For patients who will undergo breast surgery via areola incision, they should ask their doctors if they will receive a pedicle technique in which the nipples and areolas are relocated but not completely severed from the wedge of tissue that contains the milk glands and primary nerves.

The pedicle technique has become a standard in breast reduction surgery in an effort to preserve the nipple sensation, although this is not used in treating excessively large breasts as it can limit the amount of excess tissues, fats, and skin a surgeon can remove during an operation.

For women who want to undergo breast implant surgery but are concerned with the risk of permanent numbness in the nipple, most doctors would probably recommend the underarm incision in which they will stretch the tissue rather than cut it to place the device inside the breast pocket.

If the nerves are only stretched, the sensation usually returns sooner unlike if they are cut or cauterized (burned).  But regardless of the incision site, there is always the risk of partial or complete loss of sensation after a breast augmentation surgery.

Another way to reduce the risk of permanent numbness is to avoid using an implant which has a diameter larger than the base of the breast.  For example, a patient who chooses a 12 cm diameter implant even if her breast’s diameter is only 10 cm is more likely to experience this problem than a woman who “considers” her anatomy.

Some plastic surgeons also claim that placing the implants under the muscle can lower the rate of nipple numbness than if the devices are placed behind the tissue or partially under the muscle.

In case that nipple numbness occurs after a breast surgery, it may take up to two years before the sensation will return.  Meanwhile, research has shown that most women can increased their ability to breastfeed five years after the procedure because the damaged nerves and glands can repair themselves over time.

Experts suggest that massaging the nipples and breast skin regularly may encourage a complete or sooner return of sensation by reinforcing neural pathways in the brain; this is done by lightly touching the area with fingers for a few minutes several times each day.

Also called as gummy bear breast implants because of their cohesive gel, you can only access these new devices by choosing a plastic surgeon who is part of a nationwide clinical study approved by the US Food and Drug Administration.

While this new breast implant is not yet available for marketing in the US, this has already been used in Europe since 1995.  Several years ago, Canada and Australia have also approved this device for breast augmentation, revision, and reconstructive surgery.

Compared to the currently available breast implants in the US, some experts have claimed that gummy bear implants are better in terms of safety and aesthetic results.

• You will enjoy a more natural shape and feel.  The form-stable gel implants are noted for their soft and supple feel that can give you a natural result.  And because they maintain their shape inside the breasts, their edges perfectly blend into the surrounding tissues which means that you can avoid the risk of implant rippling and wrinkling.

• The implants are said to last longer.  Because the cohesive structure of the devices prevents them to fold or ripple, the outer shell is not subjected to tension which may eventually weaken it.  For this reason, many experts believe that this new type of breast implant is less likely to break and can last longer than the saline- and silicone-filled implants.

• You will not worry about the risks associated with gel leak.  The gummy bear breast implants are made of a solid mass of silicone gel which means that even if they are cut in half, the filling will stay in place and will not migrate to other parts of the body.  This is not the case in the currently available silicone implants filled with a less cohesive gel that can leak out if the outer shell is punctured.

• Lower risk of capsular contracture with this new implant.  According to studies released in Canada and Europe, women with gummy bear breast implants have a lower chance of developing capsular contracture compared to patients with saline- and silicone-filled versions.

Capsular contracture happens when the capsule-shaped scar tissues tightly compress the implants which then results to extreme pain and ball- or coconut-shaped breasts.

Breast ptosis is often aggravated by major weight loss and pregnancy, although the most common contributing factor is aging.  As women age, their tissue and skin becomes lax which often leads to low-lying breasts with nipples pointing downward; unfortunately, even an underwire bra with good support cannot correct this problem.

For women who have sagging breasts that lack in volume, they are an ideal candidate for breast lift surgery combined with breast implants.  In this approach, doctors often use the areola incision (sometimes combined with excision from the nipple down to the breast crease) in order to remove or tighten the loose skin tissue; the same incision site is also used in the implantation of the device.

By combining these two procedures, doctors can remove less amount of skin which means less risk of visible scarring.

However, the areola incision, sometimes referred to as donut lift, may not be enough to correct a more pronounced ptosis.  In this problem, most plastic surgeons will create another cut starting from the areola down to the crease, a technique which is also called as lollipop lift.

In order to achieve fullness particularly in the upper poles of the breasts, most doctors complement breast lift with round implants which have symmetrical shape.  When placed on top of a table, their contour is almost similar with an M&M candy.

In the hands of a skilled plastic surgeon, round implants do not result to an augmented, “fake” look which is just a common myth.  In fact, they can turn into a teardrop shape (just like anatomical implants) if they are being hold at one side because the gravity will pull the filling at the bottom.

To prevent the recurrence of breast ptosis, doctors often placed the round implant under the chest muscle rather than behind the tissue.  In this way, the top two-thirds of the device is covered by muscle and its lower one-third is supported by a thicker amount of connective tissue.

On the other hand, behind the tissue placement of the implants is not a good choice for women with ongoing breast ptosis since the weight of the device may further aggravate the problem.

Contrary to a popular belief, the recovery period in breast lift with implant surgery is almost the same with breast augmentation performed as a standalone procedure.

In some cases, the breast implants move downward as the tissue that supports the device becomes weak and lax.  If this happens, the breast crease will settle lower on the chest, leading to a cosmetically displeasing result.

Fortunately, there are several ways to prevent this problem and one of the most effective is choosing the right implant size.  For instance, petite women who often have a limited breast tissue and skin are generally recommended to choose smaller sizes in order to prevent bottoming out; in this way, they can also avoid visible and palpable ripples in the shell.

It is important to remember that inordinately large implants can expose patients to a higher risk of bottoming out and premature breast ptosis (or sagging) because of the extra weight the tissue and skin has to carry.

Another way to avoid bottoming out is creating an implant “pocket” which should be in the right size, preventing gross movements of the device.  But in case that the room for implants has been over-dissected, the problem will usually occur just several weeks or months after a breast augmentation.

Meanwhile, the right placement of implant, particularly the complete submuscular technique, can also minimize the risk of bottoming out since the breast implants are supported by a thicker amount of tissue in the lower poles.  This is not the case in other implant placements in which the lower poles are only supported by the skin tissue.

Another advantage of complete submuscular or “unders” is it prevents visible and palpable rippling because the top two-thirds of the implants is covered by the pectoral muscle.

Some doctors also suggest that using a bra that provides a good support to the weight of the implants can prevent or at least minimize the risk of bottoming out and breast ptosis.

But in case the implants have bottomed out, the only way to treat this problem is through another surgery which often involves an incision made along the breast crease.  In this way, doctors can cut and roll up the tissue surrounding the device and then secure it with internal sutures.

Once the implant “pocket” has been corrected, the incision site is closed with tiny sutures.

For some patients, they may be asked to downsize their breast implants particularly if the main reason for bottoming out is the excess weight of the large implants.

These are the most frequently asked questions about the new breast implants.

1.  Question:  Are gummy bear breast implants available in the US market?

Answer:  No.  However, the US Food and Drug Administration (FDA) allows patients to have these new devices as long as they will participate in a clinical trial, which means that they should choose a doctor who is part of this nationwide study.

2.  Q:  Can these implants provide a more natural result compared with the saline and silicone type?

A: Yes, because these are filled with a silicone more cohesive than the one used by the currently available silicone implants.  And with this filling, the breasts will have a more natural feel and shape.

3.  Q:  What happens after the shell breaks?

A:  Because the gummy bear breast implants use a very cohesive and firm silicone material, a leak is almost not a concern.  In fact, the implants can be cut in half and no gel will leak out from the shell.

For this reason, some experts believe that these new devices for breast augmentation and breast reconstruction are at par with the saline implants in terms of safety.

Since the saline implants are only filled with a saltwater solution, a leak will not predispose the patients to any health risk (unlike in the currently available silicone implants), although their breasts will appear deflated within four hours after the shell ruptures.

4.  Q:  Can these new implants last longer than the saline and silicone type?

A:  Because the gummy bear breast implants are not prone to rippling and folding, the shell is not subjected to a tension which may weaken it in the long run.  For this reason, most experts believe that these new devices can last longer than the silicone and saline type.

5.  Q:  Are these implants already available for marketing in some countries?

A:  Yes.  In fact, some European countries have already used these implants since 1995.  Meanwhile, Australia and Canada have also introduced these devices to the market just a few years ago.

6.  Q:  What is the most notable thing about these new breast implants?

A:  According to studies released in Canada and Europe, capsular contracture (scar tissue forming around the implants) happens less frequently on patients with gummy bear breast implants.

To guide you during your recovery after surgery, the California Surgical Institute has provided a list of answers to the most frequently asked questions about what you should do and expect during the healing time:

1.  Question:  Should I assign someone who will care for me during my recovery?

Answer:  Yes.  Assign a capable adult who will tend to your needs for at least three days following your surgery.  But in case that your procedure is an extensive one, it is best that you opt for an overnight stay at a hospital.

2.  Q:  How long is my recovery?

A:  The length of your recovery will largely depend on the treated area, extensiveness of the procedure, type of plastic surgery, and your body’s healing capability.

These are the most common cosmetic procedures and their estimated recovery time:

• breast augmentation – three to 12 months
• eyelid surgery – eight weeks to seven months
• tummy tuck – eight weeks to nine months
• traditional liposuction – eight weeks to 12 months
• facelift – eight weeks to 10 months

3.  Q:  When can I resume my work and normal activities?

A:  Most patients can return to normal activities (excluding strenuous exercises) and “quiet” work” 10 days after their surgery.  But to be on the safe side, you should always ask your doctors on when you can safely resume your daily life activities.

4.  Q:  Why is it dangerous to remain sedentary or bed-ridden for a long period of time after my surgery?

A:  If you remain in bed for a long period of time, you are at risk of developing blood clots in your legs and lungs and other serious complications.  Ideally, you should take a short, gentle walk as soon as you can in order to promote a good blood circulation.

5.  Q:  What are the most common postoperative symptoms should I expect?

A:  It is most likely that you will experience swelling, bruising, tenderness, soreness, pain and discomfort, temporary numbness in the treated area, and nausea as the anesthesia wears off.

But a week after your surgery, most of these symptoms will become less pronounced.

In case that there is no improvement within a week, you should immediately visit your plastic surgeon to determine if you are experiencing delayed healing and other complications.

6.  Q:  How can I minimize the swelling?

A:  Swelling is more common after a facelift, eyelid, rhinoplasty or nose surgery, otoplasty or ear tucking, neck lift, and tummy tuck.  To minimize this symptom, you should elevate your head and shoulder with pillows within seven to 10 days following your surgery.

Ice packs can also be helpful in minimizing the swelling and bruising.

7.  Q:  Why should I avoid aspirin and anti-inflammatory medications during my recovery?

A:  These drugs, which are sometimes called as blood-thinners, can increase bleeding during surgery and recovery and can also inhibit the body’s healing ability.  Herbal supplements and vitamins, particularly those containing green tea, vitamin E, ginseng, and ginkgo biloba have also been found to increase bleeding.

Just to be on the safe side, you should tell your surgeon all the current medications you are taking.

8.  Q:  Why is it important that I avoid smoking and second-hand smoke before my surgery and during the recovery period?

A:  The nicotine can inhibit normal blood circulation, thus significantly increasingly your risk of developing skin necrosis or death of skin tissue, a complication that often leads to delayed healing and unnecessary scarring.

9.  Q:  What is the most ideal diet during my recovery after plastic surgery?

A:  Because your body will need to repair itself after a surgical procedure, your diet should be high in protein.  However, you should watch your sodium intake since too much of this may aggravate swelling.

10.  Q:  Why is it important to wear compression garments particularly during the first few days of my surgery?

A: If you undergo breast augmentation, breast lift, breast reduction, liposuction, facelift, body lift, and tummy tuck, your doctor will require you to wear a compression garment for a certain period of time in order to prevent sagging, provide support to the new contour, and minimize swelling.

11.  Q:  What are the tell-tale signs of complications related with surgery?

A:  You should immediately seek medical attention if you experience any of the following: abnormal heart rate, swelling and bruising which do not subside after a week, delayed healing, and other conditions which are “out of ordinary.”

12.  Q:  How can I avoid or at least minimize the appearance of scars?

A:  Never expose the incision sites to direct sunlight for six to 12 months in order to avoid dark pigmentation.  You can also use petroleum jelly or special creams, ointments, and lotions especially those containing vitamin E and C, glycolic acid, onion extract, Retin-A, and emu oil.  However, you should only apply these creams after the surgical wound is completely closed (to be on the safe side, you should ask your doctor).

13.  Q:  Aside from using creams and lotions, what are the other ways to remove or minimize the appearance of scars?

A:  Scar revision procedures may include laser resurfacing, anti-inflammatory agents to flatten and/or soften the scar tissue, and medical tattooing to camouflage the dark pigments.

14.  Q:  Is the result of plastic surgery supposed to last a lifetime?

A:  It will depend on the type of procedure.  For example, the result of tummy tuck, body lift, breast reduction, and liposuction can last a lifetime as long as you will maintain a stable, normal weight and avoid future pregnancy.

Rhinonoplaty or nose-reshaping surgery is also supposed to last a lifetime unless you experience unexpected nasal growth.  For this reason, most doctors require their patients to be at least 15 years old to make sure that their nose is fully developed.

But if you will undergo a breast augmentation, expect that you will have a revision surgery at some point in your life since breast implants are not designed to last forever.

However, certain procedures including extensive tummy tuck and lower body lift for massive weight loss patients always require longer incisions that may result to visible scarring.  Fortunately, you can avoid this kind of risk by following these tips:

• Do not expose your incisions and skin to anything that will cause irritation or injury.  It is also important that you follow the proper wound care that often includes using gentle soap and avoiding vigorous scrubbing.

• Make sure the incisions are not exposed to direct sunlight for at least six to 12 months in order to avoid dark pigmentation.

• While the surgical wound is not yet completely healed, never perform strenuous exercises that may reopen the incisions.  Just to be on the safe side, you should ask your plastic surgeon on when it is safe to resume your daily life activities.

• You can ask your doctor about self-adhesive silicone sheeting.  These small patches have been the most commonly used method to minimize the appearance of scars after plastic surgery.  (See picture below.)

For over 20 years, these medical devices have been used in wound healing and also in the prevention of keloid, or the excess growth of scar tissue at the incision sites.  Meanwhile, dark-skinned patients are more prone to this problem than fair-skinned individuals.

Once the surgical scars are completely healed, these will often turn into a thin, less noticeable line.  But in case that your skin is prone to develop keloids and dark pigments, you might want to consider these other options:

• Laser resurfacing to soften and minimize the appearance of scar tissues.

• Medical tattooing needles that will inject pigments in order to hide or minimize the appearance of scars.

• Use of special lotions, creams, and ointments especially those containing vitamin E and C, glycolic acid, onion extract, and Retin-A.  But you should take note that the effectiveness of most of these ingredients is not yet proven, although many patients have reported that they were satisfied with the result.

• Use of anti-inflammatory agents to soften the scar tissues.

Meanwhile, breast implants come in two shapes: round and teardrop (also called anatomical) both of which have benefits and downsides.

Round implants have a symmetrical dimension which resembles an M&M when they are placed on top of a table.  The advantage of the round shape is that the shell can move without distorting the appearance of the breasts.

Another advantage of round implants is that they can create fullness in the upper poles of the breasts, thus resulting to a more noticeable cleavage.  And contrary to a myth, this shape does not automatically result to a fake, augmented look especially in the hands of a skilled plastic surgeon.

Compared to the anatomical implants, round implants are less expensive which makes them a more popular choice.

On the other hand, anatomical or teardrop implants appear oval in shape but when viewed from the side, they have more volume at the bottom than the top.  For this reason, many surgeons believe that this shape can provide a more natural look as it simulates the sloping appearance of the breasts.

Anatomical implants were first designed to reconstruct the breasts, although doctors have started using these devices in cosmetic breast surgery due to their aesthetic benefits.

But because of the conical shape of these implants, they may flip over while inside the breast pocket, thus leading to a cosmetically displeasing and distorted appearance.  As a result, these implants have a textured shell to prevent gross movement and to allow tissue adherence.

However, a textured surface does not provide a 100 percent guaranty that the anatomical implants will not flip.  With this consideration, it is very important for a patient to choose a surgeon who is experienced in placing these materials in the breasts.

Regardless of which implant shape is used, most doctors prefer to place this device under the chest muscles, instead behind the tissue, so more amounts of skin and tissue can cover the shell, thus minimizing the risk of rippling and wrinkling.  In addition, this implant placement can prevent or at least postpone breast ptosis or sagging which commonly occurs with advancing age or after major weight loss.

These are the types of plastic surgery performed to aesthetically improve the breasts:

• Breast lift

Due to pregnancy and natural effects of aging, the breasts may drop due to their own weight and gravity.  To treat this problem, plastic surgeons use breast lift which often involves an anchor-shaped incision—the first one is around the areola, the second travels downward from the areola to the breast fold, and the third covers the entire crease of the bust.

While the anchor lift is very effective in removing the excess skin and manipulating the underlying muscles, this approach is relatively extensive for women with small- to medium-sized breasts.  With this consideration, plastic surgery specialists have developed modified breast lift techniques which are less invasive than the traditional approach.

In some cases, breast lift is combined with breast implant surgery if a patient wants to have a more prominent cleavage.

• Breast augmentation

Traditionally, this plastic surgery procedure is performed using saline- or silicone-filled implants to increase the bust size and create a good cleavage by making the upper poles appear fuller and rounder.

But for patients who only want to slightly increase their breast size (or less than a cup), fat grafting is usually considered as a better option.  In this procedure, plastic surgeons collect fats from the abdomen (or any area where there is a significant amount of fatty deposits) and then transfer these to the bust.

• Breast reduction

For women with an extremely large bust, they can have breast reduction surgery which uses an anchor-shaped incision, allowing plastic surgeons to remove the extra skin and fats and manipulate the surrounding tissues.

In some cases, breast reduction is not only treated as a cosmetic procedure but also as a way to address the physical symptoms such as back problem, chronic pain in the shoulder and neck, skin irritation in the breast crease, and difficulty to engage in sports and other rigorous activities.

If breast reduction is used to treat the physical symptoms stated above, it is important to note that it may be covered by some insurance providers.

Meanwhile, this procedure may also involve areola reduction to make it appear more natural to the breasts.

When it comes to giving a natural appearance, most plastic surgeons believe that the silicone implant, which is filled with a cohesive gel material, provides a slightly better result compared to the saline version.  This is because it uses a filling noted for its ability to replicate the feel and natural movement of a breast tissue.

On the other hand, women with saline implants usually compare the feeling of having a water-balloon inside their breast.

Another advantage of the silicone implant is that patients can maintain their breast volume for many years unless if the shell breaks.  According to experts in plastic surgery, this may not be the case for women with saline implants which have a natural deflation rate of about 1 percent every year due to evaporation and other related factors.

Meanwhile, petite women or individuals with a limited amount of breast tissue and skin will most likely benefit from using silicone-filled implants which can lower the risk of rippling—a problem which may happen if the glandular tissue is not thick enough to cover the shell.

Many plastic surgeons also believe that patients who have had tumor removal will more likely benefit with silicone than the saline implants because they are usually left with a small amount of breast tissue.

Despite the notable advantages of silicone implant, plastic surgeons inform their patients that it has still some downsides.  For example, having this implant requires a periodic MRI screening—at least every two years—to identify any rupture in the shell which may go undetected for years if women will only rely on the “visible manifestations.”

On the other hand, this test is not a requirement for patients with saline implants because a rupture will immediately provide a manifestation in the form of breast deflation.  With this, they can easily seek a revision breast augmentation to correct such problem.

Since the saline implant is filled with a sterile saltwater, a rupture does not expose patients to serious health problems because the filling can be safely absorbed by the surrounding tissue.

Regardless of which type of breast implant is used, the primary purpose of this biocompatible, synthetic material is to increase the bust size, make the cleavage more prominent, and create a more womanly figure.