Breast Implants

About Breast Implants

Breast Augmentation is the most popular cosmetic surgical procedure in the U.S according to the American Society of Plastic Surgeons. In their cosmetic national data bank statistic reports of 2013, breast augmentation ranked as the number one cosmetic procedure with 290,224 cases preformed in that year. That is a 37% increase when compared to 2000.

Dr. Roudner’s surgical goal is to augment the breast as desired by the patient, while maintaining a natural and youthful appearance of the breast with minimizing visible scars.

Dr. Roudner may use a saline or silicone implants or use fat grafting while performing the augmentation procedure depending on the patients desires and needs while taking into account anatomical and soft tissue characteristics.

The Keller Funnel – As seen on “The Doctors” TV show on CBS


Dr. Tal Roudner uses the new Keller Funnel for both breast augmentation and breast reconstruction surgeries. Using the Keller Funnel can provide patients with the following benefits:

  • Shorter incision lengths
  • More choices for incision placement
  • No touch technique which reduces the chance of capsular contracture (hardening of the breast)
  • Reduced force on the implant and incision decreasing trauma to the tissues and implants

Click to read more about the Keller Funnel and its benefits.

Breast Augmentation Video Testimonial

Cohesive Gel Breast Implants (“Gummy Bear” Implants)

The field of plastic surgery is constantly evolving and innovative new technologies are frequently introduced. One of the most recent developments is the latest generation type of breast implant, that is created using a cohesive silicone gel that is molded into shape. One doctor coined these new implants as “Gummy Bear” implants, and the name has stuck. Cohesive Gel Implants (“Gummy Bear Implants”) have become very popular among patients looking into breast augmentation surgery.

The correct scientific term of these type of implants is anatomically shaped form stable textured highly cohesive silicone gel implants. These Highly Cohesive Gel Implants (“Gummy Bear Implants”) are only sold to board-certified plastic surgeons, which means that only trusted professionals are able to provide this new type of implant to their patients.

Call 305-767-7719 for a consultation regarding Highly Cohesive Gel (Gummy Bear) Breast Implants.

Cohesive Gel “Gummy Bear” Breast Implants Video

The Advantages of Form Stable Highly Cohesive Gel Breast Implants

cohesive gel implants
Despite the unorthodox name, “gummy bear” implants can provide excellent results when used in the appropriate patient. The key difference between the Highly Cohesive Gel Implants (“Gummy Bear Implants”) and traditional implants, is that “gummy bear” implants are filled with a highly cohesive(sticks together) silicone gel that is form stable, allowing the implant to maintain a natural breast shape at all times and negate some of the forces of gravity over time. This allows for a natural breast appearance and feel. Highly Cohesive Gel Implants (“Gummy Bear Implants”) are much less likely to rupture in case of injury due to the stronger nature of the shell of the implant and the silicone gel fill. The possibility of the implant rippling is reduced due to the form stability of the silicone gel those reducing the chances of implant rupture. If the implants rupture the silicone does not spread through the tissues due to the highly cohesive nature of the silicone gel. The Highly Cohesive Gel Implants (“Gummy Bear Implants”) are textured and enhance adhesion of the breasts soft tissues to the implant to prevent movement.

Latest studies have shown a reduced number of capsular contracture (hardness of the breast) complication with these implants. This maybe as a result of the highly cohesive gel used in the implants as well as texturing of the implants.

From the FDA: About Breast Implants

Breast Augmentation Using Form Stable Highly Cohesive Gel Breast Implants (“Gummy Bear” Implants)

As a board certified plastic surgeon, Dr. Tal Roudner has embraced the use of form stable highly cohesive gel breast implants, “gummy bear implants”, at his Miami practice. He has extensive experience placing a variety of styles of breast implants. As the co-author of a chapter on breast augmentation and breast lifts in one of the most recent cosmetic surgery textbooks, Dr. Tal Roudner is an authority on the subject of breast implants.

If you are interested in breast augmentation using form stable Highly Cohesive Gel Implants (“Gummy Bear Implants”) please call our Miami office today to schedule a consultation and examination. Dr. Tal Roudner will discuss what Highly Cohesive Gel Implants (“Gummy Bear Implants”) can and can’t do, and help you make the right decision for your needs and goals.

Highly Cohesive Gel Implants (“Gummy Bear Implants”) augmentation results in a natural tear drop breast appearance, a patient who desires an obviously augmented-looking breast may be unhappy with a shaped device.

Following your consultation at our Miami office, if you and Dr. Tal Roudner agree that Highly Cohesive Gel Implants (“Gummy Bear Implants”) are the right choice for you, you will be scheduled for surgery at our Miami surgical suite, which is located right here at our Miami office. In some cases, your surgery may be relocated to one of Miami’s excellent local hospitals.

Once your surgery is scheduled, Miami surgeon Dr. Tal Roudner will discuss your pre- and post-op instructions and provide directions regarding medications and your after-care following your form stable highly cohesive gel breast implants, “gummy bear implants”, surgery.

Ideal candidate for Form Stable Highly Cohesive Gel Breast Implants (“Gummy Bear” Implants)

Ideal candidates are healthy patient with reasonable expectations who have a good skin envelope and tissue coverage without sagging (ptosis). The form stable highly cohesive gel breast implants, “gummy bear implants”, may also be a good option for patients with a constricted lower pole of the breast (tubular breast) and in breast reconstruction surgery.

Disadvantages of Form Stable Highly Cohesive Gel Breast Implants (“Gummy Bear” Implants)

Since the implants silicone gel is more highly cohesive, at times larger incisions were required to insert the implants. In many cases the use of the Keller Funnel, which facilitates the insertion of the implants, has helped prevent the larger incisions. The use of the implants in breast revision surgery may be limited due to large breast implants pockets created during the initial surgery and the risk of rotation of the implants. They may be more palpable or visible in women with limited amount of breast tissue. They are more expensive.

Options and Placement of Form Stable Highly Cohesive Gel Breast Implants (“Gummy Bear” Implants)

Gummy Bear Breast ImplantsDr. Tal Rounder will work with you to find the form stable highly cohesive gel breast implants, “gummy bear implants”, that will best suit your body and your profile. The three standard shapes are round, oval and classic.

The procedure of placing form stable highly cohesive gel breast implants, “gummy bear implants”, is similar to the placement of the traditional breast implants. Most commonly an incision is made at the infra-mammary fold and is slightly larger than the traditional incision due to the slightly stiffer characteristics of the implant. The implant is placed in a “dual plane” (under the muscle) in most cases to obtain more tissue cover of the implant those reducing it palpability and visibility. The Highly Cohesive Gel Implants (“Gummy Bear Implants”) tend to be slightly more palpable and visible in thinner patients than traditional implants. These implants may take months to soften up as opposed to traditional implants that may take weeks to soften.

It is imperative that an experienced plastic surgeon in breast augmentation surgery performs the operation since the pocket created for placement of the form stable highly cohesive gel breast implants, “gummy bear implants”, is precise. If the pocket created is larger than needed the form stable highly cohesive gel breast implants, “gummy bear implants”, may rotate in the pocket and since it is anatomically shaped and not round like traditional implants a rotation may cause the breast to appear unnatural.

Following your form stable highly cohesive gel breast implants, “gummy bear implants”, surgery, follow Dr. Tal Roudner’s instructions for self-care to avoid complications. During your follow-up visit to our Miami office Dr. Roudner will check on the placement of your implant and your healing progress.

The Latest Generation Breast Implants – NATRELLE 410

Natrelle 410 Breast Implants "Gummy Bear"
Allergan’s NATRELLE 410 anatomically shaped highly cohesive silicone gel (“Gummy Bear”) Implants are probably one of the most talked about silicone breast implants that are currently available. These innovative 410 implants are designed to address some of the limitations of previous silicone gel implants.

Traditional Silicone Implants vs 410 Implants

The gel used in the traditional silicone implants has the ability to shift. When silicone gel implants are placed in the vertical position, this gel can gradually shift and fall toward the bottom; which can lead to rippling due to the loss of fullness in the upper pole. Sometimes this rippling can be felt or seen. For this reason, traditional silicone is not the preferred material for use shaped implants.

The 410 implant consists of a cohesive silicone that is more gelatinous or gummy; hence, the name Gummy Bear Implant. This consistency is attained through additional cross-linking during the manufacturing process. Most of the traditional silicone gel feels like honey, whereas the 410 implants feel more like a gummy bear. The 410 implants are form stable and are shaped like a teardrop.

410 Implants Maintain Their Shape in Every Position

The shells of the teardrop shaped 410 implants will not fold and the upper pole remains full even when placed in a vertical position. Rippling is minimal because the upper poles in the 410 implants remain full. The 410 implant can hold its shape because of its highly cohesive silicone gel.

The Benefits of Allergan’s NATRELLE 410 Implants

When compared to the traditional silicone implants 410 implants offer several benefits:

  • The possibility of capsular contracture is decreased
  • The likelihood of rippling is reduced
  • Gravitational forces will not affect the shape of the 410 implant
  • Reduced leakage rates

Allergan’s NATRELLE 410 Implants Offer Variety

There are 12 different 410 implant models available. Each 410 implant model varies in height, width and projection. Every 410 implant comes with an anatomical shape designed to match your body’s natural characteristics. The height of the 410 implant can be full, moderate or low. The projection of the 410 implant can be extra full, full, moderate or low. Each 410 implant style offers different volumes.

Allergan’s NATRELLE Round Gel Options
There are four different round gel options from Allergan’s NATRELLE. These round gel implants are not as firm as the teardrop shaped 410 implants are. Although these round 410 implants are not considered form stable, they are less likely to fold than the traditional silicone gel implants are.

Smooth and Textured 410 Implants
All of the 410 implants that are shaped like a teardrop are textured. The texture helps keep the implants from rotating. The round implants are available in textured and smooth surfaces; however, the round implants are not form stable.

If you reside in or near Miami and you are interested in learning more about these innovative breast implants or any other breast augmentation procedure, contact Dr. Tal Roudner’s office today at 305-767-7719 to schedule a consultation.

Breast Implants in Breast Enhancement Procedures

Saline Breast Implants
Breast implants are a prosthesis used in breast reconstruction, breast augmentation and breast lift surgery to enhance the size of the breasts improve the breast form and create a feel similar to natural breasts in women undergoing breast reconstruction. They are also used in treatment of severe breast and chest deformities and asymmetries that are either congenital or acquired.

The implants have a vulcanized silicone shell and may have either a silicone gel inner fill, saline inner fill or a combination of both.

In the breast reconstruction process a temporary tissue expander (an expandable implant) is gradually filled with sterile saline in order to create an appropriate pocket for a future breast implant prior to its exchange for the permanent implant. In cases of sever chest and breast deformities it maybe necessary to use a solid silicone implant created out of a CT scan model.

Many different materials and devices have been used since the first breast enhancement procedures. Autologous adipose tissue (patients own fat and soft tissue) was used by Czerny in 1895 to correct a defect created by a tumor removal. Prior to Czerny attempts with paraffin injections concluded in severe complications. Other substances such as glass, rubber, polyethylene and more have been unsuccessful in obtaining a safe and long lasting breast augmentation results.

Other forms of breast augmentation were used such as flaps and currently used in breast reconstruction surgery. Silicone injections in the 1950’s were complicated by granulomas and hardening of the breasts and required excision. The first silicone breast implants were made by Thomas Cronin and Frank Gerow and the Dow Corning cooperation and were used in 1962 in a breast augmentation procedure. The first saline breast implant was manufactured in France in 1964. The saline breast implant was the only available implant in the 1990’s and early 2000 while silicone breast implants were investigated by the FDA for safety issues. Saline implants allow placement of the breast implant through a smaller incision those creating smaller scars. The saline implants can achieve great results if placed submuscularly in women with adequate soft tissue but are more likely to involve rippling, palpability and are more noticeable in women with thin small breast.

Currently a fifth generation silicone breast implants are been used. The fifth generation silicone breast implants are in a semi-solid gel state which decreases the ability of the gel to leak or “bleed” as well as makes the possibility of the gel migrating through out the body very unlikely. The fifth generation silicone implants are improved and safer implants which have a lower incidence rate of capsular contracture and of device-shell rupture.

Breast implants are used in mammaplasty surgery for 3 main indications:

  1. Primary breast augmentation – to aesthetically improve the size, form, shape and symmetry of the breast.
  2. Primary breast reconstruction – in congenital (born with such as tuberous breast) and acquired (breast cancer, trauma, etc) breast deformities.
  3. Revision breast surgery – correcting unfavorable results after primary augmentation and reconstruction cases.

Breast Implant Incision Sites

Breast Implant Incision: Periareolar Incision
An incision at the border of the areola and the lighter breast skin is made. This incision is typically the most concealed out of the four type of incision and gives an excellent approach to create the pocket and position the implant as well as adjust the infra-mammary fold. It is used in the peri-areolar breast lift approach.

Breast Implant Incision: Inframammary Incision
Commonly used incision made below the breast fold. This incision is generally less concealed than the periareolar but gives a faster approach to create the breast pocket for the implant. Harder to control the infra-mammary fold and can not be used in certain cases. The infra-mammary fold incision may result in a thicker and wider unsightly scar. surgical scars.

Breast Implant Incision: Trans-axillary Incision
An incision is made in the axilla (underarm). A endoscope (lighted camera) is used to assist in creating the breast pocket for the implant. Scar is less concealed then the periareolar approach and if a second procedure is needed in the future scar tissue in the region may make this approach less attractive. Also has a tendency to have higher ridding implants with this approach.

Breast Implant Incision: Trans-umbilical Incision
An incision is made in the belly button and a tunnel created to the breast. This approach is only applicable for saline implants. Higher risk of chest trauma since it is a blind approach. This incision site is not recommended.

Breast Implant Placement

Breast Implants Surgery Placement
Breast Implant Placement: Sub-Glandular Implant Placement
The breast implant is placed between the pectoralis chest muscle and the glandular and soft breast tissue. This placement may reduce surgery and recovery time and may be less painful. It may improve the appearance of sagging breast (ptotic breast) but has a higher rate of capsular contracture and may make the breast sag faster. It has fallen out of favor.

Breast Implant Placement: Sub-Muscular Breast Implant Placement
The implant is placed below the chest muscle (pectoralis major muscle) or partially under the muscle in its superior portion and under the breast tissue in its inferior pole, also know as a “dual plane”. This placement offers better coverage of the implant and reduces the palpability and visibility of the implants and reduces the risk of developing capsular contracture. Another benefit of this approach is the increased amount of breast tissue that is seen on mammographic imaging of the breast.

Preparing for Breast Implant & Augmentation Surgery

Patients undergoing breast augmentation procedure are seen in the office at time of consultation and two weeks prior to surgery for pre-op. At that time necessary blood work and other test are performed, consents are reviewed and signed and medical clearance is obtained as necessary. Pre-op photos are taken. Patients that smoke are required to stop smoking 4 weeks before the procedure and for 3 weeks after the surgery. It is important to inform Dr. Roudner if you smoke at the initial consultation.

Medications (aspirin, ibuprofen, etc) supplements and herbs can cause bleeding problems during the surgery and post surgery. Therefore a list of any medication, supplements or herbs that should not be taken a few weeks before the procedure is given at the time of the consultation.

Prior to surgery it is important to eat a healthy diet and avoid drinking alcohol a few days prior to the procedure. Exercise and being in good shape prior to surgery is generally good for the patient’s overall health and a speedy recovery; however, day prior to the breast augmentation procedure patient’s should avoid strenuous exercise.

Patients should not eat or drink anything, including water, after midnight the night before surgery. The patient should shower the night prior to the surgery and wash the surgical site with antimicrobial soap. After the shower, the patient should avoid wearing any products such as: oils, creams, makeup, moisturizers, lotions and deodorant.

Removing any nail polish from at least one fingernail and toenail will be helpful for the anesthesia person in order to monitor the blood circulation during the procedure using a pulse-oxy-meter.

The morning of the surgery the patient’s may brush their teeth, but should not swallow more than a sip of water. If instructed by the primer care physician, patient’s may take any needed prescribed medication with sipping a minimal amount of water.

On the day of surgery the patient should wear loose-fitting clothes that open in the front and comfortable flat shoes that are easy to put on.

Arrangements for transportation of the patient to and from the procedure as well as a someone to stay with the patient for the first 24 hours after surgery should be made in advance.

Care for small children, should be arranged prior to the surgery as well as preparation of extra food and drinks. Responsibilities at home and at work should be taken care of prior to surgery in order to have worry-free and relaxing recover.

Prescription medications maybe filled at the time of surgery by the person accompanying the patient to surgery or a in advance prior to the day of surgery.

What to expect from Breast Implant & Augmentation Surgery

The preparation for breast augmentation is quite similar to other elective surgical procedures except for a mammogram that is required prior to surgery for any women from the age of 30 and above or earlier if a history of breast cancer in a first degree relative is detected at an early stage of life.

The surgery is performed in the surgical suite at the surgical center or at the hospital if needed due to patient’s medical history. The procedure maybe performed under twilight sedation (person is sedated but not unconscious) with local anesthesia or it maybe performed under general anesthesia. The procedure should take between 45 minutes to two hours depending on the complexity of the case and technique used. The patient recovers in the post anesthesia care unit and is discharged home the same day unless it is necessary to keep the patient over night (rare).

The first few days after surgery are usually the most difficult ones with some pain and discomfort. By the third day most patients have a significant improvement. On the third day, Dr. Roudner will examine the patient at the office to ensure that the breast are healing properly and that the breast is soft and the pockets are open. Follow up visits are at one week, ten days, two weeks, six weeks and three months and one year. Most of the swelling is gone by six weeks and the final results are seen at six months to one year.

Post Breast Implant & Augmentation Surgery

The patient is seen in the office and follow a protocol given at the time of pre-operative visit. The doctor and the nurses review the instructions with the patients as recovery progresses. The first 3 weeks after surgery only sports bras are used and after that a wire bra maybe used. Swelling subsides over a period of six moths to a year but significant reduction of swelling is noticed by six weeks. It is not uncommon for one breast to swell more then the other.

Patient should plan to have 5 days of rest with complete bed rest the day of surgery except for getting up to the restroom. The day after surgery the patient should be out of bed gradually mobilizing at home with out strenuous activity. On day five the patient should be able to drive. Gradual light exercise maybe started on the 4th week after surgery with full activity at six weeks after the surgery.

The post-operative instructions are to avoid sun exposure for a minimum of 6 weeks but ideally a 6 months period.

Reasons for Breast Implant & Augmentation Surgery

Women who suffer from low self esteem or loss of femininity due to congenital or acquired absent, small or asymmetric breasts or women that lose their breast volume, shape and form after pregnancy or significant weight lose could be great candidates for breast augmentation surgery.

Breast Implants Frequently Asked Questions

What can breast implants do for me?

Breast augmentation surgery can improve the shape, contour and volume of the breasts. It may also improve on very mild sagging of the breast as well as give more cleavage to certain patients. It may also improve on some asymmetries of the breast creating a more even appearance. all these benefits may improve the self esteem and confidence of women that have been bothered by these deficiencies at a young or more maturing age.

Who is a good candidate for breast implant surgery?

Most healthy women 18 years of age are good candidates for saline implants and 22 years old women are good candidates for silicone gel implants. (Women how are not good candidates for breast augmentation surgery are women who are pregnant, breast-feeding, have an active infection, have malignant or pre-malignant breast cancer that has not been adequately treated, or are under the age of 18). People with poor overall health and history of poor healing capabilities (such as smokers, chronic alcohol users and various medications), who have had previous breast surgeries, suffer from bleeding tendencies, infections and are predisposed to develop a hardened capsule around the implant should be selected out carefully for surgery after these issues have been corrected.

What anesthesia is recommended for breast augmentation surgery?

The procedure can be performed either under twilight sedation (person is sedated, but not unconscious) with local anesthetic or under general anesthesia.

Is the recovery process painful or uncomfortable?

It depends on the individual. Some patients recover with minimal pain or discomfort while some others have a more difficult time after surgery. Most patients have moderate pain in the first 3 days after surgery. After that period thing improve rapidly. The more active the patient becomes the more often pain stops them from more strenuous activity. That is the safe guard mechanism of the body to prevent injury. The patient should stop any activity at that point and rest. In very rare occasions pain persists for a long period and is mostly do to nerve regeneration or compression and needs to be treated if possible.

Additional Information on Breast Implant & Augmentation Surgery

Any surgery has risk and possible complications. Serious complications after breast augmentation surgery are rare, but may include: Post- surgical bleeding (hematoma), infection, seroma, capsular contracture (hardness of the breast- scar formation around the implant compresses the implant), scaring, change in nipples sensation (undersensitive, oversensitive or numb), nipple areolar compromise (extremely rare). Other less sever complications: Asymmetry, rippling, palpability, malpostion, rupture, deflation, leaking.

With breast implants filled with saline (salt-water) solution a deflation of the implant due to a break or leak in the shell of the implant will be noticed as a reduction in the size of the breast, your body will absorb the solution with no harm.

Although it is rare, women with breast implants may experience symptoms such as joint pain or swelling, fever, fatigue, breast pain and others symptoms associated with diseases of the immune system. The implants were studied extensively by the FDA and no correlation between the presence of the silicone implants and those symptoms has been found. The FDA considers the implants as a safe device to use in surgery. On going studies are being conducted to further evaluate correlation between those symptoms and the implants.

There’s no evidence that breast implants cause breast cancer, some clinical studies have showed the females with breast implants may detect the presence of breast cancer earlier then women that do not due to the heightened awareness of their breast and frequent breast massage.

No negative effect of the implants on fertility, pregnancy, or the ability to breast feed has been found although breast feeding may require additional supplementation.

Women with breast implants require special technique while obtaining a mammogram and should make the technician aware that they have breast implants.

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