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.

The ideal forward projection or breast implant profile will largely depend on the body frame of patients.  For instance, women with a very narrow or petite frame are recommended to have high profile implants while large-framed individuals should have moderate or low profile implants in order to achieve the most natural result.

High profile breast implants project more and their sidewall has more height, thus resulting to less risk of visible rippling.  However, their base is narrower compared to low and moderate profile implants which makes them ideal for patients with smaller body frame.

On the other hand, low and moderate profile implants have a less frontal projection but have a wider base which makes them highly ideal for large-framed women who have a broader chest.  It is important to note that these patients may end up having a cosmetically displeasing, pointed-looking breast if they will receive high profile implants.

However, not all petite patients should assume that they automatically qualify for high profile implants.  In fact, a woman with a height of 4’10” may still have a relatively wide breast base which qualifies her to have low profile implants that can provide enough coverage and avoid the “extra” space from the base of the chest.

To be on the safe side, patients should only consult with a board-certified plastic surgeon who specializes in breast implant surgery and has an extensive experience in this craft.

Patients should remember that a good plastic surgeon will always consider a person’s anatomy and will not push its limit by introducing implants that are too large in relation with the body frame or use inappropriate profiles which may result to a cosmetically displeasing result.

Aside from profiles, implants also come in different shapes (round or teardrop), sizes, shell texture, and fillings (saline or silicone gel) in order to create the most desired result and accommodate the anatomical features of a patient.

Meanwhile, petite women who often have limited amounts of tissue and skin in their breasts are generally advised to have smaller implants to minimize the risk of visible rippling, back pain due to the extra weight of the devices, “heavy” top appearance, premature ptosis or sagging, and other complications.

Using inordinately large implants in relation with the body may also result to more pain and discomfort during the healing time and longer recovery.

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.

Breast reconstruction via implants is less complex and involves fewer surgeries compared with tissue grafting.  But regardless of which technique is used, the procedure may not perfectly recreate the appearance of the breasts before the mastectomy.

In the US, only the saline- and silicone-filled implants have been approved by the Food and Drug Administration for breast reconstruction surgery.  But when it comes to giving a more natural result, many plastic surgeons recommend the silicone type because it is filled with a relatively cohesive gel that can replicate the movement and feel of a breast tissue.

Breast reconstruction through the use of implants can start right after the mastectomy particularly if a significant amount of tissue remains in the breasts.  However, this may not be possible if the tumor removal surgery is too extensive.

In case the mastectomy involves the removal of a significant amount of tissues and skin, a tissue expander is first inserted inside the breasts before the implants are placed.  This balloon-like device, which is injected periodically with saline solution, will slowly stretch the skin and tissue for six to eight weeks in order to create enough room for the breast implants.

Once the tissue expander has created a pocket where the implants can be placed, this instrument is then removed in order to start the breast implant surgery.

To create a more natural result and prevent visible lines, most doctors place the breast implants under the chest muscles so more amounts of skin and tissues can envelop the shell.  Another benefit of this implant placement is that it prevents breast ptosis (sagging) since the thicker wall of tissue can support the weight of the implants.

In some cases, doctors also add or reconstruct the areola and nipple during a breast implant surgery in order to make the appearance as natural as possible.

Meanwhile, some patients are concerned that the implants may interfere with their mammogram test which is used to detect tumors and other abnormalities.  Fortunately, there is a very low risk of cancer recurrence for mastectomized breasts which is why breast reconstruction via implants is a highly recommended procedure among plastic surgeons.

To treat this aesthetic problem, breast lift surgery is the most recommended solution as it provides a long-lasting result.  But still, it is important to note that the aging process may slightly affect the outcome of this procedure in the long run, although the breasts will not experience significant sagging.

Meanwhile, significant weight fluctuations and pregnancies may affect or even reverse the result of breast lift.  For this reason, most patients are advised to postpone this cosmetic procedure if they are 25 to 30 percent heavier than their ideal weight and if they are planning to have children in the future.

As with most cosmetic breast surgeries, this procedure involves the use of incisions which can lead to permanent scars.  But as much as possible, doctors will place the surgical lines in areas in which these will not be seen even if a patient will wear a low-cut top.

For women with large breasts and severe ptosis, the most recommended incision pattern is shaped like a nautical anchor: a horizontal cut across the breast crease, an excision around the perimeter of the areola, and a vertical incision starting from the areola to the breast crease.

However, there are cases in which the horizontal incision across the breast crease can be removed particularly if plastic surgeons only have to excise a small amount of skin and tissue.  With this minimally invasive technique, which is called lollipop lift, most patients can enjoy shorter recovery and one less scar.

Meanwhile, some women not just want to lift their sagging breasts but also desire to make their bust appear fuller.  For these patients, the most recommended approach is the donut lift (only the skin and tissue around the areola is excised) which is complemented with breast implants, preferably the silicone type in order to achieve a more natural result.

Because the weight of the implants may aggravate the ongoing breast ptosis, these devices are generally placed under the chest muscles so more amounts of skin and tissue can provide a better support.  On the other hand, placing the implants behind the tissue is not recommended since it can worsen the sagging in the long run.

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.

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.