The term gummy bear refers to breast implants made with silicone that is more cohesive than older types of implants, which gives them a gummy bear-type consistency. In contrast, older implants have more of a jello-like consistency. The medical term for gummy bear implants is form-stable, whereas the older implants are referred to as cohesive gel. The silicone in both implants is basically the same except that the silicone in a gummy bear implant has more chemical cross-links, giving it more structural integrity, making it thicker.

Are gummy bear implants better?

There are several potential advantages to gummy bear (form stable) implants. Gummy bear implants:

Gummy bear implants may have a lower long-term leak rate than older implants because the more solid type of silicone may have more trouble leaking out of the implant shell (which is also made of silicone). However, it will take several years to demonstrate if the leak rate is truly lower for gummy bear than traditional cohesive implants.

Gummy bear implants tend to 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). 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 lead to confusion since it is not a scientific definition. Some implant companies and some surgeons use the term gummy bear to refer to implants that contain the same type of silicone as older cohesive implants that Dr. Goldman does not consider form stable (gummy).

All Sientra implants can, in my opinion, be considered gummy bear, but Natrelle’s softest implant, the responsive or level I cohesivity implant, is considered by some surgeons not to be gummy or form stable, since it has the same silicone as the prior style 15 implants, which most surgeons considered cohesive but not form stable. The distinction is somewhat subjective because there is no numeric cut-off distinguishing gummy bear from traditional implants. And all three FDA approved silicone implant companies in the US (Sientra, Natrelle, Mentor) make high quality implants.

Patients can see and feel the differences between implants by handling the implants in their surgeon’s office. The differences are more apparent when implants are cut open and examined, which we have done on social media. Of course, it is important to discuss implant types and brands with your plastic surgeon to determine which implant is best for you.

 Round vs. tear-drop implants.

When a patient is upright and standing, round silicone implants will assume somewhat of tear-drop shape, which gives them a natural, soft appearance without too much upper pole fullness. Tear-drop (also called anatomic) implants will have a little less upper pole fullness. Patients may use them to have a more natural appearance, but they are also used to create more fullness in the lower breast of patients who have a tight, under-developed lower breast, which is fairly common and may represent a normal variant or be part of a breast deformity like the tuberous breast deformity (a topic for another blog).

Anatomic implants historically could lose their tear-drop shape once placed in the breast, but gummy bear implants, which tend to retain their shape like a gummy bear does, retained their shape, making anatomic implants more useful in more clinical settings. However, anatomic implants have to have a textured surface. Textured surfaces have been associated with ALCL (anaplastic large cell lymphoma), which is also a topic for another blog, but the salient facts are that there have been not quite 1000 cases of ALCL identified over the last several years in patients who had textured breast implants. About 85% of these patients had Natrelle textured implants, so the FDA recommended that Natrelle no longer sell these implants.

Sientra and Mentor (the other two FDA approved silicone implants sold in the USA) can still be used, but both surgeons and patients are understandably reluctant to use textured implants now, so anatomic implants are used less commonly.

Do you want to know about 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. Starting in the 1940s, medical applications were identified. Silicone compounds were found to be useful because they are stable, chemically inert.

By adding more cross-links between the silicone polymer subunits, silicone can be taken from a viscous liquid to a jello-like consistency, to a gummy bear consistency, to a soft rubber, to 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, 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.

Gummy bear implants and the previous cohesive gel implants have very similar silicone gel polymer inside, but the gummy bear implants have more chemical cross-links, making the silicone firmer.

Which Brand?

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 use 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 by gummy.) Also, Sientra is the only silicone implant manufacturer to offer (at no extra cost) a 20-year warranty for leak; the other companies offer a 10-year warranty. Sientra was the first company to get approval for gummy bear implant in the U.S. They have the highest fracture strength (a measure of implant strength) of all three manufactures. And they only sell implants through board certified plastic surgeons. So if your surgeon does not offer them, make sure he or she is actually a board-certified plastic surgeon. (Full disclosure, I do own Sientra stock, because I think they will increase their share of the silicone implant market over time.).