Your Questions

Q: Dr. Eppley I was just wondering the cost of gummy bear breast implants. I would like a D cup and was also wondering if that makes a price difference. Really I just need to know how much all together it would cost me? Also do you offer financing? Thank you

A: The total costs for gummy bear (highly cohesive silicone gel) breast implants is right around $5800. It does not matter what size breast implants you would get (150cc to 800cc) the costs are the same regardless of the size chosen. All financing is done through Care Credit, the largest cosmetic surgery financing company in the U.S. Gummy bear breast implants use a high cohesive gel which is more like a firm jello or like the gummy bear candies as the name suggests. Even if the outer shell of the breast implant gets disrupted, the gel is not going to extrude and the external breast will show no signs of deflation or loss of volume. (because there is no loss of volume)

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in breast augmentation. One of my breasts is bigger than the other. I would like to even them out and go up a couple of sizes. I would like to do the “gummy bear” implants. My goal would be to get the most natural look possible.

A: Generally when breast asymmetry exists, it is very rarely adequately corrected by two different sized breast implants. This is because the amount of skin, nipple position, and any degree of sagging is often quite different between the two. But for the sake of a starting point (and perhaps this will be all that is needed) I will assume that it is just a matter of two different sized breast implants for now. Otherwise the concept of a natural breast augmentation result can mean different looks to different people. While implant size is certainly one factor that goes into a ‘natural’ result, there are other factors that can also play a role in creating that outcome including  the use of round vs. shaped (tear drop) breast implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I had saline implants placed under the muscle 12 years ago. There were fine until about three years ago when I noticed rippling on the undersides. I am a thin woman being 5’7” tall and weighing 126 lbs. Why has this rippling appeared now years after surgery? Will it get better or is it permanent? Will it get worse? What is the best way to get rid of it?I am very unhappy with the shape, size and asymmetry, along with the rippling, so am leaning towards having them redone anyway.

A: Rippling is common feature of saline breast implants and every women will develop some degree of it unless they had a fair amount of breast tissue initially. It will be felt along the bottom and sides of the implants where there is not a muscular interface underneath between the implant and the skin. While perhaps not noticeable early after surgery, it may appear months to years later as the swelling goes away and the breast tissue thins over time. This rippling issue is particularly relevant in thin women with little breast tissue. This is an important consideration to know before breast augmentation surgery so this is not a surprise when it appears later. The best correction of the rippling problem is an exchange to silicone implants where the amount of rippling is considerably reduced due to the thicker and more congealed silicone gel material. This is one of the advantages of the newer gummy bear breast implants.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting breast augmentation and the new gummy bear breasts implants have me intrigued. They seem like they would be so much better than a bag of water or a bag of liquid silcone gel. Can you give me some more information about them? What happens to the material if they rupture? Do they feel soft and natural? How long do they last?

A: The use of the term ‘gummy bear’ breast implant is an urban term, not a medical one or one used by any manufacturer of them. That is a term given to them many years ago by a plastic surgeon because of how the material feels and behaves. This is a more cohesive high-strength silicone gel that does act somewhat similar to the also named candy, although I think they do feel a little softer than the candy. If you cut the implant in half and squeeze on it, it does behave like the candy. The material stays together, does not run, and only puffs out when the implant sides are completely squeezed together. I have attached a video to this answer so you can see better how they behave once cut. This would represent the most extreme form of an implant ‘rupture’ so there are no concerns about the material migrating elsewhere in the body. Since the material does not leave the shell or containment bag if it should develop a hole or tear, the outward appearance of the breast will not change. (deflate or become deformed) The lifespan of the new gummy bear implants is not known although it would be fair to say that they are going to last longer than saline implants or any older generation silicone gel breast implant. This is without a doubt the best breast implant that I have  ever seen and is the most common one I use for my breast augmentation patients.

Dr. Barry Eppley

Indianapolis, Indiana

Q: Dr. Eppley, I am interested in getting breast implants and am confused about what type of implants to get. I have seen two doctors and one uses Mentor implants while the other uses Natrelle implants. I don’t understand the differences between these two company’s implants and I realize that choice is best determined by the doctor. I read recently that there is now another company offering breast implants known as Sientra. What are the benefits to these implants if any?

A: While all silicone breast implants contain silicone gel material, there are different formulations of that silicone used by each company. These formulations are proprietary and are given different names by each company. What is becoming most important in gel formulations is how cohesive they are, also known as form stable. The more form stable implants have become known in urban terms as ‘gummy bear’ breast implants.  Sientra offers only silicone breast implants that are composed of what they call ‘high strength’ silicone gel, which is their version of the so-called gummy bear implant. What I like about the Sientra implants that they may be form stable but are also very soft. If cut in half, the gel material does not extrude or break down and remains intact. You can actually take the implant and twist it 360 degrees and the implant shell/material will not fracture or break. This is a very important feature to decrease the effects of shell stress on insertion and lower long term implant rupture rates.

Dr. Barry Eppley

Indianapolis, Indiana

Breast augmentation continues to be one of the most popular and successful body contouring procedures in plastic surgery. While it may seem hard to make the association of breast enhancement with confections and desserts, they are more closely related than one would think. This is because of two recent technological advances in the type of breast implants that are available and how they are implanted at the time of surgery.

One important, but often overlooked, aspect of the surgical implantation of breast devices is getting them placed into the breast pocket. When only saline implants were available this was never a concern as they were inflated after they were placed. This meant that very small incisions could be used for their introduction that were not even on the breast. Rolled up like a burrito, a saline implant is inserted through a one inch incision and then inflated to the desired size. With the re-introduction of silicone breast implants in 2006, larger incisions are needed as they are pre-filled and must be inserted as such.

This makes the issue of larger scars with silicone breast implants a concern for some patients. Plastic surgeons will frequently push and cram the breast implant through a small incision because of this concern. Needless to say, this technique is not good for the implant and undoubtably weakens its shell and leads to premature rupture and the early need for replacement. That has all changed with the introduction of an improved delivery method.

Known as the funnel, and looking exactly like what is used to decorate a cake, the breast implant is now easily propeled into the implant pocket….all without ever touching the implant or squeezing it too hard in one place. This incredibly simple but highly effective delivery method now makes it possible to use very small incisions again and even do silicone gel breast augmentation from a remote armpit incision.

As silicone gel has returned as an implant option to saline, it has again become a sought after breast implant material. With no risk of ever spontaneously deflating like a saline implant can (and eventually will), its more natural feel makes it a very popular choice. While the health concerns from the early 1990s with silicone has long been dispelled, the concern about rupture and what happens to the material persist. This has lead to the development of advanced silicone materials that hold together more like a solid, resulting in what is known as the gummy bear breast implant.

The gummy bear breast implant is more than just a cute nickname. It is a reflection how the silicone filling looks and feels…soft and spongy. And just like those cute little red, green and yellow bears, you can push and pull on it and even cut the material and it won’t lose its shape. The physical similarity between this new implant and the candy are striking and it is no wonder how it got tagged with this name.

Breast augmentation continues to get better and more safe as the materials and techniques to deliver them improve. This gives women more options to choose what they feel best fits their bodies.

Dr. Barry Eppley
Indianapolis, Indiana

Q: I am 23 years old and am interested in breast augmentation. I know that there are different types of implants but I am most intrigued by the gummy bear implants that I have read about. They sound like the best type of breast implant to get but are there any real downsides to them? What do you think of them?

A: The term, gummy bear breast implant, is a layman’s term and not an actual name of a breast implant. I am not sure of the history of this name but I have heard the term was coined by a plastic surgeon. It is a new generationand innovation of a silicone breast implant, technically a third-generation gel filler material. Think of the original silicone filler material as a Type I which is more runny like thinner molasses syrup and existed up until 1991 when it was removed from the market, A type II gel implant filler is in newer and current breast implants, released commercially again in 2006, and is more cohesive like very thick molasses syrup. A gummy bear implant would be a Type III gel filler and is much more cohesive or stiffer like the gummy bear candy. (hence the name)

From a manufacturer’s standpoint, they have been known as the 410 implant (Allergan) and the CPG implant (Mentor) and have been in clinical trials for years. All manufacturer’s clinical trials with these implants are now closed and under FDA evaluation. It is possible that they may be commercially released by the FDA in 2011 but that is not a certainty.

The biggest advantage to the gummy bear implant is that the gel filler material is more cohesive and has no risk of leaking. It does feel more firm which some patients may feel is an advantage. It will be introduced initially as an anatomically-shaped (tear drop) shape with a textured surface. Because of these features, it must be placed through a lower breast fold incision to ensure proper positioning of the shaped breast implant.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I have been researching getting breast implants for some time. I know the differences between saline and silicone types of implants but am confused about these ‘gummy bear’ implants. I know it is some form of silicone but it is the best type of implant to get? Why is it different and are there any known problems with it? Is it the best type of breast implant to have?

A: The first thing to appreciate is that there are numerous type of breast implants from which to choose. They all will work and are FDA-approved with the exception of the gummy bear implant to which you refer. It has yet to be shown that there is one type of breast implant that is superior to any of the others. They all have some advantages and disadvantages and each woman has to weigh out those implant differences to determine what is the best breast implant for them. If there was one specific type of breast implant that was definitely superior that would be the only one that I would be using in my Indianapolis plastic surgery practice.

The gummy bear implant is a different type of silicone that is more firm than regular cohesive silicone gel. Hence the name gummy bear as it resembles this consistency. It is a textured anatomic implant that remains under clinical trials through the sponsoring company Allergan. It has not received FDA-approval as of yet. Because of its textured surface and its more form consistency, it must be placed through a larger lower breast fold incision than would be used for either saline or cohesive gel breast implants. Whether its added firmness is an advantage in cosmetic breast augmentation is a matter of debate. Its physical properties seem to offer advantages in breast reconstruction where the breast tissue may be thinner and more prone to contracture deformity. Gummy bear implants can and do ‘fracture’, requiring removal and replacement.

Dr. Barry Eppley

Indianapolis, Indiana