The newest generation of cohesive silicone breast implants provides incredibly natural-looking and feeling results, and also a high level of safety. Previous versions of silicone gel implants had thin shells and liquid or oily silicone filler, were extremely soft, and were susceptible to rupture, leakage, or microscopic silicone “bleed.” The latest types of silicone gel breast implants (by any of the 3 USA implant manufacturers) have been used as part of the more general FDA study since 1992, and are soft, yet still a cohesive solid gel that cannot leak. These implants do not leak even if the shell is cut or punctured, and can be inserted via a 1½-inch incision. Slicing open one of this latest generation of breast implants is like cutting Jell-O—you get two solid intact parts and leakage does not occur. (These implants are often erroneously called “gummy bear” implants since they are cohesive, though the true first “gummy bear” implants were the Allergan style 410s.) Allergan style 410 implants are made with a more firm (“highly cohesive”) silicone gel that is described as “form-stable,” meaning its teardrop shape is maintained in the body (even when reclining). Because proper orientation is critical for normal breast appearance (upside-down would look mighty strange, for example), the surface of this implant style is textured to adhere to the surrounding tissues. This highly-cohesive, firm silicone gel material led to the lay description “gummy bear” implant. Like all cohesive implants, this “highly-cohesive” implant retains its form and innate integrity even when its outer shell is punctured. This implant is more firm (like a “gummy bear” or silicone bathtub seal) than the softer, latest-generation, cohesive silicone gel implants, and requires a larger 2.5 inch incision for placement. (It’s also more costly.) This implant—Allergan (formerly McGhan) style 410—has recently been FDA approved, but I feel this implant configuration is usually more appropriate for reconstructive or “rescue” operations than for primary cosmetic breast augmentation. Now that a third implant manufacturer (Silimed) is producing Sientra implants that are FDA-approved for use in this country, additional options exist for patient and surgeon choice. Sientra has decided to sell their products only to American Board of Plastic Surgery-certified plastic surgeons (a laudable position), whereas Mentor and Allergan will sell their implants to any licensed physician, regardless of specialty. (This is how Dermatologists, Family Practitioners, and doctors with little or no plastic surgical training can legally obtain breast implants, and insert them into unwitting patients who think that their “cosmetic surgeons” have the same training and certification as ABPS-certified plastic surgeons.) Whether or not this will confer better statistics, outcome studies, or lower complication rates than the other companies’ practices remains to be seen. Sientra also was the first company to receive FDA approval for their own brand of “high-strength” cohesive, textured-surface, teardrop-shaped (form stable) silicone gel implants, as their approval pre-dated Allergan’s style 410 FDA approval. They also began marketing all of their cohesive implants as “gummy bear implants.” This confused individuals who used the “gummy bear” moniker to describe the Allergan Style 410 textured cohesive teardrop-shaped implants. For this reason, I personally believe that although the term “gummy bear” is descriptive and “catchy” to use, it has now become confusing, since each implant manufacturer has its own version of textured-surface, shaped, cohesive, “high-strength,” or “highly cohesive” silicone gel implants. Plus, the “regular” smooth round silicone implants are also cohesive. So they’re ALL “gummy bears” and they’re NOT all “gummy bears,” depending on how you define the term.I hope this clears your confusion, and that you never use the term again! ALL present-day silicone gel implants by all 3 USA implant manufacturers are cohesive, in differing degrees (only minimal, but definite) of cohesiveness or firmness/softness, and therefore are what the lay public refer to as "gummy bears." Unless, of course they are really describing the Allergan style 410s. Or the Sientra-marketed "gummy bears." See what I mean? Best wishes! Dr. Tholen