Breast Implant -Capsular Contracture Study Presentation —Korea

Ultrasound Study for Breast Capsular Contracture

I do not consider myself to be an “academic” but I do know breast augmentation and the problems with the procedure. Yet in many ways the ones in the trenches of private practice like myself who deal with patients daily contribute useful studies. This is opposed to teaching and preparing journal writing or advancing their academic university career do occasionally come up with a very useful technique which clinically benefits patient care. My breast implant instrument I developed called the Boob-a-rang is an extremely well received instrument simplifies axillary breast augmentation and gives very good results is an example.

Capsular Contracture Lecture Korea 2013

Capsular Contracture Lecture Korea 2013

Therapeutic Ultrasound treats Capsular Breast Implant Contracture

KSAS is  well known South Korean Cosmetic Surgery Society which has held conferences for 27 years in which I became involved in 5- or 6 years ago and have been one of their regular contributors and teachers of breast augmentation. This year  presented my results of a 5 year study using ultrasound (sound waves ) in the treatment of capsular contractual. These were my findings though I am now preparing a manuscript for publication overall I know the result. I feel confident to say that in early capsular contracture complication this is helpful in reversing and preventing progression to a stage 3 problem.

The social side of the meeting

This is a personal blog but I did want to mention the professional aspect of the meeting. Yet many social things and fun things happen at these meetings. Good food and meeting new people sharing ideas of plastic surgery. I enjoy the many lectures from the latest techniques in fillers to hearing what is the hot new treatment in Taiwan or Japan. I enjoy the challenges to my study and the various egos of other “breast experts” yet this time I must say when one obvious local expert challenged me with questions at the end of my talk I found it rather annoying more than stimulating, It was pretty obvious the young doctor was trying to prove his superior knowledge rather than contribute,  to impress the audience. There is always one in every lecture I ever have given or attended.  When I finished my talk he stated that ” the book says massage does not prevent capsular contracture” . Well I said back ” what book?” in which he failed to respond and immediately stated my study did not have enough patients to mean anything. Well since he failed to answer my question, instead just jumped to the old standby about the the study not valid as there were not enough patients (there were 50 in the study) I could see where this was going and just moved on to the next question from someone else.


I became annoyed as I had an earlier incident the day before.

Usually when I come up against a lecture terrorist I engage them and fully bring home my point but in  this case I was frankly too tired to engage. Here is why. Well in my flight over I had eaten the airline food. About two hours after that meal I became very sick and spent most of flight in the bathroom. In fact I became so dehydrated,  my doctor friend sent an ambulance with IV fluids to pick me up at the airport. By the next day at the lecture I was recovered 70 % but still not great so when this guy started with the ego trip at the end of my lecture I just became annoyed rather than debating him…..oh well.

New Friends

Well I did make some new friends at the conference though I missed the social activities as I was sick in my room. I also met some very good peers from China,  who I will meet next month when I give my buttock augmentation  lecture in Hangzhou China.


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Breast Cosmetic Surgery— My Sore Point–doctor808

Having done cosmetic breast surgery for over 25 years I have seen everything at least once.
Yet this one thing about the industry that really gets to me.

Breast Augmentation Before and After Pictures

It has to do with the various before and after pictures. On my web site I just show pictures of before and after or will give complete information. This is not in any particular order nor do I put my best work up there that is all done perfectly with Photoshop , perfect lighting and great models. I just use my patients who sign a release,  some are really outstanding others are run of the mill breast augmentation,  if there is such a thing. Yet you get the idea. I don’t embellish my work so much. I am good at what I do,  I know that , very few of my patients are unhappy,  but like all plastic surgeons I do have a few ( a minority who like flys at a picnic, love to post ehow I am Dr. Evil on the internet) though that is a very small minority.

Day to day “irks”..

Yet what irks me is many surgeons,  when they post their before and after photos carefully describe the size of the implants– “350cc above the muscle”  type of thing. Its not that its wrong and I suppose “above the muscle ” can point to a certain look. Yet the killer to me is the cc’s or how large the fill volume is. Its not just  that, but the fact there is no mention of height and weight or frame of the patient.

In other words,  if you as a patient are looking around to see what you want and there is no indication to the size of the woman , height weight etc and they just indicate how much volume for the implant- what is the use? A 350 cc implant on a 5 foot 100 lb patient will look entirely different on a 5 ft 8 inch 150 lb patient with a large frame.

Firefox 11

So I guess that is what irks me,  is I have to deal with patients expectations that if they show me some case they like from the internet,  it takes a while to explain that 350 cc will not look like that on them for example. This gets into the eye and art of cosmetic surgery,  as I can look at the picture they like and judge looking at them how to give them that look,  as to size and style of implant. Yet some patients fixate on the idea that since that is the look they want then they must have 350 cc !! There is no convincing them otherwise.

Well I don’t blame the patient as they come to me for advice and my opinion,  I really blame the knucklehead doctors who either leave off essential data. If they don’t have a data like height and weight as the picture below ,  then that is perfectly fine as well.  Maybe I am being a stubborn person,  but almost by definition that is what is a  “pet peeve”.

Firefox 10So a message to my peers, please make my life easier by either just showing the picture just the look  or showing a picture with complete information not just the implant size.

As I said this is a personal blog not so much a professional journal , so before any other surgeons start to fire shots at me for saying this, consider its half tongue in cheek. Today I had such patient, finally I convinced her that the 500 cc implant may have looked small on the woman whose picture she had in hand , but on her it would look huge.




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Next Week off to Korea again for lecture and teaching —– Breast Augmentation Prevent capsular contracture my technique

Breast Augmentation Lecture

Breast Augmentation Lecture

Next week on October 4th I leave back to Seoul South Korea, last time I was there the North Korean dictator was trying to terrify the South,  but the South Koreans simply ignored him like one would do a spoiled child and he went away.

This trip will be a short one where I will give my lecture to the KSAS (Korean Society Of Aesthetic Surgery) once again on the topic regarding breast augmentation and return. Usually I am asked to speak on breast or buttock augmentation. This year I am going to still speak on breast augmentation,  but not directly.  My talk is on a study I have done over the last 8 years or so regarding the prevention and treatment of one stubborn complication of breast implants that being capsular contracture.

Surgically removed breast implant capsule that was thick and made the breast hard

Surgically removed breast implant capsule that was thick and made the breast hard

Capsular contracture is a common enough complication that most plastic surgeons dread when it happens. What this is , is when the normal healing process forms a thickened scar tissue around the breast implant. Its really a normal process and everyone has some capsule form around the foreign body ( the implant) and in fact usually it is a good thing. However when it becomes so thick that the breast become hard and even uncomfortable for the patient then its a complication.  This also can make the breast implanted breast appear unnatural appearing like disk on the chest wall.

The problem is no one knows how to control  how much or really how thick the capsule becomes,  though we have some general ideas and everything has been tried, sometimes it just happens. This is not my sole opinion but 99.9 % of all plastic surgeons basically agree.

So what I have been doing is the standard things , but I have also added sound waves through ultrasound to reduce inflammation and edema which occurs after any surgery. This I also believe has some direct impact on the tissue structure as the healing progress proceeds. Maybe its hokus pokus , BUT it does appear to work according to  my data.

Better yet , for early formation,  meaning that in our early post op visits if we notice a woman;s breast implants starting to get firm— We put them in intensive ultrasound therapy and massage. In fact in bad cases I will do the massage myself, as not only am I good and strong I want to learn and have a good “feel” for what is going on ( sorry about the joke) yet I am very serious in that I learn that patients breast and I feel I can then make a judgement as to if we are heading in the right direction or not. Ultrasound and the massage will help perhaps 70% of the cases so my patient will not need further surgery.

My nursing staff is excellent for ultrasound treatments, yet if a patient looks like they are going to be a difficult case I get personally involved as I really despise capsular contracture and I know my patients who have this happen despise it even more. My patients deserve me personally involved if they are having any issue.

Finally overall in my practice i have been able to reduce any requirement for any surgery to correct this so I am grateful for that knowing we are always improving. If you have this problem please give me a call and we can work with you to solve this pesky issue.

Doctor 808







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