Considering gummy bears. seeking an artistic perspective… (Photo)

Cohesive gel?…Form stable?...Gummy Bear?…what do these terms have in common? With the recent introduction and FDA approval of the next generation of devices, the attention of patients, physicians and the media has been focused on these terms. While these devices have certainly captured the public’s attention, an in-depth understanding continues to evade most.

Following the FDA moratorium on the use of silicone gel filled breast in 1992, “cohesive gel implants” were introduced to the market. How do these devices differ from their predecessors? The silicone gel of a cohesive gel implant is firmer (via the addition of proprietary cross-linker). The greater the cross-linking the firmer the device will feel. The result is a filling that doesn’t leak when the shell is compromised in the way that a traditional liquid does. This quality is best illustrated when cutting a device in half…it doesn’t yield a gooey mess but instead two stable halves.

Generally speaking today’s silicone implants are all “cohesive gel implants.” This broad term has been inappropriately applied to the next generation of “highly cohesive gel implants.” However, the recent media attention on “cohesive gel implants” is not warranted and is in fact misplaced.

These newest devices to reach the market are form stable implants. These higher strength silicone gel implants were approved by the FDA in March 2012. They contain a more “highly cohesive gel.” This increase confers upon these devices the ability to maintain shape irrespective of position. This quality has earned them the informal nickname of “Gummy Bear” implants. Imagine cutting into a gummy bear candy and the effect is the same.

While these implants are new, “novelty” does not necessarily equal “better.” There is a device for every patient. Form stable implants have both advantages/disadvantages. The advantages are: shape retention, no shell folding/wrinkling, no leakage, decreased capsular contracture. The disadvantages include: increased cost, limitations related to access incision, increased technical difficulty, device rotation.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Dear bulliedbaby,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Implant selection is best done during an in person consultation. During this important meeting you'll discuss your goals for surgery and your surgeon will take measurements of your breasts (this is different than bra size). That information will assist your surgeon in selecting appropriate implants for your consideration that will help you achieve the look you are wanting. I've included a video that I hope you find helpful.

Hello, thank you for asking, it is important to have adequate photos to evaluate yourself, in your case I would recommend gummy bear implants, the size will depend on the result you want to achieve,
It also depends on the level of expansion of your skin whether a large implant can be placed or not, this can only be evaluated in an in-person consultation. Thank you, we are at your service.

Without examining you or seeing proper photos it's difficult to give specific advice on what implants would give you the best outcome, but all of the implants you've listed were recalled back in 2019 due to a risk of BIA-ALCL. Artistic perspective aside, these implants are dangerous (and probably not even sterile anymore given that they haven't been manufactured for 5 years now) and should not be used. If you have found a "surgeon" willing to use these for a breast augmentation in 2024 you should report them to the appropriate licensing body immediately and RUN to a board certified plastic surgeon to get some proper guidance.