Today, while watching the ultrasound
since I can't demonstrate on a person
(Today's implant is a pork) I brought in some pork belly
With pork belly
I'll show you how it looks when the implant folds
and show the difference between texture implants
and smooth implants
I will show you how they differ
directly through the ultrasound
(Shinyu Clinic)
Human muscles have fibers
(You can't see the lines well with this pork) but with pork belly, it's hard to see them
However, you can still see that there are layers
(Skin) This is the skin layer
(Layer 1) You can see the layer in the middle
(Layer 2) and this layer
(Layer3) and this layer are all different
In surgery
if you enter between Layer 2 and Layer 3
there’s no bleeding
But if bleeding occurs suddenly
(Off track) it means you’ve cut into the wrong layer
You need to recognize that and stop immediately
(Doctor should realize the situation immediately) You must think that there's something wrong
Especially during breast reduction or augmentation
if bleeding starts unexpectedly,
it means the layers were not correctly identified
At that point, you should stop and check again
if you're going the right way
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If I'm using
(A scissor?)
a tool like a Mommotome
you can manipulate it while watching the ultrasound
This is very important because
(You can identify the scissor through the ultrasound) it shows the tools, that I put right here
You can see these things
and you can track them accurately
If there’s something to be removed
you can follow it
precisely on the ultrasound
and remove just that
(Seroma removal, Mommotome have the same surgery method) This is how the Mommotome works
and when there's seroma around the implant
it’s also removed in the same way
However
if there’s an implant
it is risky
Implants can rupture easily
which is why hospitals are reluctant to perform this procedure
Many people come to get serous fluid out
After surgery at another hospital
the serous fluid is pooled, so many people come to get the serous fluid out
Because plastic surgeons
touch it with their hands
It's dangerous to extract serous fluid around the implant
They come to me then
I look at the serous fluid with ultrasonic waves
And extract it with a syringe
So what does it look like when there's an implant?
I'm going to put the implant under the pork belly
(Something like a white line on the surface of the implant) This is the implant
You can see this skin
If the implant is folded
(The pork belly is too thick...) Oh, this is actually thick
It's hard to show how it's folded
(So we changed it to a pig skin hehe)
(Pig skin) If you look at this part
This white part, this reddish part
It's pig skin
White here
There are smooth lines
(You all see three lines here, right?) One, two, three go by
This is a smooth skin
Usually, the implant skin is
not just a single layer
It's three or four layers
Usually, it's four layers
But if you look at the texture implant
(It feels rough compared to smooth) It definitely feels rough
If you look at this
You can tell if it's texture or smooth
(What does the implant look like when it's folded?)
The middle part is white, right?
That's how the air could be full or the serous fluid could be full
The air is actually full right now
As if the white line breaks in the middle
It shows a different pattern?
(Can presume that the implant is folded) The serous fluid is usually pooled
Then, I'll think that this part is folded
(You can see that the prosthesis is implant from this)
When we first practice or study ultrasound
I put pork or something like that
When we practice mammotome
We put some olives in the middle
When we do things like Mommotome
We practice removing olives
If there's a tumor during the Mommotome surgery
How does it look?
It looks like there's something on the ultrasound
It looks different
Actually, the breast is ambiguous
There's something
(This... What is this?) There's a lot of uncertainty about whether there's one or not
(If an exact assessment isn't possible, monitoring over time is essential) That's why follow-up observation is the most important
We need to see how it changes
Even if it's unclear at first
it becomes clear over time
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How do I get rid of lumps?
Let's say there's an implant underneath,
If you poke the implant
(Big accident) that would be bad
Since the implant would explode
So you have to look at it carefully
Move carefully
Put the anesthetic in here
(Injecting anesthetics) Then, it floats like this
It's floating
So when there's an implant down here
This is how you make space
If you make a space like this
The distance from the implant has widened
(Get rid of the lump and it's over) so it‘s over
You can remove the lump like this
That's why it's funny
If you want to be good at Mammotome
You need to be good at anesthesia
If you want to be anesthesia, you need to be able to look at an ultrasound
(A person who is good at everything) do it like this
(Suddenly releasing know-how...?)
Oh...I'm sure you all know
It's hard to copy
It's just like how they say
after drawing, "it's easy, right?"
(Easy, right?)
(What will it look like when the air goes in?) What happens if there's air in there
Actually, no air should go in
If you get air in, you can't see it on the ultrasound
I'll do one more layer
On this layer
If you put in air
(I can't see anything..it‘s white..)
I can't see the back
That's why there's no air in there
I'm not putting the implant in a vacuum
There's a lot of air around the implant
Then you can't see it on ultrasound
If you try to extract the intestinal fluid while you can't see it
(It's really important to watch ultrasound) The prosthesis could explode
After surgery, with breast reduction or putting in implants
A lot of people say that there is a sloshing sound
This could be because of trapped air
Or trapped fluid
If it is extreme to the point of discomfort, we take it out
(Stressing) Looking at the ultrasound
doing after-care post-surgery is necessary
(Recommend getting treatment at a clinic with ultrasound equipment) Relying on touch
the plastic surgeons just feel around with their hands
Saying it’s all good
It shouldn’t be like this
Because we always looks at this
we have no choice but to do it more
Then the patients become more comfortable with it as well
And it’s also fun for me too
(The feeling of discomfort disappears!!) They say it feels much better
The areas that were filled become reduced so they say it feels much better
They all say this
Everyone feels that way
(Feeling of satisfaction after providing treatment) Then it becomes fun for me as well