Scared/conflicted about breast augmentation: I want silicone gummy bear implants.

Hi Modestkelly,

Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient.

Implant profile is one of the important considerations to make. Many patients wrongly assume that the higher the profile the better. The truth is, the more profile (or projection/height) and implant has, the narrower its base has to become. This is associated with several problematic consequences.

The first issue is that the patient loses width and therefore cleavage of the breast. The second is the breast becomes more narrow and pendulous, often falling lateral and onto the side of the chest, and third, high profile implants have a higher risk of bottoming out because they exert more pressure on the inframammary fold than moderate profile implants.

High profile implants do have a role in symmastia repair (when I need to narrow the base width) but otherwise I try to avoid them.

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.

Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.

Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Many
women are scared of implants because of the numerous complications.  Breast implants are not lifetime
devices.  Unfortunately, you have not
told us your bra size or provided photographs. 
Another alternative to consider is fat transfers.  The technique I recommend is The Bellesoma
Method.  This will reshape your breast
tissue creating upper pole fullness without implants, elevate them higher on
the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation
and the ability to breast feed are maintained. 
At the same time or later, fat transfers can be performed if additional
volume is desired.Best Wishes,Gary Horndeski, M.D.

Hi and thank you for your questions.  Feeling anxious or scared before surgery is perfectly normal and yes it does come with risks.  That being said, most surgeons would not knowingly do things that are unsafe or put your body at risk.  BIA-ALCL is something that has gotten a lot of press in the last year or so and there are some recent studies on it.  By and large, the chance of BIA-ALCL is so low, that the FDA has not pulled them off the market.  If they posed a significant threat, they would have already.  Also, it has been shown that BIA-ALCL is a texturing problem even at its low rate of prevalence.  For me, that is just another reason to use smooth implants.  To answer your questions:  1)  gummy bear implants are almost always textured and shaped.  If you came to see me, I would try to educate you about the benefits/drawbacks of these implants and then we could decide together after that.  While all implants can rupture, the silicone stays where it is.  That is because with every implant, your body forms a capsule around the implant that holds it in place.  2)  back in the 80's 90s, the FDA pulled implants because of such concerns.  They studied them extensively and found no correlations so they reintroduced them to the market.  So I would say confidently that there is no correlation and you should be reassured.3) silicone gummy implants have the same timeline as other silicone implants.  Some surgeons say leave them in until there is a problem, some say switch them out after 10 years.  My recommendation is to have them looked at after 15-20 years.Hope this helps!

Hi. It is very normal to feel scare and ideal for you to investigate about your procedure. 1. Silicone Gel Implants placed under the pectoral muscle do not migrate any where, and further more  their integrity is absolutely proven. 2. There is not one study that associates these implants to any allergic reaction form the body  to the material. 3.They are permanent, no timeline. As for the BIA-ALCL those are new studies and are limited to the capsulae formation, the condition is very rare.
International Member of the American Society of Plastic Surgeons (ASPS)
Member of the International Society of Aesthetic Plastic Surgery (ISAPS)

Thank you for your question. We believe that the silicone implants (gel and cohesive, or "gummy bear") are safe implants when used properly. They do require monitoring. Each manufacturer reports their 7-year (and beyond) rupture rates, and they tend to average out to be 1% per year (or so). You might give some thought to some of the new generation saline-filled breast implants too, if it's the silicone gel you are concerned about. Best wishes