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

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.