Answer: There are some inconsistencies in what people within and outside of the industry refer to as “gummy bear” implants, probably because this is a layman’s term that is not used by the actual manufacturers of the implants. The type of silicone implants that are currently FDA approved in the U.S. and manufactured and distributed by both Allergan and Mentor are properly described as “cohesive gel” implants. I use these implants routinely for breast augmentation and for reconstruction after mastectomy. These are excellent implants and probably will be the best silicone implants available in the U.S. for breast augmentation for many years to come.

The next generation of silicone implants that have been in clinical trials for several years are properly named “form stable” implants. The term “gummy bear” became popularized when these implants were first introduced. They are more firm and rigid than the cohesive gel implants and they are anatomical (tear drop) in shape. These implants will likely be a better option than the currently available cohesive gel implants for most reconstruction patients, but will probably be preferable for a much smaller percentage of augmentation patients. Currently, form stable implants are available only to surgeons and patients involved with clinical trials.

The inframammary incision is the preferred incision for both cohesive gel and form stable implants. Both of these types of silicone implants require larger incisions for insertion than saline implants, with larger incisions required for the form stable type than for the cohesive gel type.

Answer: The transumbilical approach is in no way the most advanced, and certainly is not the safest type of breast augmentation. The single benefit of the transumbilical approach is that it avoids a scar on the breast. Many board certified plastic surgeons will not use this approach because it is associated with a higher rate of complications. Many  non-plastic surgeons trying to do breast augmentation may choose this approach because it can be taught in  a “weekend course” as a more simple way to perform the procedure, and it may have more marketing appeal. The transumbilical approach involves blindly creating the pocket for the implant, rather than doing so under direct vision utilizing lighted retractors or endoscopic equipment. If anything, it is simpler to perform, and requires less surgical skill than more traditional approaches to breast augmentation.

In my opinion the most technically advanced type of breast augmentation is the endoscopic, transaxillary approach. This technique also avoids a scar on the breast. The safest approach to breast augmentation is through the inframammary incision in the fold beneath the breast. This approach has the lowest risk of complications such as infection, capsular contracture, implant malposition, and implant rupture or leakage. It is also the most versatile approach for any revision procedure that could possibly be indicated after an initial augmentation.  

Answer: The transumbilical approach is in no way the most advanced, and certainly is not the safest type of breast augmentation. The single benefit of the transumbilical approach is that it avoids a scar on the breast. Many board certified plastic surgeons will not use this approach because it is associated with a higher rate of complications. Many non-plastic surgeons trying to do breast augmentation may choose this approach because it can be taught in a "weekend course" as a more simple way to perform the procedure, and it may have more marketing appeal. The transumbilical approach involves blindly creating the pocket for the implant, rather than doing so under direct vision utilizing lighted retractors or endoscopic equipment. If anything, it is simpler to perform, and requires less surgical skill than more traditional approaches to breast augmentation.

In my opinion the most technically advanced type of breast augmentation is the endoscopic, transaxillary approach. This technique also avoids a scar on the breast. The safest approach to breast augmentation is through the inframammary incision in the fold beneath the breast. This approach has the lowest risk of complications such as infection, capsular contracture, implant malposition, and implant rupture or leakage. It is also the most versatile approach for any revision procedure that could possibly be indicated after an initial augmentation.

Answer: Itching of skin and scars is not uncommon after any surgery. Following breast augmentation, this may be the result of temporary irritation of the sensory nerves that innervate the breasts. More likely though, it is just the result of dry skin. Prep solutions used during surgery, and bandages and garments used after, can significantly dry out the skin. Rehydration by use of standard skin moisturizing lotions can help to alleviate the symptoms. Antihistamines in topical lotions or systemically may also help. If it is only the scars that itch, this can be a part of normal healing and should begin to improve 3 or 4 weeks after surgery. Scar fading products containing silicone liquid or sheeting and a low dose steroid may help alleviate the itching as well as accelerate the fading of the scar. For small scars I prefer a product called ScarGuard, which is liquid silicone with vitamin E and a steroid added. Don’t scratch! You will not damage the incision after two weeks, but you may cause a wound and possibly more scarring or an infection.

Answer: Breast augmentation can be performed using your own body fat. This is a somewhat controversial procedure that has been performed throughout the history of plastic surgery. Until recently, the medical community generally frowned upon this form of breast augmentation because it can leave palpable lumps in the breast or calcifications on mammography, both of which may be mistaken for a possibly malignant breast tumor. Recent improvements in techniques of fat grafting or transfer for facial rejuvenation and for gluteal augmentation have again stimulated interest in fat transfer for breast augmentation. As far as general acceptance by the medical community, I would say that the jury is still out.