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. The key questions regarding these breast implants remain: Are they better for my breast augmentation patients from Knoxville and Cookville, TN? Do they give a different and better result? Can you even tell the difference? Let’s take a closer look at these implants.

A Look Inside: Are Gummy Bear Implants Squishy?

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. 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.

“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 essential 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 needed 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.

The Appearance of the Breast

The proponents of these implants will tell you that they do, absolutely, without a doubt, give a better result. We now have some interesting data that refutes this.

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 of 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. (Afterward, he put round implants in on both sides.)

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

Neither group could tell the 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 were about 50-50; no better than tossing a coin.

Are “gummy bear” implants worth it?

Dr. Hidalgo’s study isn’t one of a kind. 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 a half with anatomic, and all the results were pretty good. We were given a button to press for voting which was which. Of the over 300 surgeons present, our ability to guess which was 50-50, again the toss of the coin.

You can see the excellent results we can achieve with regular silicone breast implants by viewing my breast augmentation patients’ before and after pictures in our online photo gallery.

“Gummy bear” Implant Cost vs. Result

Did I mention that these implants are significantly more expensive? 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 enthusiastic, support of these newer devices.

The thinking was that with their more highly cohesive gel and the anatomic shape, they would give a better result in terms of 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.

All Implants Can Rupture

The reason that this is important is what you might infer from the term “gummy bear.” If you think that the implant is 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 drawbacks.

  • 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 critical 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.

Capsular Contraction Studies Lack Firm Evidence

Perhaps the most challenging 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 drawback 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 unproven. The shaped implants have been in use for only ten 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 tough 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. If you would like to discuss your breast augmentation options at my Knoxville, TN, practice, use our online form to request a consultation or call us at (865) 450-9253 to schedule an appointment.

All the best,

Dr. David B. Reath

David B. Reath, M.D.

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31 Responses to The Truth About Gummy Bear Breast Implants UPDATED

  • Ashley says:


    I was wondering how much a breast reduction would be? Do yall accept Tricare?



  • David B. Reath, MD says:

    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:

    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.

  • Monica Capron says:

    I have been considering breast implants for some time now..very interested in the gummy bear implants

  • 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:

    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:

    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

  • Ana says:

    How much does a pair of gummies go for? I live in Honolulu, do you recommend any Dr.s in the area?

  • 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. Don’t waste your money or emotional hope on gummy bear implants. They are disappointing.

  • Kat says:

    I’m considering implants, want them soon but I’m leaning more towards saline, is that a good choice or is the silicone better?

  • David B. Reath says:

    Dear Kat,
    Thanks for your email. While you can get a good result with either saline or silicone implants, the results are better in most cases with silicone. So silicone is always my choice. They look and feel more natural, they are more comfortable to have in place, the are a bit softer and they will last longer. Both implants are equally safe.
    Like I said, I would go with regular silicone, not the highly cohesive silicone or “gummy bear” implants.
    All the best,
    David B. Reath, MD

  • Pingback: Gummy Bear"" Silcone Breast Implants Vs. Regular Silicone: A Five Point Comparison

  • Jessica says:

    Hello I am 40 yrs old and I want to get implants in a few months, I want to set up a few consultations with different doctors to see which I like the best. Are there any important questions I should ask, also I was wondering if I wanted the gummies or silicone I’m so confused

  • MAD says:

    Thank you so much for your informative blog! I have been looking into breast augmentation and seen several consults. Most surgeons that I saw do not recommend the gummy bear or textured implants. However my friends have seen some that heavily promoted them. They haven’t been around long enough to safely compare to regular silicone implants. It’s unfortunate that the the fear of silicone still exists.

  • David B Reath says:

    Thanks for your comments. The “gummy bear,” or highly cohesive gel implants are getting highly promoted by a few surgeons and some of the implant companies. I am not sure why that is. Certainly we do not have as much history with these implants as we do with the normally cohesive gel implants. The price on the gummy bear implants is quite a bit higher and I suspect that there may be a higher profit on these implants.
    And, yes, I agree that it is really unfortunate that some people still have concerns or fears about silicone implants. All the science shows these to be safe and quite effective.

  • Cynthia Long says:

    What do you think of the natrelle soft touch implants? Would you recommend the natrelle reponsive gels over the soft touch, or vice versa?

  • David B Reath says:

    Thanks for your question. My choice is generally the Natrelle soft touch implants, but there is very little difference in the feel of the implants once they are implanted.
    All the best,
    David B. Reath, MD

  • Tara Williams says:

    I’m getting surgery next month. At first I wanted saline because I was told it was the safest if it leaked (but has the highest rupture rate and isn’t recommended). Then I though of gummies because I thought they were solid and couldn’t leak at all (and less chance of rippling). After reading this, I’m unsure. The only my reason I didn’t consider regular silicone is because I thought it was toxic and could be very harmful if it leaked but according to your article, silicone is safe. Is this true even if it leaks?

  • David B Reath says:

    Thanks for your comments. First of all, silicone is not toxic or unsafe. If it were, we would not use them, period. All implants are equally safe, and all have been extensively studied.
    The highly cohesive gel implants (“gummy bear”) are not solid. In fact they more resemble the normal silicone implants (cohesive gel) than anything else. They are a bit firmer and are more expensive.
    Rippling is uncommon with the cohesive gel implants as with the highly cohesive get implants.
    My recommendation for you is to discuss your concerns with your surgeon. I definitely prefer silicone over saline, and I advise my patients to go with the normal, cohesive gel implants for breast augmentation.
    All the best,
    David B. Reath, MD

  • Shelby says:

    Very interesting read. I got the “gummy bear impants” about 4 years ago. I don’t regret my decision. They cost about 8k. I was very flat chested beforehand and didn’t have much of a base under the nipple so the doctor suggested them. I’m very pleased with the results and haven’t had any issues So far. So for women with flat chests I think they are a great option. Thanks for the article!

  • David B Reath says:

    Dear Shelby,
    Thank you for your comments. There is a lot of confusion about these implants. I am glad you have had a good result. These may indeed be the right choice for you.
    All the best,
    David B. Reath, MD

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