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.

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.

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.

With this consideration, breast reduction surgery is covered by insurance if this is reconstructive in nature, meaning, it is performed to treat the physical symptoms associated with large, heavy breasts and not just to aesthetically improve the body.

To qualify for insurance coverage, a patient should meet these following criteria:

• Experiencing physical symptoms such as poor body posture, discomfort along the bra strap, chronic pain in the back, neck and shoulder, skin irritation in the crease or breast fold, and difficulty to perform exercise.
• The estimated weight of tissue and fats to be removed from each breast should be 300 grams or more.
• Wearing a C cup bra or larger.
• A patient should be near her ideal body weight and/or body mass index (BMI).  Unfortunately, many women with enormously large breasts find it hard or even impossible to exercise because of their condition, consequently, it is important that a surgeon states this dilemma and mentions that breast reduction surgery can allow their patients to lead an active lifestyle.
• Suffering from a condition called macromastia in which the breasts become extremely large because of heightened sensitivity and/or high levels of female hormones in the bloodstream.  If each breast weighs 600 grams, this is already considered a case of macromastia.
• Have already tried other non-surgical treatments such as supportive bras, weight loss, and physical therapy which did not improve the symptoms related to large, heavy breasts.

Even if some patients meet the criteria for breast reduction coverage, there are cases in which insurance companies deny their claims because of policy exclusion or the lack of information.  For this reason, it is important to carefully read the policies before contacting the insurance agents.

In case the reason for denial is the lack of information, a patient and her plastic surgeon can make an appeal by providing more evidence such as photographs and supporting letters of other doctors and therapists.  And if the insurance providers cite policy exclusion as the cause of rejection, a patient can file an appeal to her state department since many states nowadays mandate breast reduction coverage for patients who fit the criteria.

But in case the non-surgical procedures did not solve the problem, plastic surgeons will most likely recommend gynecomastia surgery which involves incisions to remove the excess tissue and fats.  If needed, liposuction is also performed to further improve the breast’s contour by eliminating the extra fatty tissues.

But as an invasive procedure, male breast reduction surgery involves certain risks particularly for men who have health conditions that may predispose them to delayed healing, infection, bleeding, unnecessary scarring, and other complications.  For this reason, patients should meet these following requirements before they are considered as a good candidate for this surgery:

• They have realistic goals and expectations
• Well-rounded individuals
• Physically healthy with no serious illness
• Their breast development has stabilized
• They have passed their puberty stage (during this period, the hormonal imbalance may lead to overdeveloped breasts which will resolve on their own within several months)
• They are bothered by the appearance of their enlarged breasts

Because gynecomastia surgery often involves incisions, it is very important that the patients do not suffer from diabetes and other illnesses that inhibit the healing process and expose them to higher risk of infection and unnecessary scarring.

In most cases, the result of this cosmetic procedure can last a lifetime, although this may be affected or even completely reversed by a significant weight fluctuation.  With this consideration, plastic surgeons recommend their patients to maintain their normal weight through a healthy diet and regular exercise.

Also, doctors only perform this procedure on men who are within 25 to 30 percent of their recommended body weight.

Aside from being physically fit and having a normal body weight, it is also important that the patients are not smokers.  But in case that they are, they should quit the bad habit well in advance of the surgery and during their recovery to prevent the risk of skin necrosis (or death of skin tissue that may lead to unnecessary scarring).

According to a previous study, patients who are smoking are 1,500 times more likely to develop skin necrosis after a surgery compared to non-smokers because the nicotine affects the circulatory system and inhibits the oxygen from reaching the wound.

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.