Gummy bear anatomic implants vs cohesive smooth round - is it a tradeoff between looking natural and feeling natural?

Hi, trying to select implants for my reoperation due to capsular contracture, overly full upper pole and visible knuckling. Will move from over to under the muscle and do a lift. I am very thin. I have gathered that Gummy Bear Anatomicals create a more natural look but will FEEL much less natural than cohesive smooth round. I want a natural FEEL as well as a natural LOOK.Is there some sort of compromise that will achieve both goals? Thanks!

Doctor Answers 9

Natural looking and feeling results with form stable anatomically shaped gummy bear implants in the cold-subfascial plane

Firstly the unnatural feel concept is just not a reality at least in my practice.  I routinely place gummy bear implants in the cold- subfascial plane and I certainly ould not tell the difference in feel once placed.  All silicone implants feel soft and natural when placed this way.  Outside of the body there are certainly differences but once placed there are no perceptable differences.  My preference in cases like yours is to place form stable anatomic gummy bear implants in a new subfascial plane.  depending on what your previous surgeon did the fascia might have been violated but at this point it is bolstered with capsule and can be elevated and sculpted to give you a very natural form.  I hope this helps!

All the best,

Rian A. Maercks M.D.

Gummy bear anatomic implants vs cohesive smooth round - is it a tradeoff between looking natural and feeling natural?

Thank you for the question. These days there are a variety of breast implants available; the variety of breast implant available raise a lot of questions from women considering breast augmentation surgery. Personally, I think that for most patients considering breast augmentation surgery, careful selection of plastic surgeon and careful communication of goals, far outweigh the specific type of breast implant utilized (when it comes to the success of the breast augmentation procedure).

Anatomical breast implants were designed to better simulate the natural breast shape; the problem with these implants is that if they shift or rotate, the entire breast will change shape as well. This change in breast shape may require further surgery to correct. Round implants, under the hand, can shift or rotate without changing the shape of the breasts. Overall, I find that beautiful outcomes can be achieved with the use of round saline or silicone gel breast implants for the vast majority of patients.

Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “very natural” or "B or C cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

Cohesive gel or tear drop highly cohesive

Thank you for your question about your breast augmentation revision.

Sadly, there is no perfect implant. It is a matter of what is more important.
Each implant has it characteristics - 
  • The tear drop implants will solve the over-full upper pole, give a more natural appearance, be less likely to cause rippling. 
  • They are stiffer than the cohesive smooth round but it does not make them necessarily unnatural.
  • Natural breasts do not all feel the same - ones with lots of fat are softer than densely glandular breasts.
  • It is important for you decide whether a soft feel or better look is more important to you.
Always consult a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes.

Highly cohesive implants no advantage relative to capsular contractue.

The higher cohesive implants may be beneficial (and more expensive) for some clinical situations but they have no proven advantage relative to capsular contracture.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 32 reviews

Breast Implant Revision

Thank you for your question.

Yes, the textured anatomical implants are more firm.  

If you go with a relatively small round implant that is not high profile, then it is possible to achieve a natural look and a soft feel.

It is the large, round, high profile implants that have a tendency to look unnatural.

To be sure, see two or more experienced, board-certified Plastic Surgeons for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 150 reviews

Anatomical versus round implant

When an implant is placed during the course of a breast augmentation the body and actually forms a lining around the implant creating a barrier between the foreign object and the rest of the body. Normally this barrier is thin and soft and does not create any change in the appearance of the breast. This lining is called the capsule. If this capsule thickens, becomes harder and shrinks in size the breast will feel firmer and possibly change shape. This shrinkage of the capsule is called a capsular contracture. 92% of capsular contractures will occur within the first 12 months following surgery. Although the exact cause for a capsular contracture is not well understood there are a few things that seem to be related to this phenomena. One of these is whether or not the implant is placed above or below the muscle Implants placed under the muscle have a lower incidence of capsular contracture than implants placed above the muscle. By placing your new implants underneath the muscle your chances of capsular contracture and the consequent fullness in the upper portion of your breasts should be much less. A smooth round implant is able to move and change shape with changing positions. When you stand up the silicone gel will have a tendency to settle more toward the bottom providing somewhat of a "teardrop" appearance. From the way your situation has been described I would recommend a smooth round silicone implant.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 108 reviews

Gummy bears and round implants

In general you can have a natural result with either implant.  I usually use round implants because the gummys are shaped and have the potential to turn. 

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 24 reviews

You do not need to compromise

Both implants can gave you natural look and feel.


The "gummy bear"(Allergan Style 410) tend to be firmer but soften over two years.


If you have some breast tissue and will not be "all implant," both can work for you.


If you have very little breast tissue, the round smooth cohesives may ripple more than the "gummy bears"


After capsular contracture are you discussioning ADMs, eg Strattice or SERI


Best of luck

Andrew Kornstein, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 13 reviews

Anatomic versus round

First I think under the muscle is generally a lot better than over the muscle.  I think you CAN get a more round upper pole with round implants (less natural) but not always--depends on profile of implant, your tissue, etc.  Again under muscle is better.  I personally do think the anatomic implants feel firmer and less natural.  And in a redo case a significant concern is the possibility of implant rotation--not a concern with round implants.  So for me, I only use anatomic for very specific cases.  I hope that helps!  Good luck!

Michael E. Decherd, MD
San Antonio Plastic Surgeon
4.9 out of 5 stars 52 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.