Gummy bear implants may not be the best implants for you.
You have given a fair amount of information about your previous surgeries, and you now have more experience than most patients with saline vs. silicone, above the muscle vs. below the muscle, and augmentation only vs. lift plus implants. Certainly childbearing and possibly breast-feeding can have substantial impact on a woman's breasts, whether they are previously augmented or not. Your surgeon's solution was to do a lift, and switch from submuscular saline to submammary silicone. I might have disagreed with this choice just on the basis of the description alone, and apparently your result bears out my reservations about this plan.
Now, however, either you or your surgeon is suggesting "gummy bear" implants. The "true" gummy bear implants are not yet FDA-approved for general use, and I believe the study (involving only a certain number of plastic surgeons) has been closed to further enrollment. These study implants are form-stable, cohesive, firm, textured, teardrop-shaped implants that require a larger incision (not a problem for you with lift scars), do not move with changes in a patient's position, are position-sensitive (they have to be gotten in exactly the right orientation in the body as the texture prevents any movement--if they are "off" then they stay in that asymmetrical out-of-position orientation), and they remain teardrop-shaped when reclining, which normal breasts do not do (they flatten to a round shape and slide laterally towards the side of the chest). Thus these so-called "anatomic" gummy-bear implants are not really anatomic at all. Oh, did I mention that they cost more as well? Perhaps you can tell I was not a big fan. Nothing wrong with the implants, or the surgeons that used them, just overall I felt these implants were a suboptimal solution for problems that rarely exist. I certainly would not oppose using them in certain select patients in a "salvage" situation where nothing else has worked, but for general augmentation, and even most re-do patients, smooth, round, 5th generation cohesive silicone gel implants (Memory Gel by Mentor, or Natrelle by McGhan, then Inamed, now Allergan) are state-of-the-art implants that provide superior results in most patients.
Since these latest implants are also cohesive (more cross-linking between the silicone polymer molecules), and cannot leak or rupture, many patients incorrectly call them "gummy bear" implants. Both types of implant are cohesive, but with different levels of cross-linking, different degrees of firmness (or softness), and shape (round vs. teardrop-shaped), and surface (smooth vs. textured). These are NOT the same, and yet the cohesiveness is the biggest advantage of the present 5th generation of silicone gel implants in use. Read the link below for more information I have included on our website.
I would suggest several opinions from other ABPS-certified plastic surgeons in your area, particularly those with extensive breast surgery experience. Switching pockets again has a whole set of concerns that did not exist when going from submuscular to submammary, and this may not be a good idea. If you want larger implants again, you may need the additional tissue coverage that returning to the submuscular pocket would allow. But then what does your surgeon do with the "old" submammary pocket? As I hope you can see, perhaps a dose of wisdom combined with a kettle of experience is needed for the best outcome. Perhaps your own surgeon can provide this--if so, please still get several other opinions; your surgeon's judgment and sage advice will clearly shine through compared to your other bits of input. But after two operations so far, let's get this one right, shall we? Good luck and best wishes!
Rippling is much less common with cohesive silicone gel implants because they are semi-solid, but please note that rippling is still a risk. They also feel and look more natural. However, what is it that you don't like about your new breasts? Is it a lack of fullness? Less projection? Talk to your surgeon. Perhaps they can recommend a type of silicone implant that would achieve what you want.
Memory Gel Silicone Under the Muscle 3 Weeks Ago: Can Feel Implants When Massaging
As you can imagine very hard to advise without posting photos. My guess is yes go bigger and discuss in further detail with your chosen surgeon.
Gummy Bear Breast Implants
I am sorry to hear that you had a problem with your second
surgery. Gummy bear implants would work
very well since there are many shapes and sizes available. This means that the shape you are looking for
can be chosen and a more predictable result can be achieved.
The textured implants work well over or under the muscle and
do not need any pampering after surgery like massage, or special bras. These implants are well suited for the 24
hour recovery as well. For secondary
surgery such as you are contemplating they are exceptional since extra
dissection is not required.
I have added a video that explains a little more about the advantages
of these implants.
I hope that helps.
It is difficult from your description to get a good handle on what you want. An exam would be critical to perform and a discussion of your goals is key as well.
Gummy Bear Breast Implants Are Not A Current Implant Option
Since gummy bear implants are not currently available, that choice of implant is not an option. However, I think in looking at this implant style you are overlooking the real solution...a bigger implant. That is far more likely to get you back to where you once were than a different type of implant. Furthermore the stiffer texture of a gummy bear breast implant and its anatomic teardrop shape are exactly what you don't need to help fill out a larger skin sleeve. Go with traditional gel implants of the size you suggested under the muscle and this should help you achieve your desired breast goals.
The gummy bear implants for augmentation
The gummy bear, or form stable breast implants do give a very good result for some. Our preference for the gummy bear is an individual with a very small breast and thin skin coverage as the form stable implant will give shape to the breast and help reduce rounding and capsules. The gummy bear is stiffer and textured and does not flow within the breast. Combined with breast lift there is a concern that the looser skin envelop (hence the lift) will allow the breast to move over the surface of the submuscular gummy bear, a kind of disconnect. If you liked overfilled saline you might better consider a high profile submuscular gel for your 'old' look.
Best of luck,
Different opinions on gummy bear implants
Since the gummy bear implants (Mentor CPG, Allergan style 410) are not FDA cleared and so are not available in the US outside of a clinical trial, we have to rely on the opinions of a small number of surgeons. The consensus of those who used them in the trials seems to be that they are suitable for about 15 percent of patients. They are quite firm (like gummy bears) and can cause problems if they rotate, unlike round implants.
It would be very nice to switch to gummy bear implants (really called cohesive gel), but since they are unavailable except for study cases I doubt you will be able to do so. It is very difficult to give advice without photos, but sometimes a simple revision of the mastopexy is all that's needed. Good luck