FAQs GALLERY

A breast hematoma usually occurs immediately after surgery and is associated with inadequate internal hemostasis. If the amount of bleeding is small, the body may absorb it naturally. If the amount of bleeding is large, the body may not be able to absorb it quickly enough, resulting in a hematoma. This complication requires monitoring during the early postoperative period, particularly when the breast area shows unusual swelling and pain or does not improve over time.

Postoperative infection usually occurs between the third and seventh day after surgery, although in some cases it may be detected later. Signs may include loss of appetite, bland taste in the mouth, fever, breast pain, redness, or swelling. If antibiotics fail to control the infection, the patient may need revision surgery for surgical washout, debridement of infected tissue, fluid drainage, and breast implant explantation.

The risk of infection may arise from an operating room that does not meet sterile standards, surgical instruments that are not properly sterilized, or doctors and technicians failing to comply with aseptic protocols such as hand scrubbing, changing gloves, wearing sterile gowns, handling instruments during surgery, or performing surgical site antisepsis incorrectly. Choosing a specialized general hospital and a safe surgical facility is an important factor.

Mild to moderate tightness during the first 3–5 days after surgery that gradually decreases may be a natural inflammatory response of the body. However, if the pain and tightness persist, progressively worsen over time, or are accompanied by swelling, skin redness, fever, chills, or abnormal breast firmness, patients should visit a specialized medical facility for examination, testing, and monitoring. These signs should not be considered a normal postoperative response without a doctor’s assessment.

After breast augmentation, the result cannot be accurately evaluated immediately after surgery because this only represents the initial success. To achieve the desired breast shape, the breasts need 3–6 months to remodel and for the body to adapt to the new changes. Magnetic resonance imaging with a dedicated breast coil helps diagnose breast gland conditions, breast implant-related conditions, the condition of the breast implants, capsular contracture, the implant capsule/pocket, breast cancer, and other breast abnormalities. This method is also suitable for women at high risk of breast cancer, those with a family history of breast cancer, or those with inherited breast cancer gene mutations.

Patients who undergo breast augmentation surgery need clinical examinations at 1 month and 6 months after surgery. Three years after surgery, imaging examinations such as ultrasound, X-ray, or preferably breast MRI should be performed, and then repeated every 2 years. In addition to these scheduled time points, patients who have undergone breast augmentation may seek examination and consult the doctor in charge at any time if they experience abnormal signs in the breast area.

Before breast implant removal or capsulectomy, specialized breast MRI helps assess the condition of the breast glands, breast implants, implant pocket, fibrous capsule, breast implant-related conditions, and tumors. The doctor then combines the imaging findings with a clinical examination to evaluate abnormalities inside and outside the implant pocket, determine whether there is implant rupture, capsular contracture, a tumor, or related lesions, and thereby select the appropriate surgical approach. At the same time, there is also a view that conventional MRI, ultrasound, or X-ray is not as effective as specialized breast MRI in patients with breast implants and breast implant rupture.

After breast implants are placed, the body forms a layer of fibrous tissue around the implants, also known as the pocket. Normally, this tissue layer is soft, blends with the surrounding tissues, and is difficult to feel. In cases of capsular contracture, this tissue layer thickens and forms firm fibrous bands around the breast implants. Depending on the severity, this condition may cause one or both breasts to become firm, painful, contracted, deformed, or asymmetrical.

Capsular contracture may cause the breast mound to become indented or bulge in a particular area, differences in breast projection, uneven levels of the inframammary folds, and a widened and uneven cleavage. In severe cases, capsular contracture may distort the shape of the entire breast. With grade 3 and grade 4 capsular contracture, the breasts may remain firm in both standing and lying positions, become deformed, develop contracture in different areas, and cause dull pain or continuous discomfort.

Capsular contracture is divided into 4 grades. Grade 1: the breasts remain soft and appear normal, with the capsule feeling slightly firm on palpation in the supine position. Grade 2: the breasts appear normal, without swelling, pain, or deformity, but feel firmer than usual on palpation, particularly in the supine position. Grade 3: the breasts are firm and change in shape due to contracture, with possible continuous dull pain and deformity of the breast mound. Grade 4: the breast mound is distorted, displaced, and asymmetrical, with marked capsular firmness and contracture causing continuous discomfort and pain.

Grade 1 and grade 2 capsular contracture are difficult to recognize because the breasts may still feel soft or appear normal, without obvious swelling, pain, or deformity. In some cases, the breasts only feel firmer than usual on palpation, particularly in the supine position. In contrast, grade 3 and grade 4 capsular contracture are usually easier to identify clinically because the breasts are firm, painful, deformed, contracted, or asymmetrical.

Capsular contracture can occur at any time after breast augmentation. The fibrous capsule may form early during the first 3–6 months, which is the period when internal scar tissue forms and becomes organized. Because grade 1 and grade 2 capsular contracture are difficult to recognize, many cases are not detected early and may progress to grade 3 or grade 4 over time.

During the first 3 months after surgery, signs that should be monitored include severe pain, persistent pain, severe and prolonged swelling and bruising, abnormally enlarged or uneven breast size, localized infection, persistent pain, fluid accumulation, red and inflamed incisions, fluid discharge, fatigue, loss of appetite, mild fever, or high fever. If antibiotics must be used for more than 2 weeks or the breasts do not become softer over time, the healing process and any abnormalities should be monitored more closely and discussed with the surgeon. Capsulectomy should not be performed during this period because the internal wounds have not yet healed.

During the 3–6-month period, grade 1 and grade 2 capsular contracture are very difficult to recognize. When palpating the lower, medial, and lateral areas of the breasts in both standing and lying positions, patients should pay attention if they feel firmness at certain points. After 6 months, the pocket has become more stable. Patients who have undergone breast augmentation can self-check the symmetry of the upper and lower poles, the medial and lateral poles, the nipples on both sides, changes in breast softness over time, other abnormalities, and monitor the development of capsular contracture, if present.

Possible causes include an implant pocket that is too narrow for the implant size, selecting breast implants that are too large for the anatomical structure, incorrect design of the implant pocket dimensions by the surgeon, or a pocket that does not match the structure of the chest wall. When the implant is not evenly positioned within the pocket and is compressed by muscle and fibrous tissue, it may be subjected to pressure and contracture, increasing the risk of capsular contracture. In addition, injury during pocket creation, traumatic surgical manipulation, severe postoperative pain, hematoma, excessive fluid secretion, and delayed wound healing have also been mentioned as factors associated with late complications such as capsular contracture.

When the implant pocket is narrow relative to the size of the breast implant, the implant cannot spread evenly within the pocket and may be compressed by the muscle and internal fibrous tissues. Over time, folds in the implant shell at the compressed points may deteriorate more rapidly, increasing the risk of early breast implant rupture. Breast implants are usually placed beneath the pectoralis major muscle or between two pectoral muscle planes. During surgery, muscle relaxants cause the muscles to relax completely. If the pocket is created to fit the implant size only while the muscle is relaxed, the muscle may tighten again after emergence from anesthesia, causing the pocket to become narrower than the implant.

The implant pocket must be large enough for the implant to spread evenly. If the pocket is not sufficiently wide, the implant may fold, become trapped in areas that have not been adequately released, or be subjected to uneven pressure from the internal muscle and fibrous tissues. In some cases, insufficient pocket space at the lateral border, inferolateral pole, or medial border prevents the implant from lying in the correct position. When pressure within the pocket is uneven, the implant may fold, become compressed, and have a reduced lifespan over time.

A narrow or inadequately created implant pocket may be associated with early breast implant rupture. When the implant does not spread evenly within the pocket, folds in the implant shell at the compressed points may deteriorate more rapidly. An insufficient pocket, an excessively large implant, incorrect implant positioning, unreleased pressure from the pectoral muscle, or capsular contracture may all increase the risk of early implant rupture. Some cases of early implant rupture have been reported in patients with a short breast base. The implant pocket is often created more widely at the upper pole, causing most of the implant to shift toward the upper pole and be subjected to pressure from the pectoralis major muscle, especially when lying down, moving, or exercising.

Capsulectomy is considered in cases of severe capsular contracture, firm and painful breasts, deformity, contracture, or changes affecting the shape of the breast mound. In these cases, the doctor may indicate implant removal, total or partial capsulectomy, cleaning of the implant pocket, collection of fibrous tissue for histopathological examination, and assessment of whether new implants should be placed. In cases of a double capsule or difficult dissection, the surgical time may be longer because the doctor needs to reconstruct a new implant pocket.

Before capsulectomy, patients need to undergo specialized breast MRI to assess breast gland conditions, the fibrous capsule, the implant pocket, breast implant-related conditions, and tumors. The doctor then combines the imaging findings with a clinical examination to evaluate the condition of the fibrous capsule and abnormalities inside and outside the implant pocket, thereby selecting the appropriate surgical method. Specialized breast MRI plays an important role in patients with breast implants, suspected implant rupture, or abnormalities related to breast implants.

During surgery, if there are no abnormalities, the doctor may make an incision of approximately 3–3.5 cm at the periareolar area or inframammary fold, use an ultrasonic surgical scalpel to dissect through the tissues, remove the old breast implants, and check the implant brand, dimensions, size, and projection. The doctor then uses an ultrasonic surgical scalpel to remove the fibrous capsule and sends the fibrous tissue for histopathological examination to determine whether it is benign or malignant. If malignancy is suspected, a frozen section biopsy should be prepared. In cases where new implants are indicated, the doctor will reconstruct the implant pocket.

The placement of new implants after capsulectomy must follow the doctor’s indication. If there are abnormalities within the pocket, tumors, severe capsular contracture, implant rupture, or associated lesions, the doctor needs to conduct a thorough assessment before deciding whether new implants can be placed. If new implants are placed, the doctor needs to assess the width or narrowness of the existing pocket, determine whether an overly wide pocket requires suturing or an insufficient pocket requires reconstruction, and examine the dimensions and projection of the previous implants, the condition of the pocket after implant removal, and the current structure of the rib cage.

In cases involving capsulectomy, reconstruction of the implant pocket, implant rupture, or abnormal internal lesions, the duration of anesthesia may be longer than that of a standard implant removal procedure. Cases of implant removal involving abnormalities, such as capsulectomy or extensive internal tissue damage, may require drainage and an overnight hospital stay.

Pseudo-capsular contracture is a condition in which the breasts become firm after breast augmentation, but the cause differs from true capsular contracture. Patients who have undergone breast augmentation may feel firmness when palpating the breasts in both standing and lying positions, which can easily be mistaken for capsular contracture if the underlying cause is not properly examined and assessed. Pseudo-capsular contracture is commonly associated with inappropriate breast implant selection or incorrect creation of the implant pocket. This condition may occur early after surgery, causing the implant to become constricted and compressed within the pocket and preventing the breasts from becoming softer over time.

The main causes of pseudo-capsular contracture are inappropriate breast implant selection and incorrect creation of the implant pocket. The implant may be unsuitable in terms of diameter, projection, gel firmness, softness, or pressure within the pocket. In patients with abnormal anatomical structures such as a convex, concave, or uneven chest wall; thin skin; limited glandular tissue; or excessively thin tissue coverage over the implant, selecting an unsuitable implant may cause implant visibility, firmness, or palpable rippling around the edges of the pocket. If the implant pocket has a smaller diameter than the implant, is excessively large relative to the implant, or is created in an incorrect position, the implant cannot spread evenly across the upper, lower, medial, and lateral poles and may be subjected to pressure. This is one of the causes of pseudo-capsular contracture immediately after surgery.

Signs of pseudo-capsular contracture include breast firmness immediately after surgery, breasts that do not become softer over time, breasts that feel firmer than before implant placement, or implants that feel constricted and compressed. In standard breast implant placement cases, implant softness and breast shape will change during the first 6 months. If the breasts do not become softer after 6 months, patients should consult a specialist in breast diseases and aesthetic breast surgery for examination and assessment. Some signs of inappropriate implant positioning include the implant being located mostly above the nipple, implant bottoming out, pseudo-symmastia, lateral displacement toward the axilla, or the nipple not being positioned at the center of the breast mound.

If prolonged, both pseudo-capsular contracture and capsular contracture may lead to early breast implant rupture at implant folds that have deteriorated due to pressure within the pocket. An unsuitable implant or an incorrectly created implant pocket may also affect aesthetics and sensation, causing breast firmness, implant movement within the pocket, implant flipping, or implant malposition. In some cases, when the breast glandular tissue has become fibrotic and firm due to individual predisposition, breastfeeding, or frequent breast pumping, implant placement may not improve the softness of the existing tissue.

To minimize pseudo-capsular contracture, the implant size should be selected appropriately for the anatomical structure. Implants that are excessively large, have excessive projection, or are insufficiently soft should be avoided in patients with abnormal anatomical structures. The implant pocket creation technique must also be precise, avoiding a pocket that is too small, too large, or incorrectly positioned. The point dissection technique using a new-generation ultrasonic surgical scalpel helps the surgeon visualize the tissues requiring dissection, minimize bleeding, tissue trauma, excessive fluid secretion, and difficulties in pocket reconstruction, thereby helping reduce the risk of pseudo-capsular contracture compared with blunt dissection using the hands and a conventional electrosurgical device.

Breast implant rupture, particularly the rupture of gel implants, is often difficult to detect immediately because most cases do not present clear symptoms, which is also known as silent implant rupture. With gel implants, even when the implant shell is torn, the implant may retain its shape, making it difficult for patients to recognize the rupture immediately. MRI using a dedicated breast coil is a method that helps detect whether an implant has ruptured.

Some signs of breast implant rupture include breast pain, marked swelling, abnormal deflation, changes in breast shape, reduced breast size, uneven breast appearance, pain, or tightness. With saline implants, the breast may deflate rapidly when the implant ruptures, making the condition easier to detect. With gel implants, rupture is more difficult to recognize immediately because the gel has a stable structure and does not visibly leak outside the implant during the early stage.

Breast implant rupture may occur within the first 1–3 months, when the “protective capsule” has not yet fully formed. The cause may be damage to the implant during surgery. Implant rupture may also occur after the breast has developed a stable pocket and is commonly associated with saline implants or implants from brands that have not received long-term safety certification from scientific and medical organizations. In addition, implants may rupture due to deterioration after more than 10 years, folding caused by an insufficient implant pocket, pressure on the implant from capsular contracture, or traumatic surgical manipulation that damages the implant shell.

Early breast implant rupture may be associated with the placement of implants that are too large for the body’s anatomical structure, an inadequately created implant pocket, the implant being unable to spread evenly within the pocket, or adjustment of the pocket after the implant has already been inserted, causing mechanical damage to the implant. When implants are placed through an inframammary or periareolar incision, an incision that is too small for an implant with a large diameter and high projection may damage the implant during insertion, reducing its lifespan over time. Some cases of early implant rupture are associated with an insufficient pocket, incorrect implant positioning, unreleased pressure from the pectoral muscle, capsular contracture, or a short breast base. When the implant is subjected to uneven pressure, areas of the implant shell that become folded may deteriorate more rapidly and increase the risk of implant damage.

When implant rupture is suspected, patients who have undergone breast augmentation need to undergo specialized breast MRI to assess the breast glands, breast implants, fibrous capsule, implant pocket, and related abnormalities. If the implant has ruptured or abnormal fluid is present, the implant pocket must be cleaned during surgery, and the fluid should be cultured with antibiotic susceptibility testing if it appears cloudy. Some cases of breast implant rupture involving abnormalities within the pocket, tumors, capsular contracture, or associated lesions require careful assessment before deciding whether new implants can be placed.

Symmastia is a complication after breast augmentation in which the natural space between the two breasts is lost, the medial borders of both breasts are pushed close together, and the sternum in the center is covered. This condition can be identified through imaging or clinical examination; when looking downward, the two breasts may clearly appear to merge into each other. This complication may occur early after implant placement and, if prolonged, may affect aesthetics and become more difficult to correct.

Causes of symmastia after breast augmentation include creating the implant pockets too widely toward the sternum to position the two implants close together, insufficient pocket space laterally, excessive division of the muscle medially, implants with a volume that is too large for the created pockets, incorrect anatomical indications, or wearing the postoperative support bra incorrectly during the first 6–8 weeks. Patients with a sunken chest structure have a higher risk of symmastia if the pockets are created too close together to produce cleavage or are too wide relative to the implants, causing the implants to exert pressure on the medial poles and leading to symmastia over time.

Implant bottoming out is a condition in which the breast implant shifts below the inframammary fold or lies below the nipple. Signs may include nipples that are abnormally high or point upward, increasing flattening of the upper breast pole, greater fullness of the lower pole, and a lower pole that is longer than the upper pole, causing breast asymmetry. Some cases are only noticed when the breasts descend significantly toward the abdomen and may easily be mistaken for breast ptosis if they have not been monitored since implant placement.

Breast implants may bottom out or become malpositioned due to the placement of large implants that exert pressure on the lower pole, inaccurate pocket creation techniques, placement in the incorrect tissue plane, or improper formation of the lower pole of the implant pocket. When the pocket is incorrectly positioned or unsuitable for the implant, most of the implant may lie above the nipple, below the nipple, toward the medial pole, or toward the lateral pole, or the nipple may not be located at the center of the breast mound. These are signs that the implant position and implant pocket need to be reassessed by a doctor.

Patients who have had textured breast implants for more than 5 years, particularly Allergan implants, textured implants manufactured using the salt-loss technique, implants of unknown origin, or implants that have not received safety certification from scientific and medical organizations, need to have their breast gland conditions, implant condition, implant pocket, and breast implant-related conditions evaluated. The evaluation should combine clinical examination and specialized breast MRI, especially when there are abnormal signs in the breast area.

BIA-ALCL is a rare type of cancer associated with breast implants, but it is not breast cancer; it is a cancer of the immune system. In addition to BIA-ALCL, FDA warnings also mention squamous cell carcinoma and other lymphomas occurring in the scar tissue or fibrous capsule that forms around breast implants. If clinical examination and specialized breast MRI reveal an abnormal lesion suspected to be ALCL, immediate breast implant removal is indicated. If MRI shows no abnormalities, periodic monitoring is recommended.

Based on multiple saline implant removal cases, calcification of the breast implant shell may be observed. In some cases, breast deformity and grade 3–4 capsular contracture are detected during saline implant removal. Patients with saline implants should undergo specialized breast MRI, seek medical examination when abnormalities occur, and receive periodic monitoring.

In some cases, breast implants remain intact after more than 20 years, without rupture or capsular contracture. This outcome is related to implant quality, implant placement technique, pocket creation technique, surgical manipulation, and postoperative monitoring after breast augmentation. When the implant pocket is created correctly, the implant is not subjected to abnormal compression, the pocket remains stable, and severe capsular contracture does not develop, the risk of complications may be lower over time.

Pocket creation technique directly affects implant position, pressure within the pocket, and implant durability after many years. If the pocket is sufficiently wide, the implant has enough space to spread evenly and is not subjected to abnormal compression. If the pocket is narrow or uneven, the implant may fold, be subjected to prolonged pressure, deteriorate more rapidly at the folds, and have an increased risk of rupture. In some cases, despite the same duration of implant placement, the same implant size, and the same surgical method, the implant on one side remains intact while the implant on the other side ruptures or develops capsular contracture. This difference may be related to unequal pocket creation on the two sides: one pocket may be sufficiently wide, while the other may be narrow and exert pressure on the implant. With saline implants, valve leakage, implant flipping within the pocket, or a narrow pocket at the lower pole or lateral border may also occur, requiring pocket correction when new implants are placed.

Not all breast implants that have been in place for many years necessarily need to be replaced. The important factors are periodic examinations and assessment of the condition of the implants, breast glands, implant pocket, fibrous capsule, implant brand, implant type, duration of implant placement, and any abnormal signs. For textured implants, implants of unknown origin, saline implants, ruptured implants, capsular contracture, implant bottoming out, symmastia, implant visibility, or implants that are too large for the body, patients need to be examined by a doctor and advised on the suitable management approach.

The Harmonic, InnoLcon, LigaSure, and Enseal ultrasonic surgical scalpels can be used in breast augmentation and breast implant removal surgery. In breast augmentation, the first step may involve using a conventional scalpel to make a skin incision at the areola or inframammary fold; the next step involves using the monopolar Harmonic or InnoLcon ultrasonic surgical scalpel to create the implant pocket and cut tissue and glandular tissue. The bipolar LigaSure or Enseal ultrasonic surgical scalpel plays an important role in cutting the muscle to create the pocket. The ultrasonic surgical scalpel operates through a coagulation–sealing–cutting mechanism, helping to cut and seal tissue simultaneously, control bleeding, limit fluid secretion, and support precise dissection during pocket creation.

The ultrasonic surgical scalpel supports hemostasis, limits tissue damage, reduces tissue trauma, reduces fluid secretion, and creates a clean and dry surgical field. When the surgical field has less bleeding and less fluid secretion, the doctor can observe the tissue more clearly during dissection and implant pocket creation. In breast augmentation, the new-generation ultrasonic surgical scalpel also supports the precise point dissection technique, helping the doctor dissect and release tissue and better control the implant pocket. By limiting bleeding, fluid secretion, and tissue damage, the postoperative recovery process may be faster, postoperative pain may be reduced, patients may be discharged on the same day, and the additional use of pain medication or antibiotics after surgery may be limited in standard breast augmentation cases. The new-generation ultrasonic surgical scalpel is applied in breast augmentation surgery, breast implant removal, management of capsular contracture, management of implant rupture, and reconstruction of the implant pocket.

The process of breast augmentation using blunt dissection combined with hemostasis using an electrosurgical device can easily lead to a high risk of bleeding, tissue damage and fibrosis, excessive fluid secretion within the breast pocket, and may require postoperative drainage. Meanwhile, the new-generation Ultrasonic Surgical Scalpel operates through a coagulation–sealing–cutting mechanism, using ultrasonic waves and an automatic warning system to generate stable heat, control bleeding, limit fluid secretion, reduce thermal spread, reduce tissue damage, and support the postoperative healing process.

If the doctor does not have extensive experience in using the ultrasonic surgical scalpel, the ultrasonic waves may cause the tissue temperature to rise, resulting in damage to or death of fibroblasts. High temperatures may also damage fat cells, leading to fat necrosis. The use of the ultrasonic surgical scalpel requires the doctor to have professional expertise, receive thorough training, complete a sufficient number of directly performed cases, and overcome the “learning curve” to use it proficiently.

The implant pocket needs to be suitable for the implant size and chest structure. If the implant pocket is narrow compared with the implant size, the breast implant cannot spread evenly within the pocket and is compressed by the muscle and internal fibrous tissues. In this situation, folds in the implant shell at the compressed points may age more rapidly over time, increasing the risk of early breast implant rupture. The implant is usually placed beneath the pectoralis major muscle or between two pectoral muscle planes using the dual-plane technique. During surgery, muscle relaxants are used to allow the muscle to relax completely. If the pocket is created to be just sufficient for the implant size, after emergence from anesthesia, the muscle tightens again and the pocket may become narrow compared with the implant size if the doctor does not have sufficient experience in assessment.

Point dissection is a technique used to dissect and release tissue and create the implant pocket under direct observation with the naked eye or through an endoscopic monitor system. When combined with the Harmonic, InnoLcon, or new-generation Ultrasonic Surgical Scalpel, this technique helps control hemostasis, limit fluid secretion, and create the implant pocket more accurately. Point dissection is considered a minimally invasive method that supports the creation of an implant pocket with the correct size and shape, thereby reducing the risk of complications.

Shaping the incision, creating a suitable implant pocket, and performing point dissection using a new-generation ultrasonic surgical scalpel are important factors in helping the breasts remain naturally soft and durable after augmentation. This technique helps the doctor control hemostasis, limit fluid secretion almost completely, and achieve high accuracy during the implant pocket creation process. When the pocket is created with the correct dimensions, the breast implant has space to spread evenly, limiting compression, folding, movement within the pocket, or uneven pressure within the implant pocket.

Point dissection is performed under direct observation with the naked eye or through an endoscopic monitor, combined with an ultrasonic surgical scalpel to dissect, release tissue, and control bleeding. This technique helps create the pocket more easily, especially in areas where a change of plane or shaping of the lower pole of the breast is required. Blunt dissection uses instruments to dissect the pocket but does not provide uniform control of the dissection plane in the lateral border and inferolateral pole areas. The muscle may not be cut precisely around the implant border and can easily be damaged by the instruments, causing bleeding, excessive fluid accumulation, and the formation of fibrotic bands.

With the blunt dissection method in breast augmentation, the muscle is almost never cut precisely at the border surrounding the implant. The muscle may be torn or damaged by the instruments and only temporarily stretched. The surgical process may cause bleeding and excessive fluid accumulation that the body cannot completely absorb, affecting the formation of the pocket and creating fibrotic bands. Blood may collect in the lower areas of the pocket, forming hematomas and blood clots. After the organization process, these areas may not be completely absorbed, creating fibrotic areas and fibrotic bands that cause localized contracture, pull on adjacent areas, narrow the implant pocket, and compress the implant. There is always pressure within the implant pocket. Blood and fluid that remain accumulated for a prolonged period may form streaks along the direction of the applied force and, over time, develop into contracting fibrotic bands and folds. An electrosurgical device that does not provide adequate control of heat may also create prolonged fibrotic tissue during the healing process, causing contracture.

Dual Plane is a technique that places the breast implant between two pectoral muscle planes. This technique helps reposition the lower pole of the breast, allowing the implant to spread evenly to create a round and soft breast mound. Breast implants that are almost completely covered by muscle will not look natural. Because each person has different pectoral muscle coverage in terms of thickness, thinness, length, and shortness, the doctor needs to assess the anatomical structure and select the appropriate Dual Plane technique.

There are 3 Dual Plane techniques. Dual Plane I is suitable for patients with flat breasts and limited breast tissue and glandular tissue. The breast implant lies in two planes, with approximately 2/3 of the implant covered by the muscle in the upper part, while the doctor uses an ultrasonic surgical scalpel to cut slightly more than 1/3 of the muscle so that the implant lies at the lower pole in the predetermined position. Dual Plane II is suitable for patients who want to improve breast shape and size and correct grade 1 or grade 2 breast ptosis. Approximately 65% of the upper part of the breast implant is covered by muscle, while 35% of the lower part is covered by glandular tissue. Dual Plane III releases the breast tissue higher, up to the level of the nipple, allowing the breast implant to spread more widely across the lower part of the breast. Approximately 50% of the upper part of the implant is covered by muscle, while 50% of the lower part is covered by glandular tissue.

Whether Dual Plane I, II, or III is used depends on the indication of the doctor performing the surgery and is not selected by the patients themselves. Each patient has a different condition, so the doctor needs to examine the patient and indicate the appropriate implant volume, implant shape, incision location, surgical method, and Dual Plane technique.

Harmo-5K is a method that uses a new-generation ultrasonic surgical scalpel combined with the point dissection technique during tissue dissection and release. The dissection process is performed under direct observation with the naked eye or through an endoscopic monitor system, helping control hemostasis, limit fluid secretion, and achieve high accuracy when creating the implant pocket. Harmo-5K aims to meet the following criteria: limiting pain, bleeding, and fluid discharge, with no need to take medication or undergo a recovery period.

After more than 10 years of applying the ultrasonic surgical scalpel in breast augmentation, breast implant removal and replacement, and abdominoplasty, in 2021, Dr Ho Cao Vu submitted an application for exclusive ownership of the “Harmo 5K” trademark. On January 25, 2024, the Harmo 5K trademark was granted a notice of exclusive trademark ownership.

In breast augmentation, Harmo-5K uses an ultrasonic surgical scalpel combined with the point dissection technique to dissect and release tissue, control bleeding, and create the implant pocket. This method helps control hemostasis, limit fluid secretion almost completely, and create the implant pocket with high accuracy. After surgery, wound healing and fibrous tissue organization occur rapidly, limiting complications, with no need to take painkillers or antibiotics after surgery.

Breast implants need to have safety certification from reputable scientific and medical organizations, with implant shells made from medical-grade elastomer and tested for durability, recovery capacity, and elasticity. The safety and effectiveness of the implants need to be demonstrated through medical-standard scientific studies, with patients followed for at least 10 years. In addition to implant quality, the doctor needs to examine the condition of the breasts, listen to the patients’ wishes, and choose an option suitable for each breast shape, glandular tissue, chest structure, and skin elasticity.

Each person has a different anatomical structure, so the implant size needs to be suitable for the breast glandular tissue, chest frame, skin elasticity, and implant pocket. If an implant that is too large for the body structure is selected, the implant may be constricted within the pocket, create pressure on the implant, and make the breasts firm immediately after surgery. Placing an implant that is too large into a narrow pocket is similar to overinflating a balloon with a fixed volume: when touched, there will be resistance and a firm sensation. Over time, the constriction of the implant may lead to pseudo-capsular contracture, capsular contracture, or implant rupture at the folds due to compression of the implant.

Choosing an unsuitable implant size may lead to symmastia, implant bottoming out, pseudo-capsular contracture, capsular contracture, or early implant rupture. For symmastia, the risk increases when the implant is too large, the implant pocket is created too close to the medial pole, or the pocket is too wide compared with the implant. Patients with a sunken chest have a higher risk of symmastia if cleavage is created by making the pockets too close together. With implant bottoming out, the implant may shift below the inframammary fold or lie below the nipple. Signs include abnormally high nipples, a flattened upper breast pole, a fuller lower pole, and a lower pole that is longer than the upper pole. With pseudo-capsular contracture or capsular contracture, the implant is constricted within the pocket, creating pressure on the implant and causing the breasts to become firm immediately after surgery or gradually become firmer over time.

Softness after implant placement usually becomes stable after more than 6 months, when the internal tissues have completely stabilized. During the first month, the factors that need to be monitored include even inframammary folds, dry incisions, good wound healing, and no risk of immediate postoperative complications. From 2–3 months, the implants settle into the lower poles, become balanced in the upper–lower and medial–lateral directions, and the breasts gradually become softer each month. From the fourth to the sixth month, the tissues stabilize and the breasts take shape. After 6–12 months, the bust reaches a stable level of softness and remains almost unchanged.

Softness after breast augmentation depends on the surgical method, pocket creation technique, breast implant brand, the softness and elasticity of the skin, soft tissue around the pocket, adipose connective tissue, breast glandular tissue, and the fascial tissue of the pectoralis major muscle. After formation, the pocket needs to be soft, elastic, and expand uniformly with the implant. The pocket size needs to correspond to the implant volume: a pocket that is too narrow may cause implant firmness due to pseudo-capsular contracture, while a pocket that is too wide may cause the implant to lie in the wrong position, move, or flip within the pocket. The implant material, implant shell thickness, internal gel, and projection also affect the sensation of softness after implant placement.

If the breasts gradually become softer each month during the first 6 months, there is not necessarily a need for concern. However, if the breasts are firm immediately after surgery, do not become softer over time, are firmer than before, or remain firm after 6 months, patients need to visit a specialist in breast diseases and breast aesthetics for examination and assessment. After removing the postoperative support bra, patients also need to monitor the softness of the breast mound to detect abnormalities or late complications such as pseudo-capsular contracture and capsular contracture.

After surgery using an ultrasonic surgical scalpel, patients may not need to use additional painkillers or antibiotics. In some special cases, the doctor may prescribe antibiotics for 1–3 days. This applies in the context of a clean surgical procedure, with limited internal damage to the breast pocket, minimal bleeding, minimal fluid discharge, and limited damage to the tissues, glands, and muscles. Whether antibiotics are used still needs to be based on the doctor’s indication and the specific condition of each case.

Some cases may still require antibiotics after breast augmentation, such as foreign patients experiencing a change in living environment and whose bodies have not yet adapted; patients returning home on the same day; patients who need to move frequently after surgery; or when the surrounding environment does not ensure hygiene. In such cases, the doctor may prescribe antibiotics for up to 3 days to ensure that the incision does not become infected. Prophylactic antibiotics in surgery should be administered approximately 30 minutes before the skin incision to achieve an appropriate concentration in the tissues.

Scarring after breast augmentation depends on the incision site, individual predisposition, surgical technique, wound care, and the healing process. Some causes of poor scarring include an unsuitable incision, extensive tissue damage, tension on the skin, improper postoperative care, a predisposition to scar formation, or an unfavorable healing process. Choosing the incision site, performing gentle surgical manipulation, controlling the tissues well, and caring for the wound after surgery according to instructions are factors that help limit scarring.

After the wound is closed, patients may receive preventive scar treatment according to a specialist protocol to help the postoperative scar appear more aesthetically acceptable. In addition, factors such as limiting tissue damage, bleeding, and fluid discharge, promoting rapid wound healing, and following postoperative care instructions also help reduce the risk of poor scarring.

Cases in which breast implant removal should be considered include breast implants placed for more than 5 years, especially textured implants; implant rupture; capsular contracture; implant bottoming out; implant firmness; saline implants; symmastia; implant visibility; implants shifting toward the scapula; breast implants that are too large for the body; or a risk of breast implant-related conditions. Breast implant removal is a surgery that requires general anesthesia, so it needs to be performed by a doctor with expertise in breast diseases and aesthetics, at an appropriate medical facility, after the condition of the implants, breast glands, pocket, fibrous capsule, and associated abnormalities has been assessed.

Patients who have had implants for more than 5 years need to check the implant warranty card, brand, implant material (textured implants, gel implants), implant size including diameter and projection, and warranty period. At the same time, the type of implant currently being used needs to be clearly identified, with particular attention paid to implant lines such as Allergan implants, textured implants manufactured using the salt-loss technique, implants of unknown origin, or implants that have not received safety certification from scientific and medical organizations. In addition, it is necessary to check whether the implants are included on lists requiring removal or special monitoring issued by reputable scientific and medical organizations. Before surgery, patients need to undergo specialized breast MRI to check the breast glands, the condition of the implants such as implant folding or implant rupture, abnormal thickness or thinness of the pocket, breast implant-related conditions, and suspicious lesions. If abnormal fibrous tissue is present, cytological or histopathological testing may be required.

The breast implant removal procedure includes undergoing specialized breast MRI to check the breast glands, breast implants, pocket, and breast implant-related conditions; screening for cancer risks and implant-related lesions; undergoing a clinical examination to plan the surgery, manage associated complications such as capsular contracture, implant rupture, implant bottoming out, and symmastia, and determine whether new implants should be placed; and undergoing preoperative tests at a specialized general hospital. During surgery, if there are no abnormalities, the doctor makes a skin incision of approximately 3–3.5 cm at the periareolar area or inframammary fold, uses an ultrasonic surgical scalpel to cut through the tissue, removes the old breast implants, and checks the brand, dimensions, implant size, and projection. For ruptured implants or abnormal fluid, the surgical team cleans the pocket, cultures the fluid, and performs antibiotic susceptibility testing when the fluid is cloudy.

A standard breast implant removal procedure lasts approximately 30–45 minutes. For difficult cases such as capsulectomy, reconstruction of the implant pocket, implant rupture, or abnormal internal lesions, the duration of anesthesia will be longer. Patients undergoing standard implant removal and replacement may return home on the same day. Patients undergoing implant removal with abnormalities such as capsulectomy or extensive internal lesions may require drainage and an overnight hospital stay. For suitable cases using a new-generation ultrasonic surgical scalpel, patients may be discharged after 8–10 hours in accordance with the general hospital’s regulations.

The placement of new implants after implant removal needs to follow the doctor’s indication. In cases involving the removal of ruptured implants, abnormalities within the pocket, tumors, capsular contracture, or associated lesions, the doctor needs to assess the condition before making a decision. In some cases involving the removal of ruptured implants with abnormalities, new implants cannot be placed immediately. If new implants are placed, the doctor needs to assess whether the existing pocket is wide or narrow, whether a wide pocket requires pocket suturing or an insufficient pocket requires the creation of a new pocket, while also checking the dimensions and projection of the old implants, the condition of the pocket after implant removal, and the current bony structure of the rib cage.

Older patients or patients with underlying medical conditions need to be carefully assessed before breast implant removal surgery. The surgical approach should prioritize minimal invasiveness, a short surgical duration, limited tissue damage, limited bleeding and fluid secretion, and support for rapid recovery. For suitable cases, anesthesia using a laryngeal mask airway combined with point dissection using an ultrasonic surgical scalpel may help patients regain consciousness quickly, reduce nausea and vomiting after emergence from anesthesia, recover more quickly, and limit the additional use of painkillers or antibiotics after surgery.

When removing and reducing breast implant size after a period of breast augmentation, it is necessary to identify the type of the old implants and check the condition of the implants, pocket, fibrous capsule, breast glandular tissue, and any abnormalities, if present. After a period of implant placement, the anatomical structure and skin elasticity may change, so when reducing the implant size, skin elasticity needs to be assessed to select a suitable new implant size. The doctor also needs to check the condition of the rib cage after implant removal because, while the old implants are still in place, it may be difficult to accurately identify whether the rib cage is convex, concave, or abnormal.

The need to reduce breast implant size may arise after a period of breast augmentation when patients want to change the implant size, adjust the breast shape, manage the old implants, or adjust the implant pocket. Before reducing the implant size, it is necessary to check the type of the old implants, implant size, projection, condition of the pocket, fibrous capsule, breast glandular tissue, skin elasticity, and rib cage structure. When placing new implants of a smaller size, the doctor needs to assess whether the old pocket is too wide or insufficient and whether the pocket needs to be sutured or a new pocket needs to be created, so that the new implants are positioned correctly and complications after revision can be limited.

When removing breast implants and placing new implants, the doctor needs to recheck the old pocket after the implants have been removed. If the old pocket is too wide, the pocket needs to be sutured to regain control of the implant position. If the pocket is insufficient, a new pocket needs to be created so that the new implants are positioned correctly. At the same time, the dimensions and projection of the old implants, the condition of the pocket, breast glandular tissue, abnormal fibrous tissue, and the current rib cage structure need to be assessed. Adjusting the pocket helps limit implant movement within the pocket, implant flipping, implant malposition, implant bottoming out, symmastia, or implant firmness after replacement.

When selecting a new implant size after implant removal, the doctor needs to check the dimensions and projection of the old implants, the condition of the pocket after implant removal, whether the implant pocket is wide or narrow, the breast glandular tissue, skin elasticity, and the current rib cage structure. After a period of implant placement, the anatomical structure and skin elasticity may change. Therefore, the new implant size needs to be selected based on the actual condition of the tissues and pocket after implant removal, rather than only on the desire to increase or reduce the implant size.

Laryngeal mask anesthesia in breast implant removal and replacement is an anesthetic method in which anesthetic medication is administered and maintained through a specialized mask called a laryngeal mask airway. This method helps patients recover better, regain consciousness quickly, reduce nausea and vomiting after emergence from anesthesia, cause less injury to the larynx, and avoid complications associated with endotracheal anesthesia. Laryngeal mask anesthesia is suitable for minimally invasive surgical procedures that cause little tissue damage, have a short duration, and do not use muscle relaxants.

Laryngeal mask anesthesia usually does not use muscle relaxants. As a result, the surgeon can reassess the current implant pocket, whether the pressure within the pocket is excessive or insufficient, the position of the muscle, the degree of muscle tightness/relaxation, and the degree of pectoral muscle fibrosis. With endotracheal anesthesia using muscle relaxants, the doctor may have difficulty assessing muscle tightness and muscle relaxation after emergence from anesthesia because, when the medication wears off, the muscles return to their normal condition.

Laryngeal mask anesthesia may be selected for breast implant removal and replacement procedures without abnormalities requiring extensive intervention and when the surgical duration is not excessively long, except in cases of grade 4 capsular contracture. For the anesthesia team to agree to change from endotracheal anesthesia to a laryngeal mask airway, the surgeon must meet factors such as a short surgical procedure, minimal tissue damage, minimal invasiveness, and limited intervention involving the pectoral muscle.

When laryngeal mask anesthesia is combined with point dissection using an ultrasonic surgical scalpel, the duration of a standard breast implant removal procedure may be shortened to 15–30 minutes. Surgery involving pocket adjustment and implant replacement may last 30–60 minutes. Cases involving dissection and precise adjustment of pressure within the pocket without the use of muscle relaxants may recover quickly, be discharged within 4–6 hours, and require no additional painkillers or antibiotics after surgery.

Breast reduction, or female-to-male chest reconstruction surgery, is an aesthetic procedure that helps remove excess tissue, glandular tissue, and skin. This technique is quite similar to T-flap Mastopexy. Despite its reconstructive benefits, breast reduction surgery still carries risks of complications such as bleeding, fluid accumulation, infection, necrosis, loss of sensation or prolonged numbness, and poor scarring.

Complications that should be noted after breast reduction include hematoma, infection, necrosis of the nipple–areola complex, loss of sensation in the breast and nipple areas, and poor scarring. Hematoma may occur immediately after surgery if hemostasis is not properly controlled. If the amount of bleeding is small, the body may absorb it naturally. If the amount of bleeding is large, the hematoma may cause swelling, pain, bruising, reduced blood supply, an increased risk of infection, prolonged inflammation, affect the viability of the skin flap, and cause breast deformity after surgery.

The breast is an organ composed of skin, fat, glandular parenchyma, and stromal tissue. The largest breast arteries do not completely follow the ductal system but form a plexus in the anterior adipose tissue layer. Therefore, breast reduction surgery usually causes more bleeding than standard breast augmentation surgery.

In breast reduction surgery, the new-generation Ultrasonic Surgical Scalpel is used to dissect tissue, reduce breast glandular tissue, achieve hemostasis, control bleeding, and limit fluid secretion almost completely with high precision. The application of the ultrasonic surgical scalpel in breast reduction has been reported to help reduce postoperative pain, allow same-day discharge, eliminate the need for postoperative painkillers, promote wound healing, and produce more aesthetically favorable and softer scars compared with an electrosurgical device.

Before breast reduction surgery, tests are required to rule out medical conditions such as blood clotting disorders and hypertension, while anticoagulants and certain herbal medications need to be discontinued as indicated. To reduce risks, breast reduction surgery should be performed at a hospital licensed by the Ministry of Health, with preference given to a multidisciplinary hospital to ensure safety.

Recurrent breast ptosis is a condition in which the breasts become sagging again after aesthetic breast surgery. The main cause is that the surgical option indicated for the patients was not sufficiently accurate. In many cases of recurrent breast ptosis, there is no healthy skin remaining, the tissues are fibrotic and hardened, the breast glandular tissue has lost too much volume, and the nipple–areola complex is unbalanced in terms of position, size, length, and the position of the scar from the previous surgery, causing difficulties for the next reconstructive treatment.

The treatment of recurrent breast ptosis may be more difficult because the fibrotic scar tissue is firm and poorly elastic, the scars are extensive, there is insufficient breast tissue and skin for breast reconstruction with implants, and redistribution of the breast glandular tissue is also difficult. Fibrotic scar tissue may reduce the elasticity and uniformity of expansion and contraction of the skin and subcutaneous tissue, making breast shaping more difficult and increasing the risk of insufficient blood supply, fibrosis, or tissue necrosis during surgery.

With grade 1 or grade 2 breast ptosis, the signs may include the nipple being level with or 1–2 cm lower than the inframammary fold when standing in front of a mirror, relaxing both arms, and not wearing a bra. For this group, it may only be necessary to select breast implant surgery without additional intervention. The Dual Plane II technique is suitable for patients who want to improve breast shape and size and correct grade 1 or grade 2 breast ptosis.

With grade 3 or grade 4 breast ptosis, patients need to assess their current glandular tissue, skin elasticity, and the color of the stretch marks. If there is a large or small amount of glandular tissue, loose skin, multiple stretch marks in the breast area after childbirth, a predisposition to breast ptosis, and loss of skin elasticity, breast reconstruction that preserves the breast glandular tissue without breast implants may be selected. In cases with limited glandular tissue, good remaining skin elasticity, and grade 3 breast ptosis along the vertical axis, breast implant placement and areolar reduction may be selected. However, these procedures should be performed in two separate surgeries to avoid creating tension on the incision and increasing the risk of poor scarring.

Cases involving breast tumors need to be assessed by a doctor before deciding on breast implant placement. For a large phyllodes tumor that is growing rapidly within a short period, the doctor recommends complete tumor excision because the tumor is likely to continue growing larger. If patients wish to undergo the excision of a large tumor such as a phyllodes tumor combined with breast implant placement, they should choose a doctor specializing in benign and malignant breast diseases and an aesthetic surgeon to ensure safety and aesthetics in a single surgery.

A phyllodes tumor is a type of benign tumor, not cancer, located within the breast gland. The tumor usually grows rapidly, may become larger within a few weeks or months, and has no obvious pain symptoms. On palpation, it may feel like a round, multilobulated, fairly well-defined, firm and slightly hard, mobile mass.

The procedure may include three steps: using an ultrasonic surgical scalpel to create the implant pocket through the inframammary incision; excising the phyllodes tumor through the incision used to create the implant pocket or at the location of the tumor on the breast; after tumor excision, assessing the distribution, degree of aging, fibrosis of the glandular tissue, skin elasticity, and rib cage structure to select an implant size with suitable dimensions and projection. By creating the implant pocket first, the doctor can assess the possibility of excising the tumor through the same incision used to create the implant pocket, limiting the need for two incisions. After excision, the tumor is sent for histopathological examination.

The ultrasonic surgical scalpel uses ultrasonic waves through a coagulation–sealing–cutting mechanism, helping achieve effective hemostasis and reduce bleeding during and after surgery, particularly for tumors with many blood vessels. The heat generated is lower than that of an electrosurgical device, helping limit damage to surrounding tissues and reduce the risk of necrosis. The ultrasonic surgical scalpel integrates cutting and hemostasis, helping shorten the surgical time, reduce postoperative pain, promote faster recovery, and create a more aesthetically pleasing incision.

Breast reconstruction is surgery to recreate the breast after breast cancer surgery. Breast reconstruction surgery needs to be performed by a doctor with expertise in breast cancer pathology and advanced aesthetic breast reconstruction to ensure safety and aesthetics.

Breast reconstruction methods currently suitable for Asian women include breast implant placement, autologous fat grafting, autologous flaps, or a combination of these methods, depending on each case. Breast reconstruction using breast implants can be performed immediately at the time of mastectomy, called immediate reconstruction, or performed after the breast cancer treatment regimen has been completed, called delayed reconstruction. Breast reconstruction using autologous tissue uses tissue from another area of the body, which may include skin, fat, blood vessels, and sometimes muscle. Autologous tissue is usually taken from the abdomen or back and may also be taken from the thigh or buttock.

Flaps from the back and abdominal regions include the DIEP flap, LD flap, SIEA flap, and TRAM flap. The DIEP flap uses tissue from the abdomen and contains only skin, fat, and blood vessels, without the underlying muscle. The LD flap uses tissue from the middle and lateral region of the back and is a pedicled flap in which the vascular pedicle is preserved during breast reconstruction. The SIEA flap uses tissue from the abdomen like the DIEP flap but differs in the blood vessels supplying the transplanted tissue. The TRAM flap uses tissue from the lower abdomen like the DIEP flap but includes muscle and may be a free flap or a pedicled flap in which the vascular pedicle is preserved. Flaps from the thigh or buttock are used for patients who have previously undergone abdominal surgery, have abdominal conditions, or do not have sufficient abdominal tissue for breast reconstruction. These flaps include the IGAP and PAP flaps.

Breast implant placement surgery using the Harmonic ultrasonic surgical scalpel for patients who have undergone breast cancer treatment may help limit postoperative pain, bleeding, and fluid secretion, reduce the risk of capsular contracture, support wound healing, and promote rapid recovery. The Harmonic and LigaSure surgical devices operate through a coagulation–sealing–cutting mechanism with low heat generation, cause limited tissue damage, and are capable of achieving immediate hemostasis. Reduced bleeding and lymphatic fluid within the implant pocket help reduce postoperative pain and the risk of capsular contracture.

Before breast augmentation surgery in particular and aesthetic surgery in general, patients should stop taking dietary supplements for at least 2 weeks. This is especially important for products that may affect bleeding, blood clotting, or interact with anesthetic medications. Patients need to discuss directly and fully with the surgeon and the doctor performing the pre-anesthetic assessment about all dietary supplements they have used and are currently using, including product information, duration of use, and dosage.

Using dietary supplements for a long period may affect the surgical process and postoperative wound healing. Some products cause tissues to retain more water and become soft and loose, making it difficult for the surgeon to dissect and create the implant pocket. Waterlogged tissues increase the risk of bleeding. Soft and loose tissues make hemostasis more difficult. If the surgeon does not assess the condition of waterlogged and soft tissues to develop an appropriate surgical and postoperative care plan, the risk of fluid accumulation may increase.

Dietary supplements and collagen products need to be reported to the doctor before surgery. Many ingredients such as garlic, ginkgo biloba, turmeric, or echinacea may increase the risk of bleeding or interact with anticoagulants, even when basic coagulation parameters remain within normal limits. Collagen has strong water-retaining properties and may cause tissue edema and softening of connective tissue, increasing the complexity of tissue dissection and bleeding control during surgery. Some collagen products also contain hyaluronic acid, vitamin C, or glutathione, which are strongly water-attracting ingredients and increase the risk of water retention in the tissues.

Postpartum abdominoplasty is surgery to address excess skin, excess fat, and abdominal muscle separation after childbirth. This method is suitable for women with significant excess skin and fat after childbirth, especially after giving birth to twins or triplets, delivering a large baby, or gaining considerable weight after childbirth. Postpartum abdominoplasty can be divided into two types: abdominoplasty without umbilical transposition and abdominoplasty with umbilical transposition.

Abdominal sagging after childbirth may be related to abdominal muscle separation, especially in cases of twin or triplet pregnancies, an excessively large fetus, or women who gain considerable weight after childbirth. Some cases require a long period of time and a strict exercise regimen to regain body shape. When excess skin, excess fat, and abdominal muscle separation do not improve as desired, abdominoplasty may be considered after examination.

The abdominoplasty procedure may include the following steps: suctioning part of the excess fat from the lower abdominal wall, possibly together with the upper abdominal or waist areas; making a curved horizontal incision along the skin crease above the pubic bone; using the Harmonic scalpel to dissect the fat layer away from the abdominal fascia; and removing an appropriate amount of excess skin and fat below the umbilicus to avoid excessive tension after surgery. The doctor then sutures and tightens the weakened or separated abdominal muscles, removes excess fat, excises excess skin, repositions the umbilicus in cases of abdominoplasty with umbilical transposition, and closes the wound.

The Harmonic scalpel helps dissect the fat layer away from the fascia of the anterior abdominal wall muscles, limit bleeding, and limit fluid secretion, thereby reducing the risk of fluid accumulation, infection, and delayed postoperative wound healing. The Harmonic scalpel operates through a coagulation–sealing–cutting mechanism with stable heat generation, helping release the fat layer from the fascia of the abdominal wall muscles and preserve the lymphatic network within the fascial layer.

A conventional electrosurgical device generally does not seal lymphatic fluid after surgery as effectively as the Harmonic scalpel, does not control bleeding as effectively as the Harmonic scalpel, and may cause tissue burns. After surgery, fluid secretion and pain may be greater. The Harmonic scalpel helps preserve the fascial layer between the fat and the fascia of the abdominal wall muscles. This fascial layer contains many lymphatic vessels; if it is not well preserved, the risk of fluid secretion, abdominal wall fluid accumulation, delayed wound healing, and postoperative infection may increase.

After abdominoplasty using the Harmonic scalpel, the drainage period may be approximately 24–48 hours. With the conventional method, the drainage period may be longer. Cases using the Harmonic scalpel are less likely to require drainage tubes, except in cases involving extensive liposuction.

Abdominoplasty is a major surgery that may involve complications such as bleeding, fluid accumulation, infection, skin necrosis, poor scarring, loss of sensation in the abdominal skin, or delayed wound healing. The risk of complications may increase if bleeding is not well controlled during surgery, the fascial layer is not preserved, extensive tissue dissection is performed, or the patient has associated medical conditions that have not been fully assessed before surgery.

Fluid accumulation after abdominoplasty may be related to inadequate preservation of the abdominal wall fascial layer, where many lymphatic vessels are located. When the lymphatic vessels are extensively damaged, more fluid may be secreted after surgery. The Harmonic scalpel helps dissect the fat layer away from the abdominal wall fascia, limit bleeding, limit fluid secretion, and reduce the risk of abdominal wall seroma.

Abdominoplasty can be combined with the treatment of an abdominal wall hernia when patients have excess skin, excess fat, abdominal muscle separation, and an accompanying abdominal wall hernia that needs to be treated during the same surgery. Before surgery, patients need to undergo examination and assessment of the abdominal wall, the degree of muscle separation, the condition of the hernia, and related risk factors.

The surgery needs to address both aesthetic factors and medical conditions at the same time. The doctor needs to assess the abdominal wall structure, the hernia area, adipose tissue, excess skin, and the degree of muscle separation to develop an appropriate surgical plan. The medical facility performing this surgery needs to ensure adequate conditions for surgery, anesthesia, resuscitation, and the management of complications, if any.

Patients who have undergone colon surgery need to be carefully evaluated before abdominoplasty. The previous surgical incision, scar tissue, tissue adhesions, abdominal wall condition, and associated medical conditions may affect the surgical plan. The doctor needs to review the surgical history, abdominal wall condition, wound-healing ability, and risks during tissue dissection.

Previous abdominal surgery may leave scars, tissue adhesions, and changes in the abdominal wall structure. During abdominoplasty, these factors may increase the difficulty of tissue dissection and the management of excess skin and fat. Careful preoperative evaluation helps the doctor select the incision, extent of dissection, method for managing the skin, fat, and abdominal wall muscles, and an appropriate postoperative care plan.

Middle-aged and elderly patients may consider abdominoplasty when they have excess skin, excess fat, abdominal muscle separation, or abdominal wall deformity that affects daily activities and aesthetics. Before surgery, their general health, underlying medical conditions, the condition of the abdominal wall skin, fat, and muscles, and their recovery ability need to be assessed. Elderly patients need more thorough examinations of cardiovascular function, blood pressure, respiratory function, blood clotting, blood glucose, and medical conditions currently being treated.

The surgical plan needs to prioritize safety, limit excessive invasiveness, control bleeding, control pain, and closely monitor patients after surgery. Patients need to provide complete information about the medications they are taking, underlying medical conditions, and previous surgical history. The surgery should be performed at a facility with adequate conditions for anesthesia, resuscitation, and the management of complications.

Abdominoplasty and breast augmentation may be considered at the same time in certain suitable cases, but the surgical duration, degree of invasiveness, health condition, recovery ability, and risk of complications need to be carefully assessed. If the surgery is prolonged, involves intervention in multiple areas, causes significant blood loss, or the patient has underlying medical conditions, performing both procedures at the same time may increase the risks during and after surgery.

The procedures should not be combined when the patient’s general health is not adequate, underlying medical conditions are not well controlled, the anesthetic risk is high, the tissues in the surgical areas require extensive intervention, or the expected surgical duration is prolonged. Combined surgery needs to be directly assessed by a doctor and performed at a facility with adequate conditions for surgery, anesthesia, and resuscitation.

Blepharoplasty is a method of creating a more defined eyelid crease by intervening in the skin, fat, orbicularis oculi muscle, and levator muscle. This method is suitable for patients with thick upper eyelids, thick upper eyelid skin, middle-aged eyes with loose and sagging skin, loose fat pads, a weak levator muscle system, previous botched blepharoplasty, fibrotic scarring after aesthetic procedures, or limited eye opening. The aim is to create a defined but natural eyelid crease, manage excess skin and fat, adjust the connection between the levator muscle system and the tarsal plate, and improve the consequences of botched double-eyelid surgery or botched blepharoplasty.

Double-eyelid surgery and blepharoplasty both aim to create a clearly defined eyelid crease. Double-eyelid surgery is suitable for young patients whose eyes have no excess skin, hidden eyelid creases, multiple eyelid creases, thin eyelid skin, not too much fat, and an original eye structure that has not previously undergone aesthetic procedures. Double-eyelid surgery is a non-surgical method that only affects the orbicularis oculi muscle and skin. Blepharoplasty intervenes in the skin, fat, orbicularis oculi muscle, and levator muscle and is suitable for cases involving excess skin, excess fat, fibrotic scarring, or previous botched eyelid procedures.

A successful blepharoplasty procedure needs to create a defined but natural eyelid crease, remove old scars if present, appropriately manage excess skin and fat, adjust the connection between the levator muscle and the tarsal plate, and help the eyes remain flexible and have an expression that is harmonious with the eyebrows, eye sockets, and the entire face. The aesthetic result does not only lie in whether the eyelid crease is large or clearly defined, but also in balance, eye opening, the ability to express emotions, and the natural appearance of the eyes.

Botched blepharoplasty or botched double-eyelid surgery can cause infection, inflammation and swelling, dry eyes, excessive tearing, a foreign-body sensation in the eyes, itchy eyes, uneven eyelids, overly wide-open eyes, dull-looking eyes, lifeless eyes, weak levator muscles, inflexible eyelids, and unsightly, clearly visible scars along the eyelid creases. In some cases, the eyelids lack an emotional and expressive connection with the eyebrows, eye sockets, and face, affecting patients psychologically and causing them to lose confidence.

The soulful expression of the eyes may change when the eyelid creases are not harmonious with the structure of the eye sockets, eyebrows, levator muscles, and the entire face. The eyes may appear overly wide-open, sad, empty, dull, or emotionless if the procedure is incorrectly indicated, excessive skin and fat are removed, or the levator muscles are managed inappropriately. When the eyelids are no longer flexible, facial expressions around the eyes are also affected, making the face appear unnatural.

Blepharoplasty and double-eyelid surgery require an understanding of the anatomical structures of the eye socket area, eyelid skin, eyelid fat, orbicularis oculi muscle, levator muscle, and tarsal plate. When performed at a facility that does not meet the required conditions, lacks sterility or professional expertise, or provides an incorrect indication, the risks of infection, poor scarring, uneven eyelids, overly wide-open eyes, dry eyes, and eyelid deformity may increase. Before the procedure, patients need to be examined to determine whether double-eyelid surgery or blepharoplasty should be performed, the degree of excess skin and fat, the condition of the levator muscles, and the history of previous eyelid procedures.

An examination is necessary when the eyelids are uneven, the eyes are overly wide-open or dull-looking, the eyelids are not flexible, the scars along the eyelid creases are unsightly and clearly visible, or when there are dry eyes, excessive tearing, a foreign-body sensation in the eyes, persistent pain, or a loss of harmony between the eyes and the face. Patients who have previously undergone botched blepharoplasty or have fibrotic scarring after aesthetic procedures need a careful assessment of the orbital structure, eyelid skin, eyelid fat, levator muscles, and scar tissue before revision.

Revision of botched eyelid procedures requires identifying the cause of the unsatisfactory result: excess skin or excessive skin removal, inappropriate management of eyelid fat, fibrotic scarring, weak levator muscles, uneven eyelid creases, or overly wide-open eyes. The revision method depends on the current anatomical structure and the scar tissue from the previous procedure. Undergoing another procedure too early or failing to assess the scar tissue correctly may make the revision result more difficult to control.

Postpartum female cosmetic genital surgery is a group of methods that help improve the size, shape, elasticity, and sensation of the vaginal–vulvar area after childbirth. After childbirth, the vaginal structure and hormone levels undergo many changes, such as vaginal laxity, looseness, widening, loss of elasticity, changes in the contour structure, weakening of the anterior and posterior vaginal walls, and unmet expectations in sexual life.

Female genital surgical procedures include labia minora reconstruction, labia majora reconstruction, vaginal tightening, and female genital rejuvenation. The goal of female cosmetic genital surgery is to restore a firmer vaginal sensation and improve sexual satisfaction for women and their partners.

Complications that may occur after Female Cosmetic Genital Surgery include infection, bleeding, hematoma in the surgical area, severe postoperative pain, suture dehiscence, urinary incontinence, prolonged pain during sexual intercourse, vaginal dryness, loss of sensation during sexual intercourse, inflammation and infection causing itching, an unpleasant odor, pain and burning during sexual intercourse, poor scarring, urethral injury, rectal perforation, and rectovaginal fistula. Results that do not meet expectations may cause patients to feel self-conscious, lose confidence, fear sexual intercourse, and affect their sexual life.

Postoperative infection usually appears from the third to the seventh day after surgery, while some cases may be detected later. Signs may include loss of appetite, a bland taste in the mouth, fever, persistent pain, redness, or swelling in the genital area. When these signs occur, patients need to seek early examination by a specialist.

Vaginoplasty may cause complications such as infection, prolonged pain, bleeding, suture dehiscence, poor scarring, excessive narrowing, pain during sexual intercourse, reduced sensation, urethral injury, rectal injury, or rectovaginal fistula. The surgery needs to be performed by a doctor with professional expertise and experience because incorrect techniques and methods may lead to unwanted complications.

Female cosmetic genital surgery procedure needs to begin with an examination and assessment of the condition of the vagina and vulva, the degree of laxity, width, elasticity, tissue condition, postpartum scarring, and associated problems such as urinary incontinence, pain during sexual intercourse, or infection. After determining the appropriate method, the doctor performs the indicated surgery, such as vaginoplasty, labia minora reconstruction, labia majora reconstruction, or female genital rejuvenation. After surgery, patients need to be instructed on wound care, hygiene, monitoring for pain, bleeding, and infection, and the follow-up schedule.

Surgery may be considered when the genital area is lax, loose, widened, has lost elasticity, has changed in shape, when the labia minora or labia majora cause discomfort in daily activities, or when vaginal sensation is no longer as desired after childbirth. Before deciding on surgery, patients need to undergo an examination to rule out infection, assess the vaginal and vulvar structures, and select the appropriate method.

After surgery, the surgical area needs to be kept clean and dry, the wound needs to be cared for according to instructions, medications need to be used as prescribed, follow-up visits need to be attended as scheduled, and abnormal signs such as fever, increasing pain, redness, swelling, bleeding, abnormal discharge, or an unpleasant odor need to be monitored. Patients need to limit activities that may place pressure on the surgical area during the initial period and only resume normal activities according to the doctor’s instructions.

A follow-up examination is necessary when there is fever, persistent pain, redness or swelling in the genital area, bleeding, hematoma, suture dehiscence, abnormal discharge, itching, an unpleasant odor, prolonged pain or burning, or pain during sexual intercourse. These signs may be related to infection, inflammation, unfavorable wound healing, or postoperative complications.

Labiaplasty is surgery to correct the shape of the labia minora when this area is enlarged, asymmetrical, causes discomfort in daily activities, or affects the aesthetics of the genital area. The method needs to be indicated after an examination to assess the shape of the labia minora, the amount of excess tissue, the condition of scars, infection, and the patient’s wishes.

Surgical vaginal rejuvenation requires accurately identifying the problem that needs to be treated: a widened vagina, reduced elasticity, enlarged labia minora, changes in the shape of the labia majora, postpartum scarring, or sensory disorders. The surgery needs to be performed by a doctor with professional expertise and experience to limit complications such as infection, prolonged pain, poor scarring, loss of sensation, and injury to the urethra or rectum.

Structural rhinoplasty is surgery that uses artificial graft materials and autologous materials such as auricular cartilage, septal cartilage, costal cartilage, and synthetic grafts to reshape the entire nasal structure. Structural rhinoplasty requires precise dissection skills and experience in cartilage harvesting and cartilage grafting techniques to construct the nasal columella and reconstruct the nasal tip. Experience in assessing blood supply and selecting suitable graft tissue is an important factor in achieving long-term stable results and limiting complications.

Materials used in structural rhinoplasty may include artificial graft materials and autologous materials. Autologous materials commonly include auricular cartilage, septal cartilage, and costal cartilage. In addition, synthetic grafts, dermal fat grafts, or MegaDerm may be used depending on the case. Each material has its own advantages and disadvantages and needs to be selected according to each nasal area, each grafting method, and the tissue condition of the person undergoing surgery.

Complications after structural rhinoplasty include bleeding, postoperative hematoma, nasal infection, nasal contracture, deformity, exposure of the nasal bridge implant, redness and shininess of the nasal tip, and nasal necrosis. Swelling and bruising around the nasal bridge, inner corners of the eyes, lower orbital area, upper eyelids, or forehead area above the nasal root may occur after surgery. This condition is usually related to trauma or an inflammatory response after tissue dissection and decreases after the fifth day.

Bleeding and hematoma may occur when cartilage harvesting and hemostasis are not performed properly in areas such as the nasal septum, the auricular cartilage harvesting site, or the costal cartilage harvesting site. If there is significant bleeding, patients may require surgery to remove blood clots, achieve thorough hemostasis, and place drainage if necessary.

Nasal infection may occur when sterility is not maintained during surgery, including the sterility of the operating room, surgical instruments, the surgeon’s hands, or graft materials such as cartilage and artificial grafts. Signs may include pain, swelling, warmth, redness, and possible fever, usually appearing 3–5 days after surgery.

The nose may become contracted, crooked, or deviated when the nasal tip is elevated too high but does not correspond with the stability of the cartilage framework after grafting. When the nose is lengthened excessively but is not compatible with the elasticity of the subcutaneous connective tissue and skin, the junction between the cartilaginous and bony parts of the nasal dorsum may become constricted, curved, or deviated. Tissue injury, bleeding, and infection during and after surgery may cause fibrosis and contracture around the cartilage graft and lead to deviation of the nasal tip–dorsum axis. This condition may occur later and be detected after 3–6 months.

Exposure of the nasal bridge implant and a shiny red nasal tip are late complications that may appear several years or many years after rhinoplasty. The causes are commonly related to incorrect assessment of skin thickness, placement of cartilage grafts that exert excessive pressure on the soft tissue and nasal skin, or the use of poor-quality cartilage grafts. When the skin and soft tissue of the nasal area do not provide sufficient coverage, the graft material may exert prolonged pressure, causing the nasal tip to become shiny and red or exposing the graft material.

Nasal necrosis may occur when infection is not detected and treated early, causing damage to the main vascular pedicle or extensive tearing and perforation of the nasal mucosa during dissection. Insufficient blood supply is a dangerous cause of necrosis. When pain, swelling, warmth, redness, fever, or abnormal signs occur after rhinoplasty, patients need to seek early examination by a doctor with professional expertise.

Revision of botched rhinoplasty requires consideration of an appropriate time. Performing revision too early within the first 6 months after surgery, when the doctor does not have extensive experience and specialized expertise, may increase the risk of failure in the next revision surgery. Most cases need to wait longer, approximately 1–2 years, especially when there is infection or extensive scar fibrosis after multiple surgeries. Some situations may be revised earlier, such as displacement of the graft material without requiring major surgery, exposure of the graft material through the skin of the nasal tip or the vestibular mucosa, or significant deformity that affects aesthetics.

Revision of botched rhinoplasty requires selecting an appropriate time and surgical method and achieving a balance between the desired aesthetic result and the stability and long-term durability of the cartilage framework after grafting and reconstruction. The doctor needs to assess the graft material, scar tissue, the condition of the skin and mucosa, the stability of the cartilage framework, the cartilage harvesting site, and complications such as columellar deviation, nasal bridge deviation, septal deviation, or exposure of the nasal bridge implant.