than what we do in the United States. This approach is also common in Asia, it’s still very common in South America, it’s it’s actually common in Europe, but they’re not putting in larger volume implants like we are in US. So I think this is why it works for certain patients and if you don’t want a very very large implant we can definitely make it work for you. So I hope the three placements under the muscle dual plane above the muscle or sub glandular and under the fascia subfascial those are the three main ways that we can actually place your implants for your breast augmentation and now you know why the preference typically is under the muscle dual plane or subfascial. So if you have any other questions please let me know. Thanks so much for watching.

Types of Incisions

There are different types of incisions for breast augmentation. So this is Dr. Roy Kim here and the major way of doing it or the main way is through the breast fold. It’s called the Infra Memory Fold IMF or the breast fold incision. The advantage is I can create a circular perfect pocket. I can actually also go underneath the muscle or above the muscle, sub -fascial. I can even go sub -glandular, totally above the fascial muscle and I have the ability to really see everything, control the pocket, make sure it’s irrigated well and place the implant properly before closing it up. The areolar incision or nipple incision, in other words through the brown circle area of your areolar nipple, same length. I still control the pocket. I still have good visualization. It’s not a favorite incision because there are bacteria that sort of hang out in the milk ducts and if it gets onto the implant even when I’m putting it in under sterile conditions in an operating room setting, it can still sort of create issues, specifically too much scar tissue around the implant, also known as capsule contracture. So, this is why the areolar incision is less favored, myself included, but many plastic surgeons don’t favor it. The underarm incision is a decent option in some patients, however, you have to create a tunnel that connects to the circular pocket and I’m creating the tunnel and the circular pocket from an underarm incision. So, there are a couple of problems with it. One is that you’re going to have a lot of swelling in the tunnel while you’re healing. So, as long as you’re aware of it and as long as you wear a strap, massage it or just be aware that there’s going to be swelling in your underarm for a couple months after surgery, I think you’re fine. I think the other problem with that incision is that when you lift up your arms, sometimes it’s visible. So, of course, it has the advantage of no scar on your breast, technically, however, you can see it when you raise your arms. The breast fold incision, I guess you can see it, but this is the thing. You have to be topless, you have to be holding up your breasts and someone has to be underneath you sort of looking up to be able to see that incision. Technically, if you’re walking around topless, it’s very difficult to see that incision because you have to remember, you’ve healed up, your breast implants and breast tissue have dropped down slightly in a natural position and it’s very hard to see that incision. So, in terms of your preference, that’s up to you and you have to figure out what’s more important to you or not. So, I hope this answers this question. If you have any other questions, please fire away and let me know. And thanks so much for watching.