Breast reshaping in the extreme weight loss patient almost always require the combination of an extended breast lift and a breast implant. The loss of breast tissue from the weight loss and the now overstretched skin results in a deflated breast with a significant sag. The nipple lies below the lower breast crease and in many patients it points directly to the floor. Such a misshapen breast requires both volume (breast implant) and a radical skin reshaping. (lift)

While this combination breast reshaping procedure is commonly done, it is not easy to get a good symmetrical breast result. The need for secondary revisions with this approach is not rare. Revision rates may be as high as 25% to 35%. The reason this procedure is difficult from a cosmetic standpoint is that the breast lift and the implant work against each other in achieving their goals. A breast lift is a skin reduction procedure that lifts and tightens, a breast implant is an expansion procedure that stretches and lifts. There is no exact science that can tell a plastic surgeon exactly what size implant is needed for how much skin is removed in a lift. It is as much an art as anything else.

One valid approach is to do the breast lift first and defer the placement of the breast implant as a second stage months later. While this staged approach has its advocates, it condemns the patient to two operations 100% of the time. While the combination of a lift and implant may require a significant percent of patients to need two operations due to a revision, the majority of patients (> 50%) will be able to get a satisfactory result in one combined operation.

The primary objective of this form of breast reshaping is to get the nipple lifted and centered on the breast mound. This results in the classic anchor breast scars to achieve it and the blood supply to the nipple is always in jeopardy with the low but real risk of nipple loss. The implant is placed through the same approach as that of the breast lift.

The combination of breast scars, an uplifted nipple position, breast implants, and having two breasts makes achieving perfect symmetry and shape between the two breasts a difficult proposition in the combined lift/augmentation procedure. Fortunately, most extreme weight loss patients are quite satisfied with significant improvement in their breasts even when revisional procedures may be needed.

Since silicone implants were banned in the 1990s, saline has been the only choice open to women who wanted breast augmentation. Silicone made a comeback in 2006, but many women are still leery of them because of the chance of leakage. Saline implants cause rippling and don’t feel as natural as silicone. They also have a possibility of rupture, leakage and deflation.

So, given the disadvantages of all these implant choices, manufacturers like Silimed have been working on alternatives for years. Gummy bear or cohesive gel implants are the newest innovation in these devices. Because of the consistency and cohesive properties of the gel they do not leak and provide a safe alternative for women concerned by the possible adverse health effects of leaking silicone.

These devices consist of a very dense, high-strength, solidified silicone gel. When cut, this gel resembles the popular gummy bear candies in consistency and holds together, preventing the silicone leakage that was feared to cause connective tissue disorders like lupus. That’s the reason they are known as “gummy bear” implants.

What are the advantages of gummy bear over traditional saline?

Gummy bear implants have been used by women in Europe for a decade and have only now been approved for use in clinical trials in the U.S. Because they are designed to hold their shape and are much less likely than salines to shift, wrinkle, fold or ripple, they are one of the most popular choices for women opting for augmentation surgery.

Because they hold their shape better, they also tend to remain in an upright position and cause much less sag over time. Plus they do not make sloshing sounds like salines make. Gummy bears are the most promising alternative to standard gel and saline filled devices.

The disadvantage is that they are inserted as a complete unit and require a larger incision than saline implants, a fact that also limits the incision placement options. These devices also have an increased risk of scarring, but for many women, their durability and long-term benefits outweigh these disadvantages.

How natural do gummy bear devices feel?

Saline implants can feel very hard when overfilled, but gummy bear devices do not have this problem. Women like them because they feel very natural and closer in feel to a natural breast.

How safe are they?

Silimed, the manufacturer of these new devices has an ISO 9001 certificate that means they meet the quality standards for these which these medical devices. The FDA has also given them a clean chit of safety and allowed them to be used in clinical trials in the U.S. Plastic surgeons have also reached a consensus that they are safe and effective for use in augmentation surgery. In Europe, they have been used by women for years and are one of the most popular choices.

What sizes do they come in?

Gummy bear implants are available in all cup sizes up to “DDD”. A competent and experienced surgeon can help you decide which one is best suited for your body type and aesthetic preferences.

How do I know if gummy bear implants are right for me?

Only you and your surgeon can take that decision. Make sure your surgeon is qualified to practice plastic surgery and has training and experience in using these devices. Also ask him to show you before and after photos of former patients to assess if his results match those you hope to achieve.

Breast enlargement is one of the fastest growing plastic surgeries in the United States today and is becoming increasingly common in young women who seek to take control of their bodies and enhance their natural shapes. The FDA has approved two main types of implants to be used in this type of plastic surgery: silicone gel implants and saline implants (e.g. a type of salt water).

According to FDA restrictions, silicone gel filled implants are only available to women aged 22 or older for breast augmentation because a woman’s breast tissue continues to develop into her early twenties. Saline implants, on the other hand, are available to any woman 18 or older for augmentation as they are considered to have slightly lower risk compared to those using silicone.

The implant is either inserted under the chest muscle or under the breast tissue depending on the woman’s body type and the size of the implant. Prior to getting plastic surgery, you should consult with your surgeon as to which of these two types of implants would work best for you.

In addition to deciding which type of implant to get, it is also important to consider the cup size you desire. It is crucial you think about what would look best with your body frame, as well as just how big you want to go! Many ladies will bring in pictures of their favorite model or celebrity prior to their plastic surgery to show the ideal size they are aiming for. You can also try on the implants by inserting them in your bra prior to plastic surgery to see what you think looks the best!

You will hear the surgeon discuss breast implants in terms of cc’s or cubic centimeters. This represents the amount of fluid which will go into the implants. For example, about 189 cc of saline is needed to go up one cup size.

However, it is important to note that there is no real formula for how to determine the number of cc’s that is equal to each bra cup size. For one, you have probably noticed that every brand of bra fits you differently as there is no such thing as a “standard size.”

The amount of fluid that is needed in the implant is also determined by your individual chest wall and the amount of breast tissue you have. It is best to discuss with your doctor exactly how many cc’s will be best for you based on your enhancement goals.

The reason many women undergo augmentation is to increase their confidence level and feel better about themselves. It is one way we can empower ourselves to have the sexy body and look the way we have always wanted. Who doesn’t want a sexy, curvy shape especially when wearing a bikini on the beach or low cut tops?

It is important to know the facts about breast enlargement and to do your research prior to having any plastic surgery. Knowing the types of implants and the lingo used is an important step in the process. Overall, having breast implants and feeling good about your body can give you the confidence to say and do what you want to. Why not be the woman you’ve always wanted to be?