What Are Gummy Bear Implants?

Gummy bear is not a scientific term. Nonetheless, the term has certain utility when it comes to silicone breast implants. The term gummy bear has become popular online because it is a cute, memorable term that does accurately describe the consistency of the silicone within modern breast implants.

The term gummy bear refers to breast implants made with silicone that is more cohesive (sticky) than older types of implants, giving them a gummy bear-type consistency. In contrast, older implants have more of a Jell-O-like consistency. Because gummy bear tends to stick to itself, it tends to feel firmer, ripple less, and maintain its shape better long term. More cohesive silicone likely has a lower leak rate than older implants as well.

Are gummy bear implants better?

I do think that gummy bear implants, which doctors refer to as form stable implants, are better than older generations of implants. There are several potential advantages to gummy bear (form-stable) implants:

• Gummy bear implants may have a lower long-term leak rate than older implants because gummy bear silicone is more cohesive; it tends to stick to itself, to hold together, and therefore may have more trouble leaking out of an implant shell, even if that shell develops a tiny defect or pinhole. However, it will take several years to demonstrate if the leak rate is truly lower for gummy bear than traditional implants.
• Gummy bear implants retain their inherent shape, giving them a firmer look and feel, which can look more youthful, more perky.
• Gummy bear implants may ripple less than older, less firm implants. Thinner patients or patients with less breast tissue are more at risk for visible rippling (ridges over an implant) and therefore are often ideal candidates for gummy bear implants.
• All implants have some potential to show rippling. Silicone implants tend to ripple less than saline. Gummy bear implants tend to ripple less than older cohesive gel implants.

How do I know if my implants are gummy?

The term gummy bear has led to confusion since it is not a scientific term and it can be used by any manufacturer in their marketing to describe and sell their implants. Some implant companies and some surgeons use the term gummy bear to refer to implants that contain the same type of silicone as older implants.

As a surgeon, I feel that only newer generation, denser, and cohesive implants can accurately be referred to as gummy bear. In my opinion, the simplest way to assess this is by cutting an implant open. The differences between implants are more apparent when they are cut open and examined, but obviously patients do not have access to implants to see what they look like on the inside. There are videos online, including from our website and social media, demonstrating the consistency of the silicone inside the commonly available implants. Patients can see and feel the differences between implants by handling the implants in their surgeon’s office. Of course, it is important to discuss implant types and brands with your plastic surgeon to determine which implant is best for you.

Personally, I feel that all types of Sientra implants are accurately called gummy bear, but that only the two more cohesive styles of Natrelle implants are gummy. The Natrelle Soft Touch implant is similar to the silicone that was used in their style 15 implants for decades, which were excellent implants but the silicone on the inside has more of a Jell-O-like consistency than a gummy bear consistency. I do feel that the Natrelle Responsive and Cohesive styles are dense enough to be referred to as gummy bear, but the majority of Natrelle implants sold and used are the less dense Soft Touch implants, which I do not think are cohesive enough to be considered gummy.

The distinction is somewhat subjective because there is no scientific, quantifiable cut-off distinguishing gummy bear from traditional implants. And all three FDA-approved silicone implant companies in the U.S. (Sientra, Natrelle, Mentor) make high-quality implants. So discuss these issues with your surgeon.

 Anatomic and textured implants.

Tear-drop (also called anatomic) implants may, in certain patients, have a more natural appearance than round implants, generally with less fullness at the upper pole (upper aspect) of the breast. In addition, anatomic implants are often used in patients who have underdeveloped lower breasts (a constricted lower pole), which is fairly common but may be part of a breast deformity like the tuberous breast deformity (a topic for another blog).

In the past, anatomic implants could lose their tear-drop shape once placed in the breast, but gummy bear implants retained their tear-drop shape long term, making anatomic implants useful and esthetic in specific patients.

However, anatomic implants must have a textured (rough) surface. The textured surface minimizes the chance that a tear-drop shaped implant will rotate out of position (which is not an issue for a round implant). Recently, textured implants have been associated with a type of cancer called ALCL (anaplastic large cell lymphoma). Natrelle’s textured implants were recently taken off the market by Natrelle and the FDA because they comprise about 85% of ALCL cases. Less than a thousand ALCL cases have been identified worldwide, out of millions of breast implant cases, so ALCL is rare, but all patients must be aware of it. And patients with textured implants need to review issues related to ALCL with their surgeons, especially if they have Natrelle (formerly called McGhan) textured implants.

Although all anatomic implants must be textured (to minimize the potential for rotation), round implants can be smooth or textured, and most are smooth. Also, textured implants from Sientra and Mentor (the two other FDA-approved silicone implants sold in the USA) can still be used, but both surgeons and patients are understandably reluctant to use textured implants at all now because of ALCL, so anatomic implants are used less commonly than previously.

Also note that smooth versus textured pertains to the outer silicone shell of the implant, not the material on the inside, which can be saline or silicone, gummy or not.

What is the chemistry of silicone?

For those interested in the chemistry of silicone gel, here is a summary: silicon is an element on the periodic table of elements, like oxygen, hydrogen, gold, etc. Silicon bonds with oxygen to form silicon dioxide, or silica, which makes up compounds like sand, quartz, and glass and is one of the most abundant chemicals on our planet.

Chemists in the early 1900s found that silica bound to methyl groups formed a stable, inert compound, siloxane, which is the basic building block of silicone gel. A long chain of siloxane molecules (which themselves can differ in size and weight) forms silicone. Starting in the 1940s, medical applications were identified for silicone. Silicone compounds were found to be useful because they are stable and chemically inert.

By adding more cross-links between the silicone polymer subunits, silicone can be taken from a viscous liquid to a Jell-O-like consistency, to a gummy bear consistency, to a soft rubber, or even be made into a hard plastic.

In the early 1960s, the first silicone gel breast implants were approved. Silicone gel with the consistency of a viscous liquid was contained in a soft rubber silicone shell. Over time, silicone gel that was more homogenous and more cross-linked was used for breast implant fill, while the silicone shell or envelope that contained the silicone was made more durable in part by making it multi-layered. Leak rates decreased as implants evolved.

From a chemical standpoint, the main difference between more and less cohesive silicone is cross-linking. More cross-linking means more cohesivity, which means more of a gummy bear consistency or a denser implant.

Which Brand of Breast Implants Is Best?

Surgeons often only use one brand of breast implant, but they should be familiar with all the FDA-approved brands available in the U.S., and they should be able to tell you why they use the brand they have chosen for you.

I prefer Sientra because I do consider all of their implants to be true gummy bear implants. (I do not consider the Natrelle Responsive or level I silicone to be gummy.) Also, Sientra is the only silicone implant manufacturer to offer (at no extra cost) a 20-year warranty for leak; the other two companies (Natelle and Mentor) only offer a 10-year warranty.

Sientra was also the first company to get approval for gummy bear implants in the U.S. They have the highest fracture strength (a measure of implant strength) of all three manufactures. And they only sell implants to board-certified plastic surgeons, so if you surgeon does not offer Sientra implants, make sure he or she is actually a board-certified plastic surgeon.

(Full disclosure: I do own Sientra stock.)