Can a textured gummy bear implant be inserted through the areola?

Question

I'm a 27 y.o. mother of two i breast fed each for 6 months each. I'm very interested in getting a breast augmentation as I went from a 34C pre-pregnancy to a 34DD while breast feeding, NOW a 34A-B and a bit deflated. I'm looking into the textured gummy bear implant, I can't decide on round or shaped yet. I'm Latina and have a history of keloids, even with scar therapy. So is it possible to have the textured gummy bear implant inserted through the areola where there's less of a chance of keloids?

Larry S. Nichter, MD, MS, FACS · Answer

The size of your areola and the size of your implant would be required to hazard an opinion. Please note that the areola does not necessarily have less chance of a keloid, and this location is linked with a higher chance of capsular contracture vs an incision below the breast.

Richard H. Tholen, MD, FACS · Answer

Thanks for your question. In a patient who has a history of developing keloid scars, you are wise to consider which incisions will lead to the lowest chance of unsightly keloids. However, since inflammation and bacteria are known inducers of keloid scars, periareola incisions (bacteria in the breast ducts) are not what I would consider to be the best location, nor would I suggest axillary incisions, for these areas are warm, moist, with lots of bacteria in the sweat glands, and subject to arm movement, all increasing inflammation and higher risk of keloids. I would suggest that inframammary (crease) incisions will offer the least inflammation, fewest bacteria, minimal movement, and also best access for your surgeon to obtain precise hemostasis and the proper submuscular pockets to minimize caspsular contracture (CC), which would require re-operation (and another risk for keloid formation). I would also suggest submuscular implant placement, since submammary implant placement has a higher risk of CC, although textured implants do reduce these risks. But inserting them via periareolar incisions would increase the risk of keloid formation, IMHO. Also, you must have large areolas to allow this incision choice, and IF you do end up with keloids, they will be front and center, often uncomfortably tender and visible through clothing because of their protrusion.At least with inframammary (crease) incisions, if you end up with keloids, they will be hidden, and in an area where scar pad therapy can be held in place by your brassiere.As for round vs. teardrop-shaped, you need to read (click on the web reference link below) my Comprehensive Guide to Breast Augmentation--there is a whole section on choosing implants that discusses the pros and cons of round vs. shaped, smooth vs. textured, etc. Best wishes! Dr. Tholen

Andrew P. Trussler, MD · Answer

The 5th generation cohesive gel breast implants have advantages and disadvantages over gel implants. The cohesive silicone helps protect against silicone bleed or migration after rupture, as well the cohesive gel helps to shape the breast. Advantage for this implant may be in the deflated breast, the thin, athletic breast, and in breast reconstruction after mastectomy. These implants are firmer and less forgiving because of their shape. Precise pocket dissection helps to ensure them from moving and rotating. They do require a larger incision for placement and a periareolar approach is likely not the best choice for placement. A round, smooth 5th generation breast implant would be possible through a periareolar approach.

Heather J. Furnas, MD · Answer

If your areola is large enough and the implant small enough, one could insert the gummy bear implant through the areola.  However, as it needs a larger incision, it can create trauma even when using a funnnel.  If you are a ture keloid former I would be worried about the armpit incision. If you keloid there, it is very hard  to conceal in sun dresses and bathing suits.  Keeping a fold incision as short as the funnel allows could be an option.  There are excellent scar treatments available afterwards including Embrace therapy.  Consult in person with a board-certified plastic surgeon and ask all your questions.Click on the link below to see a healed Sientra implant augmentation with a fold incision.

Francisco Canales, MD · Answer

A gummy bear implant will require a larger incision to place. If the areola is chosen, the areola needs to be large enough to acommodate that incision.  The chance of trauma to the areola/nipple complex and the surrounding tissues is increased , even with the use of a Keller funnel (see below).  A properly placed fold incision carries fewer of those risks. Discuss it in person with your board-certified plastic surgeon.

Rafi S. Bidros, MD, FACS · Answer

Thank you for your question. Textured shaped implants require a slightly larger incision to insert and it's easier to insert with the funnel, but you have to have a relatively large areola and small implant to accomplish. My recommendation would be to insert the gummy bear implant through the inframammary fold.  In the event you get a keloid, it is under the breast and not as visible as a keloid around the areola. Best Regards,

Victor Ferrari, MD, FACS · Answer

Thank you for your questions.  If your areola are large enough in diameter, you could get implants put in through that site.  However, you mentioned keloids.  If you are truly a keloid former, you may want to consider another access route (such as the underarm).  In other words, if you formed an ugly scar, would you rather have it right in the visual focal point of the breast (i.e.-  the nipple/areola) or would you rather have it under the breast fold or underarm.  Whoever you go to, be sure they use a Keller Funnel to minimize the length of the scar.  Also, be sure to ask them if they ever re-use the Funnel.  In other words, Keller Funnels are disposable devices, but many surgeons re-sterilize them to save money.  If you look on my website, there are Frequently Asked Questions about breast augs that may guide you in making decisions about what is best for you.  Please let me know if you have other concerns.

Tom J. Pousti, MD · Answer

Thank you for the question.  In my opinion, much more important than selection of specific type of breast implant will be the patient's selection of  plastic surgeon.  You will find that it is likely that the selected plastic surgeon will have his/her preferences when it comes to the “ideal” breast implant type/size/shape, as well as the best incisional approach to achieve the specific patient's goals.
Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery (regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work. Sometimes, it is necessary to seek several consultations before you feel comfort will about your choice.
2. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as  “natural” or "C or D cup”  etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup  size may also be inaccurate. Again, best not to discuss your goals and/or judge the outcome of the procedure performed based on achieving a specific cup size.
3. Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery. I generally select appropriate breast implant size/profile after the use of temporary intraoperative sizers and viewing the patient's chest in the upright and supine positions.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps.

Steven Schuster, MD, FACS · Answer

Although I'm sure they can, usually the incision has to be larger than for round smooth implants and it becomes much harder to place the implant properly.  I advise my patients not to use this approach unless they are having some type of mastopexy at the same time.

Can a textured gummy bear implant be inserted through the areola?

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