Requests from patients during their initial breast augmentation consultation for the “gummy bear” implant are becoming more and more frequent. They have either read or been told about the advantages of “gummy bear” silicone gel implants but don’t have an understanding of “cohesive” silicone gel implants. These two terms are not mutually exclusive, in fact the gummy bear implant is part of the cohesive silicone gel implant family. Cohesive silicone gel simply means that the silicone gel sticks together. In essence it is more solid than liquid making it less likely to leak out of the implant. This is different from older silicone implants which had the consistency of a very thick liquid, like cold honey or molasses. The stickiness or cohesivity of the newer silicone gel implants is due to the “cross linking” of silicone gel particles. The more crosslinking there is between silicone particles the more cohesive the silicone gel becomes. Thus, there is a continuum of cohesive gel implants with the “gummy bear” implant being the most cohesive implant along that continuum. As silicone gel implants become more cohesive, they become more solid or “form stable“, which means the silicone gel maintains it shape when cut much like molded Jello. Form stability was a necessary characteristic for the gummy gel to have as it was initially used in tear dropped shaped implants. These implants had to maintain their form so that the natural, tear drop shape could be maintained.

The gummy cohesive gel is now being used in round silicone gel implants, giving patients a range of options from the lower cohesive gel implants to the more highly cohesive gummy gel implants to choose from. It is important to understand the pros and cons of increased cohesivity so that you can make an informed decision about which implant is best for you. As the cohesivity increases, the implant is less likely (not completely) to show rippling which is an advantage in the appropriate patient. Unfortunately, they also begin to feel more and more firm to the touch as cohesivity increases. This firmer feeling can be bothersome to some patients. In addition, as the cohesivity increases so does the cost. On average, gummy bear implants, cost around $1000 more per pair than the standard lower cohesive gel implants.

There are many options to choose from when considering breast augmentation. No longer is it simply about what volume you want and a choice between saline or silicone implants. Do you want shaped or round implants? If you prefer round, do you want low, moderate, high or ultra-high profile round implants? Do you want smooth or textured surface implants? If choosing silicone gel, how cohesive do you want the gel to be? Over or under the muscle? Having so many options to choose from can make the process confusing if not daunting. A consultation, including breast examination, by your prospective surgeon is key in determining what options work best with your breasts and aesthetic goals. During the consultation the pros and cons of each option and why one might be a better choice than another should be discussed. Working collaboratively, you and your Plastic Surgeon, can then determine which implant works best for you.