What is the squishest most natural feeling breast implant? Please be specific on brand as well.

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 are currently 3 devices with FDA approval available to the public at large. They are the Allergan/Inamed 410, Mentor Memory Shape, Sientra. Each represents a different point along the cohesive gel spectrum, the former being the firmest and the latter the softest.
In general, traditional silicone implants are preferred over saline implants by many patients and surgeons for their more natural feel. 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. With regards to your specific question, the available smooth round cohesive gel implants from all three major manufacturers would likely suit your "soft and squishy requirements." The majority of my patients choose an Allergan Natrelle Inspira (higher fill ratio) but the Mentor Memory gel is an equally good option. You should be able to feel/sample all the options at your consultation.As always, discuss your concerns with a board certified plastic surgeon (ABPS). 

Hi.  There are several different types of silicone gel available now.  For example, there are now 3 levels of gel firmness available in the Allergan Inspira range.  Both the Mentor Memory gel and the softest of the Allergan Inspira range would meet your criteria for "soft & squishy".