David B. Reath, MD
Knoxville, TN (865) 450-9253

The Truth About Gummy Bear Breast Implants UPDATED

The Truth About Gummy Bear Breast ImplantsBack in 2014, I wrote a popular blog about “gummy bear” or highly cohesive silicone gel (fifth generation) breast implants. Specifically, I addressed how these implants are made and why they weren’t like the gummy bear candies we know and love. It’s time for an update.

For breast augmentation surgery, the highly cohesive gel implants used are almost exclusively anatomic or shaped implants. The key questions regarding these breast implants remain: Are they better? Do they give a different and better result? Can you even tell a difference? The proponents of these implants will tell you that they do, absolutely, without a doubt. We now have some interesting data that refutes this.

The Appearance Of The Breast

 

Do “gummy bear” implants look better?
A recent study has shed light on this issue. David Hidalgo is a plastic surgeon in New York City whom I respect a great deal. He did a study on 75 patients. During a breast augmentation, he placed a round implant on one side and an anatomic implant on the other. He then set the patient upright, and took photos. (Afterwards he put round implants in on both sides.)

He then showed their photos to a panel of lay people to see if they could tell a difference. He showed them to a panel of experts: other plastic surgeons.
Surprise. Even plastic surgeons can’t tell the difference.

Neither group could tell a difference or could say that one breast looked better than the other. The chances of successfully telling if one breast had a round or anatomic implant was about 50-50; no better than tossing a coin.

Dr. Hidalgo’s study isn’t one of a kind. There have been several other studies which have reached the same conclusion.
In 2014, I had the interesting experience of being in a meeting of plastic surgeons where we were shown 20 sets of before and after pictures of women, half with round implants and half with anatomic, and all the results were pretty good. We were given a button to press to vote which was which. Of the over 300 surgeons present, our ability to guess which was which was 50-50, again the toss of the coin.

The Consistency of The Silicone Gel Inside

Breast Implant sizer sisters
Calling them “gummy bears” is cute, but misleading.
When you think about a gummy bear what do you envision? We have all had these great little candies – they are a favorite of my wife. They were created by a German confectioner, Hans Riegel in Bonn Germany, in 1920. His company Haribo continues to make the yummy little candies which are known as Gummibärchen. But I digress.

What you probably think of when you think about these candies is that they are a soft, chewy, solid little nugget of goodness. And I would agree. The point that I am making here is that these are solid candies. Soft, but solid with a solid consistency throughout and there is no outer shell.

So, it might be logical to assume that, like the candies, the fifth generation, highly cohesive silicone gel implants – which have been referred to as “ gummy bears” would also be solid. Right?
Wrong.

They are not solid.
The “gummy bear” implants are not solid. Just like the fourth generation cohesive get implants, the highly cohesive gel implants are also made of a semi-solid gel contained within an outer shell. It’s just that the gel in these implants is more cohesive than the others, but not as solid as the moniker “gummy bear” might imply.

It is important to pause for a moment and note that none of the manufacturers of these highly cohesive gel implants refer to them as “gummy bears”. It was a plastic surgeon who gave them this name.

Here’s what happened when I cut into one.
Recently, in the operating room, I had the occasion to remove a set of these implants. Being curious, at the end of the case I cut into one of them. Honestly, if I had not known that these were highly cohesive gel implants (fifth generation), I would have thought that they were just regular cohesive gel implants (fourth generation) which I cut into as a demonstration on this video. Because inside the shell was a semi-solid, viscous silicone gel, that looked and acted just the same.

 

All Implants Can Rupture.

 

The reason that this is important is what you might be inferring from the term “gummy bear.” If you are thinking that the implant is a solid, you would assume that it can never rupture. This would be wrong. Like the preceding generations of implants, these can rupture as well.

It is also important to note that there is no danger to your health if a silicone implant ruptures. But if you are drawn to the fifth generation, “gummy bear” implants thinking that they will never rupture, and therefore may last forever, you are being misled.

Shaped vs Round Breast Implants

 

Shaped implants have some definite draw backs.

  • They are more significantly more expensive.
  • They are slightly firmer and can be felt more easily.
  • They do require a slightly longer incision. This means that these implants will have to be placed through incisions on the bottom of the breasts.
  • Since they are shaped their orientation is very important and improper positioning of the implant is not uncommon. And they can rotate.
  • They are textured to keep them firmly in place. Breast Implant Related Anaplastic Large Cell Lymphoma (a rare lymphoproliferative disorder arising from the capsules around implants) is associated only with textured implants. Right, a topic for another blog.

Round silicone implants have been around for a long time, longer than me. They are safe, effective, and have a proven track record. The surface of these implants is smooth and does not carry some of the risks of textured implants. (Textured round implants do exist, but I don’t use them.)

Natural Breast Tissue Changes Shape.

 

Something that a lot of people don’t understand is that the breast will change shape depending upon body position, and an ideal implant should do the same. When a woman is lying down, her breasts are round and when she is upright they are more conical or shaped.

Round silicone implants do this as well. They mimic the natural breast tissue: round when horizontal, and slightly tapered when vertical. On the other hand, shaped implants are conical no matter which position they are in.

Just Because It’s New, Doesn’t Make It Better.

 

The move to promote these implants has never been something I have understood well. Pardon me for being cynical, but many of these proponents who were involved in the development and testing of these implants have a vested financial interest in them, which can call into question the reasons for their, sometimes zealous, support of these newer devices. Did I mention that these implants are significantly more expensive?

The thinking was that with their more highly cohesive gel and the anatomic shape they would give a better result in terms of the breast shape, longevity, and reduced rates of capsular contracture. But, I am unconvinced by the reports that I have read that any of these occur.

Capsular Contraction Studies Lack Firm Evidence.

 

Perhaps the most difficult issue to resolve is the incidence of capsular contracture (firmness after healing). Some studies do show a slightly lower rate with the highly cohesive gel implants, but you have to balance this with the fact that these are firmer implants in all patients.

However, I think these studies have a real draw back in that they are comparing the results with the new anatomic implants against historically reported results with round, smooth implants.

I do not feel that this historical control is accurate because we are doing things much differently now than we did in the past in terms of placing every implant – round or shaped — and this is probably the reason for the reports of lower capsular contracture rates with these new cases.

In terms of longevity, this is totally unproven. The shaped implants have been in use for only 10 years, in their initial pilot studies. Since the majority of breast implants will last 20 to 25 years, we just don’t know if there will be a difference in the long-term results.

The Best Thing About “Gummy Bear” Implants Could Be Their Name.

 

Anatomic textured implants will not go away, to be sure – too much has been invested in them. And they probably shouldn’t. It is possible that they could be a better implant for breast reconstruction after mastectomy. However, it is really hard to make a case for any other implant than a round, smooth implant for breast augmentation.

During my medical training, I was told that a difference, to be a difference, must make a difference. When it comes to results of breast augmentation and breast shape, the anatomic implants do not appear to make a difference. When you add to this the extra cost and possible complications of these implants, I can personally find no reason for their use in routine breast augmentation.

All the best,

Dr. David B. Reath

David B. Reath, M.D.

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20 Responses to The Truth About Gummy Bear Breast Implants UPDATED

  • David B. Reath, MD says:

    Crystal,
    The “gummy bear” implants are more expensive than the normal silicone implants. The cost difference is about $1000.
    Recovery time from breast augmentation is about a week for normal activities. A little longer for more strenuous work.
    All the best,
    David B.

  • David B. Reath, MD says:

    Sophia,
    For most patients, I prefer the normal cohesive gel silicone implants and not the highly cohesive (gummy bear) silicone implants. They are softer, and less expensive.
    David B.

  • Trisha Hamor says:

    I have had my implants for 5 years now and I LOVE them… I have know many of my friends who get implants but I’m glad I went with the higher end of them… I was a 34 A and went up to a 34 DD … one thing I can say is I have lost a lot of sensitivity. For instance when i had my first daughter before I had implants I could not nurse I felt it was to painful and uncomfortable but after I had implants (under the muscle) i found nursing my 2ed child was fine.

  • Nikki says:

    Hello! In the comments, you said you preferred silicone over gummy bear because they’re softer and less expensive. One factor that drew my attention towards the gummy bear implant is the gradual slope it has to make the breast look natural instead of the full, round implant. Is silicone also available in the gradual tapered slope form?

  • Dr. David B. Reath says:

    Nikki,
    Thanks for your question. The highly cohesive gel (aka “gummy bear”) implants have a tear drop type shape. But these implants are asymmetric and can rotate if not placed properly. They are also more expensive and slightly firmer than the normal cohesive gel implants.

    If you look at a “round” cohesive gel implant when it is flat, it appears round. When it is upright, it will take on a sloped or natural look which is what a natural breast will do. However the tear drop or shaped implants will always be fuller at the base whether upright or lying down.

    Because of this, I feel that the normally cohesive gel implants are more natural-looking. They do not have the over fullness of the top of the breast like saline implants will have (unless you are going overly big on the size).
    All the best,

    David B. Reath, MD

  • Jessica says:

    Thank you for the post! It really helped clear up the real difference between the two. I had found it so hard to understand before. I have one question, how much breast tissue is needed in front to avoid the behind the muscle placement? I may be wrong but it seems to look more natural. Thanks

  • David B. Reath, MD says:

    Jessica.
    I’m glad this was helpful. Much of what has been written makes this whole thing a bit difficult to understand.
    In order to have implants on top of the muscle, I really like someone to be about a B cup. This can vary, of course, and I would always need to see someone to know for sure.
    All the best,
    David B. Reath, MD

  • sharon says:

    I’m a 38 DDD and sagging. When I was younger they didn’t sag and looked great. What can you offer to make them look young and great again?
    Do you remove some tissue then add the implants? I don’t need to go larger only form them up

  • David B. Reath, MD says:

    Dear Sharon,
    Thanks for your question. I cannot really recommend anything specific to you without seeing you. However, more than likely what you need is a breast lift to reshape and lift the breasts. If you do not wish to be larger than you are now, implants are not necessarily needed.
    All the best,
    David B. Reath, MD

  • Kathleen Harrington says:

    Do u think 71 years old is too old for breast implants?I’m 36C but need a lift maybe. That’s wit padded bra.

  • pam Caudill says:

    I heard you Don’t have to get implants changed every ten years. is that true? my breasts are sagging. I’m a d and I’m 43 years old.

  • David B. Reath, MD says:

    Dear Pam,
    Thanks for your question. It is true that you do not have to get your implants replaced every ten years. As long as they are intact and your result is good, you needn’t change them. Most saline implants can last up to 20 years, and silicone can last longer. Most implants are changed because of rupture, capsular contracture (firmness), or because someone wants to change her size.

  • Christina says:

    Dear Dr. Reath,

    I have the gummy bear shaped implants. I spent $9500 on the augmentation and I completely agree with you that these implants should only be encouraged for reconstruction patients. There is nothing attractive about them. There is no cleavage, and they are boring at best to look at. They look like old breast. If women want sexy breast, choose round saline types. Don’t waste your money or emotional hope on gummy bear implants. They are disappointing.

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