All About Gummies

Oooh...good topic!

I have bilateral Allergan Style 20, 500 cc's, high profile, smooth round silicone gel implants.  We were just discussing this issue of "bounce and jiggle" on the Exchange City site the other day.  My implants feel soft and pliable to me, albeit odd, as I still have minimal sensation in either breast.  My DH, on the other hand, thinks they feel remarkably real and would want to play with them all day if I would let him.    

Liz, I do just what you do - I examine other women walking down the street and watch as their breasts sway and bounce with each step.  Mine do not do this.  I can walk down the street in a tank top with no bra and there is really very little, if any appreciable movement.  I can make them bounce if I maneuver them with my hands - and believe me - we ALL do this and try this - trying to get some semblance of normal extracted from these foreign bodies sitting on our chest. 

The amount of bounce and jiggle and real softness though is really rather subjective.  In the breast augmentation realm, implants are, in many instances, being coupled with breast fat and connective tissue and these are the elements we are missing with mastectomy.  Some of us have skin and muscle overlying the implants which are lax enough [and perhaps this happens more over time] which will relax and enable the implants to move more freely within the pocket.  I must say though, if you look at very small breasted women who have very little breast tissue, when they undergo breast augmentation, they are pretty firm and there is not a great deal of movement.  I have a friend who has had implants for ten years now and she has no more bounce or jiggle than I do....

My plastic surgeon here in So. Cal has said to me she believes the "gummies" - the Allergan 410's and Mentor CPG's - when approved for widespread use - "will be the standard in the industry."  She thinks that the anatomical Allergan 410 will be the best implant to address my lack of upper pole fullness I am concerned with - but I have told her I really do not think I want them.  I am still investigating my options - to address rippling bilaterally and a step-off on one side - but I just do not feel that I would personally be happy with the firmness of the 410's or CPG's. I think that women undergoing breast augmentation who have sufficient skin thickness and underlying breast tissue will probably love them.  But for breast reconstruction patients - as we can see by some of the comments here - the jury is still out.  I do believe that breast reconstruction patients in particular have not had sufficient "trial" time to know how these true gummies are going to feel two years down the road.  You will quite likely still have nice perky breasts, while my implants have happily bottomed out and require hydraulic lifting. 

Libragirl:  Oh don't do a thing at all!  You look fabulous - not too large by any stretch of the imagination.  There is a guy out there with your name on him who is going to be a very happy man with those boobies!!!!  Trust me......

You single girls.....this guy is going to love you and he is going to love everything about you - including these fake boobies.  If he doesn't - OFF WITH HIS HEAD!  A man's view of breasts is so different from ours.  We are SO critical of ourselves....I am in the mirror dissecting every flaw and my husband just does not see the flaws.  You are not going to settle for less than someone who adores you!!!!  PROMISE ME you won't settle!!!!

OmahaGirl:   

Here is a thread discussing this very procedure:

http://community.breastcancer.org/forum/44/topic/736507

Here is a link to a website describing this procedure - along with Alloderm grafts:

 http://www.breastrecon.com/id27.html

Liz I am so sorry and disappointed that these seem to be your only options.  Even though you really respect and trust your ps judgment, perhaps it is still worthwile to consult a few others.  If you really don't feel happy and right with your gummies, maybe the softer gel with fat grafting would be worth it in the long run, even if you have to go through several fat grafts/procedures to get a result you feel good about.  I was thinking about this myself today, that although I loathe the thought of more or multiple surgiers, I think I'm willing to do what it takes to get where I want (and I need to convey that to my ps, who I get the sense feels I should be happy with the result I have).  These foobs are not accessories; we need to feel that they are "us." 

Another thought - I've heard that there are saline anatomicals but have no recollection of who makes them and who they are recommended for.  Perhaps this is something to explore?

Barbara:  Touche', touche', touche'!!!

Liz - Do not be sad and do not give up this quest.  Frankly, when I read about your long torso and what you were describing as your nice long sternal notch to nipple ratio - I was pretty floored that your PS did not tell you about the extra full projection implant style.  I personally think you have the right build for this.  As long as you have a fairly narrow ribcage....the Allergan Style 45 and the Mentor Extra Full Profile/Projection silicone implants are indeed still "rounds", but this style is narrow and tall - it sits up higher on the chest wall.  It really is a beautiful style of implant for the appropriate situations - especially for women with a narrow ribcage and a long torso and a good SN to N distance.  On page 99 of the Exchange City thread, I have explained how to calculate these measurements - check and see where you are in this regard.

I think your issues also with the gummies is that they are textured - must be textured by their inherent anatomical nature to keep them in place - but you are getting traction rippling, which is a known problem with textured implants.  I just think you would be a very good candidate for the extra full projection style implants.  If it means finding someone else who is interested in pursuing this further, then perhaps this is a route you need to consider.

Liz:  Sadly [and I wish I had the time and energy to be a political activist in this regard] many plastic surgeons just do not think outside of the box with breast reconstruction patients. It is perplexing to me.  The breast augmentation patient comes in the door, money in hand - and the design studio is set up for her with glittering lights and everyone jumps through hoops to give her the boobies of her dreams. The plastic surgeon is in major competition - he has to deliver the goods to get the referrals and the name.

The woman who has had a mastectomy comes in, her chest ravaged by surgery and the mission and the vision changes.  It is bizarre.  After all, the plastic surgeon makes more money on the breast reconstruction patient than he will ever make on the breast augmentation patient.  Is it because WE are not paying him personally that this relationship changes?  Does he feel beholden to the insurance company to not make us too terribly gorgeous, for fear the insurance provider will think he has gone too far?  [I hope I do not initiate any debate about this....I am today just feeling rather frustrated - I talk to women weekly who are so very unhappy with their reconstruction results and their plastic surgeons are telling them "this is as good as it gets"  and one particular case today has me all fired up!]

Now again, there are many plastic surgeons out there who do make it a personal effort to make these new breasts as beautiful as possible.  Many take a true interest in this regard.  But there are too many out there who do not fit into this category.  Now interestingly, some of them turnaround quite nicely, once the patient starts pushing and prodding, becomes well-informed, and demonstrates they are not going away quietly into the night.  So keep asking questions!

ADDENDUM:  And herein I am specifically addressing tissue expander-based reconstruction - not the microvascular specialties.  They DO take a different approach and there is a vision for cosmetic enhancement with the NOLA's of this world.

I am so happy for all the info on the different types of implants. I have many months before my exchange, but I didn't even realize all the different types of implants there were (gummies vs cohesive gel). Are there good web sites to view the aesthetics of these implants? I had a bilateral mastectomy, I start radiation soon (with the TE) and have 6 months to wait for exchange - lots of time for research. Thank you for all the info on these pages!

I'm no authority here either but have done a TON of research on implants. All implants today are cohesive to some degree.  The gummies are the MOST cohesive with more crosslinks in the silicone than the other 'lesser' cohesive gels on the market today which were approved by the FDA (after testing) in November 2006.  My PS actually had one of the 'lesser' cohesive gels (which is what I have) cut in two in her office.  I pushed on the implant and the gel started to ooze out of the shell but as soon as I left off pressure, it retracted back into the shell.  The old runny (oily) silcone implants have been removed from the implant market. BTW, the round implants take on a contoured shape because of gravity but if they rotate, there is no harm done.  HTH  Best wishes

Thank you Liz and thank you RubyTuesday. That information is helpful and I will ask my PS next time that I see him. I dont know names or gel types, but I do know he wants to use a teardrop shape. I was worried about it flipping, but he said that it shouldn't be a problem. I hope he is right! Being in Canada (Montreal) and not in the U.S, I always worry we are not getting the most up to date information and using the most up to date implants. I hope I am very wrong here.

Liz - I did get to the area with the pictures, I started looking through them and they are amazing. The women here are incredible and so inspirational. I feel lucky to have found this site and all you amazing women.

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Hey Ladies, thought I'd throw in my experience for what it's worth...

I had my exchange surgery in August 2005--so my implants have had a good four years to do whatever settling they're going to do.

I have Mentor silicone gel.  I can't tell you what size or the "model" number as it's been four years and I don't think I ever bothered to find out that information in the first place.   If anyone is interested, I could find out from my surgeon or dig through my paperwork.

 I was a 34 barely-A prior to bilateral mastectomy.  I'm now a 34D.  I figured if I had to go through surgery and chemo I was dang well going to get some bigger boobs out of it!  I spent hours on the computer prior to my exchange surgery researching photos of reconstructed breasts, and I took the ones I liked in to my surgeon.  He did a wonderful job.  The non-cancer side implant looks great--completely natural.  The cancer side is not shaped as well, not because of the implant but because of the scar tissue from the mastectomy.  Both implants feel soft and natural to me--but keep in mind I previously had small, dense breasts so that's what I'm comparing to.  There is some slight rippling when I lean forward, I have very thin skin which may cause the rippling to be more visible. I have very little upper body fat (all my fat congregates in my rear and thighs ) and there is no step-off with my implants.

While both sides have settled a *tiny* bit, neither implant has drooped at all--I joke that the rest of my body is suffering the effects of gravity, but my foobs will never droop.

I can't give you any insight on how a man would feel about my foobs--my BF bolted while I was going through chemo and frankly I haven't been all that interested in finding a replacement since then.

Liz, you may want to at least talk to another plastic surgeon for a second opinion.  Never hurts to get someone else's thoughts.

Liz:  Based on what you are describing, you have partial submuscular placement of your implants.  If "partial", the lower 1/3 of the implant is covered only by skin...if complete submuscular - the lower 1/3 is under the fascia, connective tissue and rectus abdominus. [In both placement methods, the implant is partially under the pectorals.]  It seems you might have been a good candidate for Alloderm, which I think would have reduced the likelihood of this kind of complication in the lower pole of the breast.  I have Alloderm and partial unders and trust me, if I did not have the Alloderm I would be experiencing the same thing, because my skin flaps are very thin.  Additionally, as rubytuesday mentioned previously, the problem with textured surface implants is that they do have a tendency to grab onto the skin, bringing about traction rippling. 

Referable to your last question, that is what I am going to be doing with Kaiser in Southern California - hopefully before the end of the year.  I will be meeting with breast cancer patients to answer questions, discuss implant options and "show and tell" what they might be able to expect with implant-based reconstruction.