Would gummies be best option for me? Can you do two different sizes or would saline be better? (photos)

I've been wanting boobs for as long as I can remember I am a small B now and think I want a full C. One of my breasts is smaller than the Other. Just deciding which implant would be best for me. I know I can make a consult appt but wanted to start here. Thanks

Doctor Answers 8

Slightly different breasts does not warrant different size implants

Breasts can be different sizes for many reasons. If one is narrower it might be smaller , but a larger implant would not be added to the outside but instead might end up squeezed like a toothpaste tube and the extra volume on that side be superior or on top, and look worse in the bra. If you are small and add 300 cc implants to each size your size difference should be smaller. If you are now 150 on one side and 100 on the other and add 300 to each you are then 450 and 400 which is a 10% difference as compared to 50% before. If the smaller is narrower that would account for the difference.We are not sculpting new breasts nor adding a breast to the outside or snapping new outside breasts on, but putting an implant in your skin envelope. The majority of women have some difference. I see great results from the cohesive gel shaped implants in women with breasts like yours and would highly recommend them for the long term holding the shape, less wrinkling, more natural look and lower reoperation rates.

Breast Implant Revision/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

I appreciate your question. The size of implant best for you is dictated by your chest wall measurements.  Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance.  Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision.   Silicone will give you a fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a more liquid silicone (less cross-linked), if this implant should rupture, it will leak only into the scar capsule formed around the implant but may cause some discomfort or implant distortion. Anatomic gummy bear implants might be a good choice to give you volume. These highly-sought-after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, are a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak. During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery. Best of luck! Dr. Schwartz Board Certified Plastic Surgeon Director-Beverly Hills Breast and Body Institute #RealSelf100Surgeon

Please do not use "gummies." (the term) But choose cohesive silicone gel implants.

All (silicone) implants by all 3 USA manufacturers are now cohesive, meaning they all have a soft solid consistency. Teardrop-shaped form-stable textured "anatomic" implants are made of an even slightly more firm cohesive silicone gel, and the McGhan (now Allergan) style 410 textured, form-stable, teardrop shaped implants were the first implants that were called "gummy bear" implants, and these are now FDA approved for use.

Sientra actually had the first FDA-approved form-stable, teardrop shaped, highly-cohesive silicone gel implants (before the 410s were approved), and the manufacturer decided to capitalize on the "catchy" moniker "gummy bear" implants, and decided to market all of its silicone gel (all cohesive) implants as "gummy bear" implants. So it depends on if you're talking about round or teardrop, smooth or textured, cohesive silicone gel implants from Sientra ("gummy bears"), style 410 teardrop-shaped textured cohesive silicone gel implants from Allergan ("gummy bears"), or Mentor smooth round cohesive silicone gel implants. ALL are cohesive, so all are "gummy bear" implants, and yet the term was originally used only to specify a certain "anatomic" teardrop-shaped more-cohesive form-stable silicone gel implant from one company. Stop the insanity!

This is too confusing, so I think we should all agree to stop using the term "gummy bear" and talk about what actually we mean, including our patients, who naturally are confused!

I have a whole section in my Comprehensive Guide to Breast Augmentation that answers many of your questions about the different types and styles of implants. Click on the web reference below for that information.

That being said, 85% of women and their plastic surgeons choose  cohesive silicone gel implants, and the vast majority put them below the muscles to reduce capsular contracture. Smooth, round silicone implants are not rotationally sensitive (do not require precise placement like textured teardrop implants, which also don't drop much or move as naturally), drop to the side of your chest when reclining like naturally larger breasts, are teardrop-shaped when upright, and round when reclining (just like natural breasts), and are soft when you hug someone! Plus, they don't EVER leak or deflate like saline implants can do, don't ripple as much as saline implants do, and have the same lifetime replacement policy if there is ever a manufacturer's defect (super rare).

I do NOT recommend periodic MRI studies with silicone gel implants, though surgeons who like or recommend saline implants often "bring this up" as a scare tactic to dissuade patients from considering silicone. They are not needed since cohesive silicone gel implants cannot "leak." Rupture is extremely rare unless the implant is damaged by the surgeon on insertion, which IMHO is the single most common reason for implant "rupture."

Read my Comprehensive Guide, see one or more ABPS-certified plastic surgeons who do lots of breast surgery (ASAPS member), and you're on your way to a new you! BTW, two different implant sizes can account for any pre-existing asymmetry and improve your result. Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

Would gummies be best option for me?

There are many implant choices and all have some degree of trade off and therefore some will be a better choice for one individual though not all. Your photos show a mild asymmetry and two different implant sizes might be needed. Gummies have a stiff footprint in that the form is stable, no flow, and the incision is larger to get them in place. A typical option is a round, moderate profile smooth gel implant. Again not a best implant for all, but pleasing for most.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.1 out of 5 stars 39 reviews

Using Differently-Sized Implants for Breast Asymmetry

Gummy silicone implants would be a nice option for you. Whether or not they are the best option for you depends on your personal preferences. I can appreciate the breast asymmetry that you have baseline. Adding a slightly larger silicone implant to the left side as compared to the right would likely help account for that volume asymmetry. That being said, when you add the same volume to each breast, the percent difference you had at baseline will decrease even if the absolute difference between the breast volumes does not change. 
While a breast augmentation can not create breasts that are mirror images of each other, it certainly is a great time to try and account for some of the volume discrepancies that have have noticed for a long time. 
Best of luck!

Ashley B. Robey, MD
Indianapolis Plastic Surgeon
5.0 out of 5 stars 24 reviews

Breast Augmentation

There are a number of potential options for you.It is always possible to use two different size implants but it is not always advisable. You have more tissue in your lower poles so it may be useful to use an implant that fills both the upper and lower poles of the breast.Computer imaging is helpful  I believe in cases like yours  to illustrate the options available to you.


I would recommend cohesive gel implants ( gummy bear) for a natural look and feel.  Consult with a board certified plastic surgeon to discuss your options and expectations.

Robert E. Zaworski, MD
Atlanta Plastic Surgeon
4.9 out of 5 stars 55 reviews

Would gummies be best option for me? Can you do two different sizes or would saline be better?

Thank you for the question and pictures. Yes, I would recommend the use of silicone gel breast implants for you.  You will find a lot of information on this website outlining the pros/cons associated with saline versus silicone gel breast implants. If your breasts are significantly asymmetric,  then the use of two different sizes of implants will likely help improve symmetry.
Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging) as well as careful measurements (dimensional planning) will be critical.   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 "full 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 for petite patients) helps. Best wishes for an outcome that you will be very pleased with. 

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.