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.

To help you become better prepared for plastic surgery, the California Surgical Institute has provided a list of answers to the most frequently asked questions about preoperative preparation.

1.  Question:  What medications should I avoid before my surgery?

Answer:  You should avoid aspirin, anti-inflammatory drugs, and herbal supplements especially those containing green tea, ginseng, and ginkgo biloba which are found to increase bleeding during the surgery and recovery.  These medications should be stopped at least two weeks prior to the operation. Just to be on the safe side, you should tell your doctor about all the medications you are currently taking.

2.  Q:  Why is it important to quit smoking well in advance of the surgery?

A:  The nicotine has been found to inhibit the normal circulation of oxygen, thus predisposing patients to higher risk of skin necrosis or death of skin tissue.  If this complication happens, they may experience delayed healing and unnecessary scarring.

If you are a smoker, you should quit the habit at least two weeks before the surgery and avoid this during your recovery period.

3.  Q:  What are the things that I should prepare in order to have a comfortable recovery?

A:  Your doctor will prescribe all the drugs (antibiotic, pain medications, etc.), medical garments, proper clothing, icepacks, and other supplies that you will need during your recovery.

In addition, you should purchase easy-to-prepare foods such as soup, yogurt, oatmeal, frozen dinners, cottage cheese, crackers, and protein shakes.

4.  Q:  What other supplies should I purchase prior to my surgery?

A:  It is important that you prepare antibacterial soaps, thermometer, petroleum jelly or moisturizers for the incisions, loose clothing (ideally button-down shirts and pajamas), and low-sodium foods.

5.  Q:  How long is my work leave should be?

A:  You should take a leave from work so you can have plenty of rest and sleep.  But since the length of recovery will depend on the extensiveness of the procedure and your body’s healing ability, you should ask your doctor on when is the safest time to return work.

And because your recovery may take several weeks, you should also prepare some magazines and books, DVDs, video gaming devices, and other sources of entertainment to fight boredom.

6.  Q:  Should I assign a capable adult who will tend to my needs while I recover?

A: Yes.  Arrange someone to care for you during the first 24 to 72 hours of your recovery since it will be difficult for you to move around while the anesthesia wears off.

7.  Q:  Should I arrange for an overnight stay at a hospital?

A:  While most plastic surgery procedures are performed as an outpatient basis, you may choose to have an overnight stay at a hospital (or sometimes even longer if your surgery is extensive).

8.  Q:  How can I prepare my house in order to have a comfortable recovery?

A:  Have a telephone near your bed (turn off the ringer while you are sleeping) so you can call your doctor or someone in case that you will experience something that is out of ordinary; clean your house prior to the surgery; place all the supplies you will need everyday in accessible areas or at hip level (so you will not bend down or reach your arms too high); and if you have a small child, ask someone to take care of him/her while you are still recovering.

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.

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.

While this surgery can be performed at any age, most doctors recommend their patients to wait until they are at least 18 years old, a stage in which their breasts are fully developed.  Most experts also advise women to postpone breast reduction if they are considering having children in the future since their ability to breastfeed may be compromised.

Because breast reduction is relatively extensive, surgeons often perform this under general which can put a patient to sleep during the entire operation.  However, the surgery is typically conducted in an outpatient basis which means that a woman can return home on the same day of the procedure.

Nowadays, doctors use different incision patterns and techniques in order to achieve the most desired outcome.  But for women with excessively large breasts, the most ideal is the standard approach which involves an anchor-shaped incision—one around the perimeter of the areola, another cut that travels vertically from the nipple down to the breast crease, and a third one that horizontally covers the crease.

In some cases, the horizontal incision is removed particularly when only a small amount of tissue and skin is removed from the bust.

Once the incisions are made, the extra tissue, fats, and skin are excised in order to reduce the size of each breast.

In many cases, the nipple and areola remain to their original position.  However, doctors who are treating women with inordinately large, heavy breasts will have to remove and reattach this area to a higher position in order to achieve a more natural result.  And if needed, the sized of an enlarged areola is also reduced.

One major downside of detaching the areola and nipple from their original nerves and blood vessels may result to reduced or permanent loss of sensation.  In some cases, this procedure may also lead to a woman’s inability to breastfeed.

After a breast reduction surgery, the incisions are closed with tiny sutures and the chest is then covered with an elastic bandage or gauze dressing.

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.

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.

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.