Dr. Apirag Chuangsuwanich, a prominent member of the IMCAS faculty, is the President of the Plastic Surgery Society of Thailand as well as the Royal College of Surgeons of Thailand. The IMCAS Team sat down with him to ask about his advice for breast augmentation procedure.

Tell us a bit about your history as a plastic surgeon.

Dr. AC: I completed my basic training in Thailand over 30 years ago. After finishing my training, I went to the University of Pittsburgh, Pennsylvania, for a one-year fellowship in craniofacial surgery. Then, I returned to Bangkok to work in a government teaching hospital. I spent over 30 years there as an instructor and eventually became the chief of the plastic surgery division.

What were some differences you noticed in your education when you moved to Pittsburgh?

Dr. AC: Not much, as education in Thailand follows the systems of the United Kingdom and the United States. However, there are some minor differences in certain specialties. For example, the anatomy of Caucasian and Asian patients differs, particularly in skin patterns.

In your opinion, what are the key factors to consider when selecting products for breast surgery, specifically implants or tissue expanders?

Dr. AC: In Thailand, we mostly focus on implants for aesthetic purposes rather than tissue expanders. Currently, tissue expanders are not readily available in Thailand; if we need one, it must be ordered about two months in advance. For breast reconstruction, particularly immediate reconstruction, patients typically request medium-sized implants rather than large ones, so expanders are not commonly used. We generally rely on soft tissue from the patient.

How do you consider patient-specific factors, like age, body type, and medical history, when deciding between implants, fat grafting, or other options?

Dr. AC: For fat grafting, it is suitable if the patient only wants to increase by one cup size and prefers autologous tissue. If they desire a larger increase, implants are the better choice.

When choosing implants, I always prioritize products approved by the FDA. Additionally, I consult the FDA Advisory Board in Thailand for guidance on implant imports. The manufacturer’s background, research, and adherence to quality standards are also critical factors.

How do you determine the right implant size and shape for a patient?

Dr. AC: We start by discussing the patient’s preferences regarding size and shape. Patients often come in with a specific volume in mind, such as 300cc or 400cc. After examining their body type, I evaluate whether their desired volume is suitable. If it’s not, I discuss alternative options with the patient and recommend adjustments based on their anatomy.

Can you tell us a bit about saline and silicone implants? How do you decide which one to use?

Dr. AC: Currently, saline implants are no longer available in Thailand. I used them early in my career because silicone implants at the time were of poor quality and prone to issues like gel bleed, which caused capsular contracture. Saline implants became popular as an alternative but were discontinued due to problems with valve leakage. Now, silicone implants dominate the market.

Do you believe silicone implants are the best option available today?

Dr. AC: Yes, at the moment, no other material surpasses silicone. Historically, there have been attempts to use other fillers like gel or oil, but they often resulted in significant problems. Silicone remains the gold standard.

Have there been any recent advancements in implants or tools for insertion that enhance safety and efficacy?

Dr. AC: Recent advancements include implants with cohesive gels that are soft, flexible, and easy to insert through smaller incisions. These implants also have durable envelopes for better protection. Additionally, new tools, like injectors for placing implants, help reduce trauma during surgery.

How do you evaluate the long-term safety of breast implants for your patients?

Dr. AC: Long-term safety depends on the research and data provided by manufacturers. Before using any product, it’s crucial that it has undergone at least 5 to 10 years of testing. Without proper research, it’s impossible to ensure the safety and quality of the implant.

Have you ever encountered a product that you found problematic or unsuitable?

Dr. AC: Not necessarily. If a product doesn’t suit a particular patient, it doesn’t mean the product itself is bad. It’s more about finding the right match for the patient.

How do you educate your patients about different implant options?

Dr. AC: I prioritize products approved by the FDA. Patients sometimes request specific brands based on advertisements or recommendations from friends. In such cases, I ensure they understand the pros and cons before making a decision.

What advice do you give patients for long-term implant care?

Dr. AC: I tell patients that manufacturers typically estimate a lifespan of 10 years for implants. However, they should have regular follow-ups every 6 months to a year for routine examinations, including mammograms or other imaging tests.

What role do you think 3D imaging and modeling play in customizing breast surgery?

Dr. AC: 3D imaging can help visualize potential outcomes, but many devices currently lack the ability to assess tissue elasticity and quality, which are critical factors. While these technologies are promising, I haven’t adopted them yet, as I believe they need further refinement.

Is there anything else you’d like to add?

Dr. AC: Ultimately, successful outcomes depend on knowing your products, understanding your patients, and staying educated to deliver the best care possible.