If the procedure is performed not just for cosmetic reasons but primarily to treat the physical symptoms associated with large, heavy breasts, there is a chance that some insurance companies provide coverage for the surgery’s cost.

In order to get approval from insurance providers, a patient must be able to meet certain criteria while her plastic surgeon must prove that the procedure is beyond cosmetic reasons and is needed to alleviate or treat the physical symptoms of large and heavy breasts.

One of the most important criteria is the discomfort and physical symptoms experienced by a patient because of her inordinately large breasts.  For this reason, most insurance companies require at least 500 grams (or about 1.10 lbs.) of tissue and fats to be removed from each breast before they consider a surgery as a “reconstructive” and medically necessary procedure.

In addition, a plastic surgeon must describe in his letter all the efforts of his patient to resolve macromastia (or breast enlargement) which had failed.  Photos can also be helpful to show the severity of the condition which makes the surgery a necessity rather than a procedure to improve one’s appearance.

Most insurance companies also stipulate that a patient should be near her ideal body weight, and unfortunately, this requirement is relatively “tricky” since it is often difficult or even impossible to perform exercise and lead an active lifestyle if the breasts are too large and heavy.  For this reason, a plastic surgeon should highlight this dilemma in his letter and tell an insurance provider that breast reduction can allow a woman to shed her extra weight.

In case that a patient is overweight, it would be helpful if her surgeon will state in the letter that she already had macromastia even if she was previously near her ideal body weight.

Meanwhile, it is important that both the surgeon and his patient only provide honest information to the insurance companies since it is considered a crime to give misleading and false claims.

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.

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 the problems associated with overly large bust size, plastic surgeons use reduction mammaplasty which can trim off the excess fats, skin, and tissue.  If necessary, this is performed in conjunction with liposuction to further reduce the breast size by eliminating the extra fatty tissues.

In cosmetic and reconstructive plastic surgery, the most common breast reduction techniques are the anchor incision and its modified versions, the lollipop and donut incisions which are ideal for women with smaller breasts and/or moderate ptosis (sagging).

Women with inordinately large breasts with severe ptosis will benefit more with the anchor-shaped incision which is the most invasive technique as it involves excising the extra skin and  and tissue around the areola, across the breast crease, and the vertical area between the nipple and the crease.

While this approach provides a dramatic outcome, this is too extensive for women with smaller breasts and those with minimal to moderate ptosis.  For these patients, plastic surgery specialists will most likely recommend a minimally invasive approach which also provides a great result minus the excessive scarring.

For women with large bust and moderate to minimal ptosis, and patients with medium-sized breasts and severe sagging, the lollipop incision is the best option.  This technique also uses the same incision sites found in the anchor method, minus the one across the breast crease which is the area that takes the longest time to heal.  For this reason, women can expect faster recovery and one less scar.

Another less invasive technique in breast reduction is the donut incision which is performed by excising the tissue around the areola.  Meanwhile, the scars are well-hidden along the edge of the skin and areola which makes this technique appealing to many patients.

But to fully enjoy the benefits of donut incision, many plastic surgeons believe that patients should have a smaller bust with minimal ptosis.  On the other hand, this approach is not enough to address larger breasts particularly with severe sagging.

Some doctors in plastic surgery complement the donut incision with breast implants in order to correct a more pronounced sagging.  But since the weight of these materials may further exacerbate the ongoing ptosis, they always place these under the chest muscles to make sure that a thicker wall of tissue and skin can provide a reliable support.

In 2009 alone, about 5.2 million reconstructive plastic surgery procedures were performed in the US, according to the American Society of Plastic Surgeons (ASPS).  This is an increase of 5 percent from the previous year.

In a survey conducted by ASPS, the top five reconstructive plastic surgery procedures in 2009 were (in respective order) tumor removal, laceration repair, scar revision, hand surgery, and maxillofacial surgery.

While cosmetic procedures are not usually covered by insurance companies, it is important to note that reconstructive surgeries are typically included in the insurance policy as these are medically necessary, according to plastic surgeons.

However, certain cosmetic surgeries may also be used as a reconstructive procedure.  For example, rhinoplasty (or more commonly referred as “nose job”) can improve the aesthetic feature of the nose while correcting abnormal growth or injury that is usually associated with difficulty in breathing, frequent nosebleed, and recurring nasal infection.

Another example of cosmetic treatment which can also serve as a reconstructive procedure is the breast implant surgery (either with the use of saline- or silicone-filled implants).  According to plastic surgeons, this approach is ideal for women who had tumor removal surgery (to prevent or treat cancer) and want to regain the volume of their bust.

To perform reconstructive breast implant surgery, doctors usually place tissue expander under the chest muscle to create enough room for the implants.  After this, they will inject this balloon-like device with saline solution every one or two weeks to stretch the skin and tissue.

Once the device has created enough room for the implants, surgeons will then remove and replace this with saline or silicone implants.

Meanwhile, breast reduction surgery is another cosmetic procedure that may be sometimes considered as a reconstructive treatment.  With this, some insurance companies cover the expenses related to this surgery, although most of them require that it should involve a significant amount of skin and tissue and that the patients should be suffering from physical symptoms related to extremely large bust size.

Some big-breasted women suffer from poor body posture, inability or difficulty to engage in sports, skin irritation in the breast crease, and chronic pain in the back, neck, and shoulder.

While reconstructive plastic surgery is obviously necessary for teenagers as this will improve their body’s function, treat physical difficulties, and help them live a normal life, this is not the case for cosmetic surgery which is solely performed to improve the physical appearance.

One of the most cited reasons why teenagers should delay cosmetic plastic surgery is that their level of emotional maturity may not be enough to understand its limitations and risks.  In addition, they are prone to social pressure compared to other age groups; in fact, a study conducted by the American Society of Plastic Surgeons (ASPS) has shown that teens view surgery as a way to fit into their community while adults see this as a way to stand out from the crowd.

Aside from emotional maturity, another important consideration is a patient’s physical development.  According to plastic surgeons, a teenager’s body is still growing which may affect the result of cosmetic procedure, and for this reason, she will most likely need a revision treatment in later years.

For example, if rhinoplasty or “nose job” is performed on patients aged younger than 14, there is a great chance that they will undergo a revision procedure several years after their initial treatment since their nasal structure is not yet fully developed.  It is important to note that subsequent surgery is usually more expensive and complicated and involve more risks.

Because the natural development of the body may affect the result of a particular cosmetic procedure, plastic surgeons consider the age of their patients and usually turn down anyone who will not meet this requirement.  For instance, breast augmentation surgery through the use of saline implants require a person to be at least 18, or 21 years old if she will have the silicone version.

In liposuction treatment, most doctors also require their patients to be at least older than 20 since some people just appear plump because of their “baby fats” which usually disappear in later years.  But in some cases, this procedure is given to male teenagers who are suffering from gynecomastia, a condition in which their breasts become enlarged due to the excess fats, skin, and/or tissue.

On the other hand, pseudogynecomastia is primarily caused by the fatty deposits rather than the tissue.  For patients with this condition, most doctors would rather recommend weight loss than plastic surgery that usually involves excision technique and liposuction.

According to a recent study, about two-thirds of pubescent boys have gynecomastia due to the hormonal changes in their body.  And because of this reason, plastic surgeons require most of their patients to wait until they are physically mature since the condition may disappear on its own, in most cases in just several months as the levels of hormones normalize.

But if the condition appears during adulthood, it tends to persist unless if there is a medical intervention which may be in the form of plastic surgery, treatment of the underlying cause, and avoidance of medications that are causing the aesthetic problem.

If gynecomastia is caused by a certain disorder or tumor, this should be addressed first instead of performing a cosmetic plastic surgery on the breast.  Meanwhile, if the condition is due to hormonal imbalance (because of the use of certain drugs such as steroids and those containing estrogen), doctors would rather find ways to normalize the levels of hormones so as to avoid scarring related to surgery.

But in case that gynecomastia still remains despite the use of non-surgical means, the most recommended procedure is excision technique in which plastic surgeons trim the excess tissue and skin.  If needed, they complement this procedure with liposuction to further improve the breast by removing the fatty tissues.

To create the best result, the incisions made during the gynecomastia surgery are placed depending on the location and amount of excess tissue and skin.  And as much as possible, plastic surgeons create the excisions along the natural creases of the skin and/or around the perimeter of the areola to hide the scars.

For gynecomastia surgery that involves liposuction, the procedure is performed first by creating several small incisions directly to the fatty area to remove the excess fats.  After this, doctors place a diamond- or U-shaped incision that travels along the breast crease to the areola above.

If the diamond-shaped incision is used, a horizontal scar will travel across the nipple.  But in the U-shaped incision, the scar will fall perfectly along the breast crease which makes it less noticeable.

For women who have undergone a very extensive mastectomy, they are most likely left with a small amount of tissue and skin that makes reconstructive plastic surgery more difficult.  In this case, usually the best approach for them is the tissue-based method in which their plastic surgeons use their own muscles, skin, and fats to recreate their breasts.

Meanwhile, some patients can have breast reconstruction surgery at the same time of their mastectomy.  In this way, they can expect a more convenient recovery instead of having to undergo two separate procedures.

But in some cases, plastic surgeons perform breast reconstruction a few months or years after mastectomy to reduce the risk of complications and limit the surgical trauma for certain patients.

As with any extensive plastic surgery, tissue-based breast reconstruction is usually performed under general anesthesia in which the patients are pain-free and asleep during the entire operation.

Currently, there are several ways to reconstruct the breasts using a patient’s own muscle, tissue, skin, and fats, although the two most common techniques used by plastic surgeons are the latissimus muscle flap with breast implants, and transverse rectus abdominous muscle flap (TRAM).

In latissimus muscle flap with implants, doctors make an incision in the upper back to the side of the breast to loosen the fats, skin, and muscles from this area.  After this, they connect this tissue under the skin in the breast which has undergone mastectomy in order to recreate it.

To prevent the risk of skin necrosis and other complications, doctors make sure that the blood vessels remain connected to the area where the tissue is taken from.

Once the tissue is reshaped to simulate the natural appearance of a breast, plastic surgery specialists will place silicone or saline implants under the chest muscles.  If needed, they will also reconstruct the nipple and areola to further achieve a more natural look.

On the other hand, TRAM involves an incision across the lower abdomen (from hipbone to hipbone) to loosen the fats, skin, and muscles in the area which can serve as the tissue to recreate the breasts.  The blood vessels also remain attached to their original site, although some doctors prefer to completely remove the tissue from the area and reconnect this to the blood vessels under the arm.

Once the tissue is shaped to recreate the breasts, surgeons will then close the abdominal incision using sutures.

These are the most common breast problems and their corresponding solution, according to LA plastic surgeons:

• Drooping breasts

Due to aging, pregnancy, and major weight loss, some women develop drooping breasts with nipples pointing downwards.  To treat this problem, plastic surgery experts use breast lift which involves removing the excess skin, manipulating the underlying muscles, and raising the bust to a higher position.  In some cases, they complement this surgery with implants to further make the breast, particularly the upper pole, appear fuller.

• “Swooping” breasts

While the breasts do not have a pronounced droopiness, they bend inward above the areola resulting to a “swooping” appearance.  To treat this aesthetic problem, plastic surgeons use breast implant surgery to improve the contour of the bust.

• Smaller breasts

Due to genetic predisposition, some women have extremely small breasts almost comparable to men’s.  Fortunately, breast augmentation through the use of saline or silicone implants can increase their bust size.

For women who do not want to use synthetic materials to increase their breast size, they can opt for fat grafting, a procedure in which doctors collect fats from their tummy (or areas where fats tend to accumulate), which are purified to separate the blood and tissue and then re-injected to the breasts.

However, fat grafting can only increase the breast with less than a cup, which means that it is not ideal for women who want to significantly augment their bust.

• Tuberous-shaped breasts

In this problem, the breasts have a prominent outward projection from the chest wall and are very narrow at the base, thus resulting to a tubular shape.  This condition usually happens on women who have small breasts with noticeable droopiness due to skin and tissue laxity.

In LA plastic surgery, most doctors treat this problem through breast implant surgery that is usually combined with breast lift especially for women with extremely sagging bust.

• Enlarged areola

In some cases, women who need breast lift or breast reduction will also benefit from areola reduction surgery to further create a more natural-looking appearance.  Fortunately, combining this procedure with other breast surgeries does not require additional incisions because they usually have the same surgical site.