Back 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
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?
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,
David B. Reath, M.D.A Girlfriend's Guide
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