Silicone vs. gummy bear implants: I am currently a 34C with no upper pole.

There
is not a right or wrong answer here; the answer is based upon a multitude of
considerations that I, and the patient, can sort out easily in a few seconds after I have
examined the patient and discussed the pros and cons of each type of implant.
Women
who have traditional silicone implants report that they feel like a soft,
natural breast at a higher rate than women who have gummy bear implants.
A gummy bear implant will feel firmer and be less squeezable.  The more cohesive nature of the gummy bear
implants makes them a bit harder and necessitates a larger incision for
placement.  Some women are better suited for a gummy
bear round implant if the breasts lack superior pole
fullness. 
My
patients try on implant sizers in a sports bra of various shapes and volumes while
wearing a tight t-shirt, bathing suit, or other favorite garment from
their wardrobe.  Feeling the implant, and viewing various
profiles in the mirror allows them to determine the type and size that is
most pleasing and comfortable for them.  Kenneth Hughes, MD, Board Certified Plastic SurgeonLos Angeles, CA

I appreciate your question.

The size of implant 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.

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

#RealSelf100Surgeon

#RealSelfCORESurgeon

Dear ctomrun,that is a great question I get in the office all of the time.  Gummy bear implants are actually silicone implants but are a more cohesive type of silicone, kinda like a gummy bear.
Imagine cutting a gummy bear in half, nothing runs out of it, that is basically the same concept.  There are shaped and round gummy bear implants, both of which have their advantages and disadvantages. The important step is to find a plastic surgeon that can discuss with you which implant is right for you.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

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. There is also the risk of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) which while rare is loosely associated with textured silicone implants.
With regards to your original inquiry, a round cohesive gel silicone device is more than likely sufficient.As when making decisions about any form of surgery, patients should have an in-depth consultation with their board certified plastic surgeon before selecting the type of implant to use. While form stable anatomic implants are newer, they may not be suitable for all patients. 

The question is not regular gel implants vs. gummy bears, but more how much laxity to the skin and where is the nipple in relationship to the crease.  If it is just involution/or volume loss, either implant will provide an excellent result.  I prefer the smooth wall cohesive implant over the textured gummy bear implants.  I truly feel they have a more natural look and less issues post op.  If the nipple has dropped significantly, then an augmentation with a lift may be the best option.  Make sure you seek out a Board Certified Plastic Surgeon with a lot of breast lift and implant experience.