Why do some doctors dislike gummy bear implants?

In my practice I use all kinds and brands of implants.  There is a "best" implant for each patient based on their goals and breast type.   I have found that the term "gummy bear" is being used differently in different practices.  In the truest sense, gummy bear implants are tear drop shaped implants.  The idea is that a firmer silicone is necessary to create and hold the shape of the implant.  Modern round implants are also cohesive, just less so.  Some practices are calling cohesive round implants gummy bear and I would encourage you to clarify this distinction with your consulting physicians.The advantages of gummy bear (anatomical) implants are:1) ability to control both height and width of the implant2) a softer (more natural) upper breast shape.  This could be a disadvantage for the patient who prefers a rounder result.3) lower contracture and rippling rates.4) these implants do great above the muscle if the patient is a good candidate5) theoretically less risk of silicone migration in the event of ruptureDisadvantages are:1) higher cost2) slightly longer scar (only a few mm)3) risk of deformity if improperly placed or rotated4) firmer feel (in my opinion this is very slight when covered by the breast)5) less roundness of the upper pole if the patient prefers a rounded result.I personally love these implants for the proper patient and currently use them approximately 10-15% of the time.  These have been used for over a decade outside of the U.S. with excellent results and safety.  There is definitely a learning curve and the surgery has to be very precise but I have seen results with these implants that surpass what I could do with standard round implants.  

In my experience the major problem with textured form stable gel breast implants is that because of the texturing they are very difficult to insert.  We use a no touch technique where smooth-walled cohesive gel implants are placed through a Keller funnel so that during the course of your surgery the implant is never touched.  Our opinion is that this reduces the chance of potential chronic infection and capsular contraction.The textured implants are more difficult to place and as a result in my opinion there is more trauma to the breast tissue and pocket with their use.  The other difficulties in terms of positioning, palpability etc. are discussed in other answers.

There are certainly patients who can get a very nice result with these implants but it's important to go through the pros and cons with your plastic surgeon.  While the chance of rippling is less with these implants, it is not zero, and some surgeons are concerned about a small chance of the implants turning or shifting so that the fullness at the bottom shifts to the side.  That being said, they can create some very nice results in many patients.  Great question and good luck!