For many women, potentially needing post-mastectomy radiation can affect the ability to have immediate breast reconstruction. Mastectomy patients who are diagnosed with invasive breast tumors often don’t know whether they need radiation until after their mastectomy; that’s because the extent of lymph node involvement and clear-cut staging of the tumor really can’t be done until the mastectomy is performed.

Breast cancer experts often advise women to delay having breast reconstruction if there is a possibility that adjuvant (after surgery) radiation will be needed. It can be a very disappointing turn of events for women who were hoping to have immediate breast reconstruction along with their mastectomy—they’ll not only wake up from mastectomy without breasts, but they miss out on the cosmetic benefits of having immediate breast reconstruction. They also have to endure additional surgery and recovery if they choose to have delayed breast reconstruction at some later time.

One approach to this issue is delayed-immediate breast reconstruction. It’s not exactly traditional immediate reconstruction or delayed reconstruction. Rather, it’s a hybrid of the two. During this procedure, after the breast tissue has been removed, a tissue expander is placed in a pocket under the pectoral muscle. The expander is then fully inflated; this preserves the remaining breast skin and breast shape for later reconstruction.

If it turns out that radiation isn’t needed after all, the expander can be swapped out for a full-size breast implant or a flap of the woman's own healthy tissue. If radiation is required, the expander can be deflated (so there is no chance that it might interfere with delivery of the radiation) but left in place. A few months after radiation treatments have been completed, the expander can be replaced with a natural tissue flap. (Breast implants aren't the best option for reconstruction after radiation, due to the significant potential for complications Radiated tissue is usually a poor combination with breast implants, and even though a natural tissue flap is a better option for most women, the radiated reconstructed breast may take on a different shape and feel than the opposite reconstructed breast.
 
 

The Mayo Clinic is using an innovative approach that emphasizes pain control with less use of intravenous opioids to facilitate easier, quicker recovery for women who have breast reconstruction after mastectomy.

Enhanced recovery pathway (ERP) is an evidence-based approach that was developed in Denmark more than 15 years ago. Patient feedback and studies show that ERP works, although many of the components contradict standard pre- and post-op practices. ERP patients are not required to fast prior to surgery (they may have a small meal the night before their operation and a protein beverage the morning of surgery), and contrary to standard post-surgery procedure, they are encouraged to rehydrate in the recovery room and to eat shortly thereafter.

Mayo Clinic plastic surgeon Michel Saint-Cyr worked with anesthesiologists, pharmacists and nursing staff to develop a unique ERP for breast reconstruction patients. The protocol has been so successful, it is now used for all plastic surgeries at the Mayo Clinic. Compared to traditional methods, the new approach includes preoperative analgesics to help prevent pain, nonsteroidal anti-inflammatories, preventive nausea treatment, and use of an inoperative nerve-numbing agent at the surgical site.

In a study of 48 women who had free flap breast reconstruction at the Mayo Clinic, 31 individuals who experienced ERP reported significant postoperative improvements compared to the 17 patients who did not receive ERP, including:

·      Ambulatory within 24 hours of surgery. 
·      Reduced pain (ranging from 0 to 4 on a scale of 10, compared to 6 to 8).
·      Reduced (by half) use of opioid painkillers.
·      Less pain reported 24 hours after surgery.
·      Shorter hospital stay (an average of 3 days compared to 4½).
·      Acetaminophen rather than narcotics were sufficient for many upon leaving         the hospital.
·      Resumed driving and returned to work in 2–3 weeks, compared to 4 to 6 
       weeks.

 
 
Guest Blog
Although most women who consider breast reconstruction do so following mastectomy, many women who have a lumpectomy to treat breast cancer are candidates for reconstruction. In the following guest blog plastic surgeon Dr. Nirav Savalia explains the philosophy behind oncoplastic breast reconstruction and its benefits.

What Is Oncoplastic Breast Reconstruction?
Following a breast cancer diagnosis, many women are often overwhelmed by their diagnosis and treatment plan. Then they have the added worry of how their breasts will look after a medically necessary lumpectomy or mastectomy. Thankfully, advancements in surgical techniques offer the right lumpectomy candidates a better breast reconstruction method known as oncoplastic reconstruction surgery. Oncoplastic surgery successfully removes the cancer while saving as much natural breast tissue as possible and addressing cosmetic concerns at the same time.

Simply put, oncoplastic reconstruction is oncological (cancer) surgery combined with reconstructive breast surgery, all in one procedure. Oncoplastic reconstruction is ideal for women whose cancer necessitates a lumpectomy that would dramatically alter the appearance of the breast.

During the procedure, the removal of any unhealthy tissue by the cancer surgeon is the first and most important step. After this, I reshape the affected breast by repositioning the remaining tissue and redraping the skin for more natural-looking contours. Next, if needed, I can modify the opposite, healthy breast to improve symmetry, sometimes through tissue removal, a breast lift or a combination of the two. The ultimate goal is to effectively address both the health and aesthetic aspects of breast cancer surgery, while preserving as much natural tissue as possible.

Oncoplastic Breast Reconstruction Benefits
Here are the major ways women can benefit from this reconstructive technique. Oncoplastic breast surgery:
  • allows the cancer surgeon to make a wider excision around the tumor without compromising aesthetics.
  • requires just one operation that combines cancer removal and reconstruction of the breast ("immediate" reconstruction).
  • in many cases can be combined with intraoperative, single-dose radiation treatment, eliminating the need for 6 weeks of follow-up radiation appointments.
  • can be performed for women with both noninvasive (DCIS) and invasive breast cancer.
  • is covered by major insurance plans as any other reconstruction method.
  • saves more natural breast tissue, helping me to create a more satisfying and natural-looking result compared to traditional reconstructive techniques.
Different Reconstruction Methods
As with every surgery, not every woman is a candidate for an oncoplastic procedure. While the simultaneous approach and tissue-saving aspects of the surgery may appeal to some women, delaying the reconstruction process may be more appropriate or preferable for others. Sometimes the thought of dealing with reconstruction while also participating in a treatment plan is simply too much, while in other cases, reconstruction may be better delayed until cancer treatment is complete. Consulting with an experienced breast reconstruction specialist can help you decide which options are best for you.

Dr. Savalia has been performing oncoplastic breast reconstruction with a team of cancer specialists at Hoag Hospital in Newport Beach, California for many years.

 
 
Visible scars on a reconstructed breast are an ever-present reminder of mastectomy and reconstruction. Surgery and scars go hand-in-hand; scars form as the body’s healing process floods the incision with collagen, the body’s version of spackle.

The evolution of a scar
Reconstruction is performed through the mastectomy incision. If you have immediate reconstruction (at the same time as your mastectomy), your plastic surgeon will place a breast implant or tissue flap before the mastectomy incision is closed; your breast surgeon and plastic surgeon work together to decide on the location and length of the incision. (Many women, especially those who have larger breasts, require more than one incision to adequately allow for removal of the breast tissue.) If you have delayed reconstruction, your mastectomy incision will be reopened to facilitate your reconstruction.

Mastectomy incisions cut through the dermis, the thick tissue beneath the skin; that initially produces red, prominent scars. They fade to pink after a few weeks, as collagen and new blood vessel facilitate healing. Mastectomy scars never disappear, but they can often be hidden under the new breast or by a tattooed areola. A year or two after mastectomy, most scars have faded to thin white lines.

Your genetics and age, the depth of the incision, and how the underlying tissues were sewn influence how your incision heals and how your scar will eventually appear. Smoking and poor circulation, which inhibit blood flow, may impede healing and contribute to larger, angrier-looking scars. Two women who have identical mastectomy and breast reconstruction procedures by the same surgeons may have scars that look very different. Your scars from previous surgeries will give you a good idea of how your mastectomy/reconstruction scars may appear.

What you can do to improve the appearance of scars
Despite a booming market in “scar improvement” products, no well-documented studies have found any topical treatment that significantly improves the appearance of a surgical scar. But you can take steps to promote healing and make your scars look smoother and less noticeable.

  • Let your incision heal. Don’t pick at the surgical glue or tape your surgeon places over your incisions; they help to hold the edges of wound tightly together.

  • Moisture your scar. Applying lotion that does not contain alcohol or fragrance, such as coco butter, mineral oil or aloe vera, to your incision will keep it moist and encourage healing. Don’t apply anything to the incision until it is completely closed and your surgeon gives you the okay to do so.

  • Massage your scar. Massage lotion or cream along the line of your scar with your fingertips to stretch the fibers under the skin

  • Give your body the nutrition it needs. Maintain a balanced diet that provides your body with nutrients that aid healing.

  • Protect your scar from the sun. Ultraviolet light may darken scars, especially in the first year after surgery. Once your incision heals, apply a sunblock of SPF20 or higher to protect against both UVA and UVB rays. Reapply frequently.

  • Try a scar management product. Consistent use (repeated application daily for several months) of over-the-counter creams or silicone sheeting may help your scar to fade.

If you develop keloids, thick scars that spread beyond the incision into the skin, or hypertropic scars, scars that rise above the surrounding skin, apply silicone gel sheeting as soon as your incision heals. Ask your dermatologist or surgeon about cortisone or steroid injections, prescription topical treatments or application of a fractional carbon dioxide laser. Scars can also be surgically revised—this involves cutting away the hardened tissue and resuturing the scar into a tighter line. It doesn’t guarantee a better scar, but in some cases, it may help.

 
 
If you’re facing mastectomy of one of your breasts, what should you decide about the other? Increasingly, women are choosing contralateral prophylactic mastectomy (CPM) of their opposite healthy breast to reduce their future risk of breast cancer. But health experts are concerned that many women who choose CPM don’t really “need” it. CPM is not typically recommended for women of average risk who are diagnosed with early-stage disease because it has not been found to improve survival. National Comprehensive Cancer Network guidelines recommend CPM on a case-by-case basis for women who have a high risk of breast cancer, including those who have a BRCA gene mutation—their risk for contralateral breast cancer is higher than women who do not have an inherited predisposition to the disease (only 5-10 percent of breast cancer diagnoses are caused by a genetic mutation). Counseling regarding CPM may also be advised for women with a strong family history of breast cancer.

If contralateral breast cancer is a low risk for most women, why are so many making the difficult decision to sacrifice their healthy breasts, even when doctors tell them it isn’t really necessary? Here are some reasons for the rising CPM rate:

·      Women often overestimate their risk of a new breast cancer. Studies show that women commonly believe their breast cancer risk is far greater than it really is. For most women, the risk of developing breast cancer in the opposite breast is quite low—an estimated 3-9 percent of women who have lumpectomy or unilateral mastectomy develop breast cancer in the opposite breast. So, most women who hear “you have breast cancer” in one breast are not as likely to hear it again regarding their remaining breast. The risk of developing breast cancer in the second breast is greater for women who have tumors in more than one area of the breast, invasive lobular cancer, a BRCA gene mutation or a strong family history of breast cancer.

·      Increased use of MRI scans before mastectomy. Use of pre-mastectomy MRI, which sometimes shows early-stage abnormalities in the healthy breast, is more common now than in previous years. Although MRI may produce false positive results, women who have a pre-operative MRI are more likely to request a CPM.  

·      Fear of going through it all again. Facing mastectomy of one breast, many breast cancer patients decide to remove their opposite breast, even if the risk of breast cancer is remote. They would rather “get it all over now” than face another diagnosis, treatment and potentially another mastectomy in the future.

·      Better reconstructive results. For women who want breast reconstruction, many feel their new breasts will be more symmetrical if they are reconstructed at the same time, rather than trying to match a reconstructed breast to a natural breast. After unilateral mastectomy, however, (and in the hands of a skilled plastic surgeon) a recreated breast of natural tissue can closely match the size, position and shape of the opposite healthy breast, which can also be augmented, reduced or lifted for improved contour, size and symmetry.

Should you let what you know in your head (that your risk of a new cancer is quite low) override what you feel in your heart (the need to do anything possible for peace of mind)? Even after knowing that your actual risk of a future breast cancer is lower than your perceived risk, you may decide that you won’t be able to sleep at night waiting for another diagnosis.

Not all decisions are straightforward or easily made. Deciding about CPM is complex, difficult and very personal. Whatever you ultimately decide, first allow yourself time to consult with a genetics expert who can estimate your future risk and discuss how risk management alternatives can reduce that risk. Consider your options, and weigh the pros and cons of each one (making a list helps). If you are concerned with reconstruction, talk to two or three reconstructive surgeons about your potential outcome. Then make the informed decision that is best for you.

 

 

 
 


DIEP flap reconstruction uses abdominal fat and skin to create new breasts after mastectomy. But what if a woman who is facing unilateral mastectomy and prefers not to use breast implants for her reconstruction doesn’t have enough fat for natural tissue reconstruction?

Very thin women are often advised that they “don’t have enough fat” in their abdomen, even to reconstruct a single breast, but an innovative variation of the DIEP flap can provide a very workable solution. A stacked DIEP, sometimes also referred to as a double DIEP, combines skin and fat from both sides of the abdomen to create one reconstructed breast.

A stacked DIEP is essentially two separate DIEP procedures. It involves harvesting two abdominal tissue flaps—as if a bilateral reconstruction were being performed—each with its delicate supply of blood vessels. The two DIEP flap tissues are then “stacked” on top of each other to create the new breast. (In some stacked DIEP procedures, a single flap from the width of the abdomen is harvested and then folded over.) The procedure is difficult, because the blood vessels from both flaps must either be connected to each other or to an internal artery in the chest. The flaps are then shaped into the new breast. The opposite healthy breast can be lifted, reduced or augmented for better symmetry. (Harvesting tissue from both sides of the abdomen eliminates the tummy as a donor site for any future reconstruction.)

In addition to very thin women, stacked DIEP can provide a viable reconstructive option for those who have a midline abdominal scar from a previous cesarean section, hysterectomy, or bowel surgery.

As with any surgery, a surgeon’s experience with stacked DIEP is vitally important. See our listing of DIEP surgeons to locate a physician who is experienced with stacked DIEP (you might want to contact any surgeon who is listed as performing DIEP, since our listing may not reflect stacked DIEP if it has been recently added stacked DIEP to their repertoire.)

 
 

Back in the early 1980s, surgeons began performing the transverse rectus abdominis myocutaneous (TRAM) flap—a fancy mouthful that means using your own abdominal tissue to rebuild breasts after mastectomy. It was a huge step forward in reconstruction, because it offered an alternative to using implants: building new breasts with a woman’s own warm, living tissue, and offering a tummy tuck at the same time.

Attached TRAM flaps
Any tissue flap needs a healthy blood supply to survive when it is moved from the donor site up to the chest. In an attached or pedicled TRAM reconstruction,  a flap of skin, fat and most of the underlying abdominis rectus muscle is separated from the abdomen and then tunneled under the skin and up to the mastectomy site. A single strip of muscle acts as an umbilical cord between the new breast and it’s original blood supply. This produces a good reconstruction with reliable blood supply, but recovery is intense, and the trade-off is the loss of one or both abdominal muscles. (One muscle is used to create a breast for unilateral reconstruction; both muscles are used for bilateral reconstruction.)

Free TRAM flaps
Free TRAM
reconstruction was developed to preserve a part of the muscle; it uses the same tissue as the attached TRAM, but the flap, including a portion of the muscle that surrounds the blood supply, is transferred entirely from the abdomen to the mastectomy site, where the blood vessels in the flap are then reconnected to blood vessels in the chest. This eliminates the need to tunnel under the skin (and the bulges that may develop) and reduces the likelihood of hernia. There’s a downside with Free TRAM as well, however: although the muscle remains in the abdomen, it is cut across its width to remove the small portion that is included in the flap. So even though most of the muscle remains in place, much of the muscle functionality is destroyed.

Muscle-sparing DIEP and SIEA flaps
The premise behind DIEP and SIEA flaps is simple: recreating breasts with living tissue without sacrificing any muscle. Deep inferior epigastric perforator (DIEP) flaps and superficial inferior epigastric artery (SIEA) flaps are improvements on tummy tuck flaps that are used for reconstruction. Unlike attached and free TRAMs, these DIEP and SIEA flaps leave the entire abdominis rectus muscle intact. The surgeries do require advanced skills to carefully extract the blood vessels from the muscle, and the operation takes longer, but the result is the same soft reconstructed breast with shorter recovery and no loss of muscle functionality in the abdomen.

DIEP and SIEA are essentially the same technique. The only difference is the source of blood vessels feeding the flap. Whichever artery provides the dominant supply of blood to the abdomen is used. The SIEA is advantageous because it runs just under the skin and doesn’t require cutting into the muscle at all; recovery is improved because the abdominal muscle is not only spared but is left undisturbed. In most women, however, the SIEA is usually too small to support the breast flap or has previously been severed during hysterectomy or cesarean surgery.

Bottom line
Attached TRAM was developed based on surgical abilities and restrictions more than 30 years ago, before techniques to tease delicate blood vessels from within the muscle made DIEP/SIEA possible. Even so, the attached TRAM is still widely performed, primarily because it is more available than DIEP/SIEA.

Looking at a reconstructed breast, you wouldn’t be able to identify which was created with a TRAM, DIEP or SIEA flap. Each of these procedures produces soft, natural-looking breasts. Nor would the abdominal incision site provide a clue: each of the surgeries leave a hip-to-hip scar between the belly button and the pubic bone.

Easier recovery and no loss of muscle make DIEP and SIEA advantageous for most women, but there are reasons why a lot of women have TRAMs instead. TRAM has been around a lot longer than DIEP/SIEA, and doesn’t require advanced microsurgical skills, so more surgeons perform TRAM. In some cases, health insurers still insist that DIEP/SIEA is experimental, even though they have been performed for several years. Some women never realize that DIEP/SIEA i even an option. For others, the need to travel to a DIEP/SIEA surgeon may be more than they are willing to do.

The good news is that more and more reconstructive surgeons are learning to perform DIEP/SIEA (and more health insurers are recognizing DIEP/SIEA as reconstructive options, making it more likely that women have the opportunity for muscle-sparing abdominal flaps for their breast reconstruction.



 
 
More and more women who have mastectomy are traveling for breast reconstruction, but like skinny jeans and whipped cream, traveling to a distant surgical facility isn’t for everyone.

The thought of facing such a big operation away from home may seem overwhelming, particularly when you’re having to come to grips with the idea of losing your breasts, so you might ask yourself why anyone would deliberately add travel into the mix. The fact is, most women who have reconstruction do so close to home; however, there are many good reasons why traveling for breast reconstruction has become more appealing.

Perhaps you have no reconstructive surgeons nearby. Or maybe you have your heart set on an advanced procedure--direct-to-implant, DIEP, GAP or TUG—but your local surgeons offer only traditional reconstruction (expander-to-implants, TRAM or latissimus dorsi flaps) that may involve lengthier recovery. In that case, you may need to travel to a nearby city, an adjacent state or across the country to find surgeons who perform the newer procedures. The good news for those who are willing to travel for breast reconstruction is that more surgeons now perform advanced procedures, increasing the chances that an experienced surgeon may be closer, rather than farther from your home.

Other factors may also influence your decision. You may want to travel to a highly-recommended surgeon or one who is more experienced with the procedure you prefer. Having extended family in a city with experienced plastic surgeons might also sway your decision, and be kinder to your budget. And the type of reconstruction you want may also play a role. If you’re interested in GAP reconstruction (where fat is moved from the upper or lower buttock to create the new breast), for example, it may be important to you to find a surgeon who performs bilateral simultaneous GAP, rather than others who perform GAP only one side at a time.

Cost can also be a significant factor. In many cases, it can be a deal breaker, especially if your healthcare company covers the cost of reconstruction only by surgeons and facilities in a preapproved network. In any case, health insurance does not typically pay for travel expenses or hotel costs related to surgery, and your out-of-pocket expense will be higher.

Journeying to another city for your surgery entails more time, cost, and careful planning, but after considering everything involved, you may find that it is worthwhile to pack up for a few days to get the surgeon and procedure that you want. More and more women are doing it, and out-of-town patients now make up a considerable part of many reconstructive practices. Your surgeon’s patient relations coordinator can facilitate your consultation appointment, coordinate insurance coverage, and help you navigate other facets of your surgical experience.

If you’re thinking about traveling for your breast reconstruction, consider the following:

1.     Do your homework when choosing a remote surgeon. Research his/her expertise and skill with the procedure you desire, as you would for a surgeon in your own hometown.

2.     If you can manage it, you can drive or fly in for a consultation and return home the same day. If that doesn’t work, you can swap information, including photos of your breasts and donor site, by e-mail, followed by a phone consultation.

3.     If you’ll be having mastectomy with immediate reconstruction, your remote surgeon will coordinate with a local breast surgeon.  

4.     Be clear on what to expect regarding the length of your hospital stay, how long you’ll need to stay in town (with family, friends or in a hotel) before returning home, when you’ll be able to return home, and the timing of your post-op check-up.

5.     Once your surgery date is set, you can complete all the necessary pre-op testing in your hometown, with a copy of the results forwarded to your distant plastic surgeon.

6.     Ask the remote surgeon’s office about accommodations; many offices have pre-arranged discounts at hotels for post-surgery recuperation.

7.     Consider how you will arrange for childcare (if necessary) while you’re away.

8.     Arrange for follow-up care if needed when you return home, and a local surgeon who can handle any infection or other post-op problems that may occur.

9.     Will you need to return for stage 2 revisions and/or tattooing?

10.  Consider the input of other women who have traveled for their reconstruction.





 
 

Removing all cancerous tissue during surgery, and obtaining clear margins—the area of tissue that is free of cancerous cells—is critically important, but it is not always easy or possible.

As archaic as it sounds, a surgeon has no way of knowing precisely where cancerous tissue ends and the margin of healthy tissue begins. Often, when post-surgery pathology shows that cancer cells remain, cancer patients, including those with breast cancer who undergo lumpectomy or mastectomy, need another visit to the operating room to eradicate rogue tissue that may otherwise escape a surgeon’s visual examination. According to Dr. Jim Olson, a pediatric oncologist at Fred Hutchinson Cancer Center who cares for children with brain cancer, “Thirty percent of women who have breast cancer find out that where the surgeon stopped cutting, there are still cancer cells, and that they probably need to have more surgery done. And unfortunately, they get this information 7 to 10 days after they’re out of the operating room.”

Inspired by many of his young patients, Dr. Olson and his creative research team developed Tumor Paint to identify cancerous tissue during surgery so that it can be removed during the initial operation. Simple and effective, injectable Tumor Paint is derived from a peptide in scorpion venom that naturally binds to brain cancer cells. Combining it with a fluorescent molecule that “lights up” cancerous cells and bypasses healthy cells, surgeons can more easily distinguish normal tissue from tissue that needs to be removed and that might otherwise go undetected. (After a tumor is removed, the surgeon uses a special near-infrared camera to make sure no stray cancerous cells have been left behind.)

Initially developed to save healthy brain tissue, in preclinical trials involving animals, Tumor Paint has successfully illuminated prostate, colon, breast and other cancers. If human clinical trials next year are successful, Tumor Paint will become perhaps the most important surgical tool for reducing repeat surgeries, limiting or elminating the amount of normal tissue that is removed, and ultimately, saving lives.

To learn how Dr. Olson was inspired by individual patients that he cared for, and how this inspiration led to a whole new platform of potential cancer drugs that come from violets, sunflowers, spiders, scorpions and other nature-based sources, watch his recent TEDxSeattle talk. To encourage those who care about breast cancer to spread the word, the Washington Research Foundation (WRF) has offered to donate up to $50,000 ($10 for each view).

 
 
Choice can be a wonderful thing, and thanks to long-awaited FDA approval of high-strength cohesive silicone gel breast implants, women have another option for breast reconstruction.

After widespread use in Europe since 1995, in Canada since 2000, and other countries for several years, these fifth-generation semi-solid “gummy bear” implants are now available in the U.S. by three manufacturers: Mentor (MemoryShape), Allergan (Natrelle 410) and Sientra (Silimed).

Gummy bear implants offer several advantages over saline and earlier-generation counterparts:
  • New “gummies” mimic natural breasts with gradually-sloped tops and full bottoms, rather than the “half-grapefruit” appearance that often results from round implants. Gummy bears retain their shape over time, a significant advantage over non-cohesive implants that retain no particular shape once they are placed in the chest. 
Picture
Turned upright, a gummy bear implant (right) retains its form. A non-cohesive silicone implant (left) does not. Source: cohesiveimplants.com
  • Cohesive gel does not shift as other implant fillers do, so wrinkles and ripples (more of a problem with saline implants), and folds that often cause implant leaks are less likely to develop. This not only improves appearance, but limits friction and tension that may weaken the outer shell. Some experts expect cohesive silicone gel breast implants to last longer than other types of breast implants.
  • Silicone from a ruptured gummy bear breast implant is less likely to leak and migrate to lymph nodes and elsewhere in the body: it holds together in a single mass, like Jello or gummy bear candy.
Picture
A gummy bear implant remains intact when it is squished or even cut in half.
  • Although long-term data is not yet available, gummy bear breast implants are believed to reduce the rate of capsular contracture (the most common problem and source of reoperation with other breast implants).

Gummy bear breast implants may be an improvement over older models, yet despite a high rate of patient satisfaction and reported lower problem rate, they are still subject to problems that are inherent to all implants:
  • Gummy bear breast implants are more expensive.

  • Like other types of breast implants, gummy bears are not lifetime devices and need to be replaced soon or later.

  • Not all surgeons provide gummy bear implants.

  • Semi-solid gummy bear implants cannot be pushed through small incisions as saline and non-cohesive silicone gel breast implants can, and require larger incisions.

  • The risk of rupture, although reduced with highly cohesive silicone gel implants, is not eliminated. The FDA recommends MRI screenings beginning three years after the implant is placed and every two years after that to detect “silent” rupture.

  • Infection anytime after placement surgery may occur.

  • Many women report that highly cohesive silicone gel implants feel firmer and less natural than earlier silicone implants.

  • Gummy bear breast implants require a perfectly-sized submuscular pocket to avoid rotation that could lead to breast distortion.

  • Women who prefer more projection or fullness at the top of their reconstructed breasts may better served with round implants.

  • Long-term study data (10 years or more) is not yet available.

So are highly cohesive silicone breast implants really better? That remains to be seen, and like most things in life, it depends on personal choice. Gummies may not be right for all women, but they do add another choice to the implant menu.