Breast implants are common medical devices used for both cosmetic augmentation and reconstructive surgery. One specific category is the highly cohesive, form-stable silicone gel implant, popularly referred to as the “gummy bear” implant. This nickname refers to the implant’s distinct internal consistency and ability to maintain its shape, much like the candy. Patients often inquire whether the external shell of these devices is textured or smooth, a detail that has implications for both performance and long-term health considerations.
Defining the Cohesive Silicone Implant
The material that gives the cohesive silicone implant its distinctive “gummy bear” name is a highly cross-linked, semi-solid silicone gel. This unique composition provides a high degree of viscosity, making the filling material much thicker than the traditional liquid silicone used in earlier implant generations. The molecular structure features stronger bonds between the silicone molecules, which prevents the gel from flowing freely within the outer shell.
This increased cohesivity allows the implant to hold its defined shape, a property surgeons refer to as form stability. If the outer shell is compromised, the silicone gel is designed to remain intact and not migrate into the surrounding breast pocket. This internal structure is a primary distinction from older silicone implants, where a rupture could lead to the softer gel leaking or spreading outside the shell.
The Purpose of Surface Texture
The outer shell of any breast implant is typically manufactured with either a smooth or a textured surface. A smooth surface is slick and allows the implant to move more freely within the surgical pocket, often resulting in a softer feel and movement that mimics natural breast tissue. In contrast, a textured surface is intentionally roughened, ranging from a slight micro-texture to a more pronounced macro-texture.
The mechanical function of this texture is to promote adherence between the implant shell and the surrounding tissue capsule. By creating micro-pockets, the textured shell encourages the tissue to grow into the irregularities of the surface. This tissue integration is designed to anchor the implant in place, preventing it from rotating or shifting within the breast pocket.
The Link Between Implant Shape and Texture
The connection between the internal form-stable gel and the external textured surface is functional, as the vast majority of gummy bear implants are shaped. These implants are often anatomically contoured, meaning they have a teardrop shape to mimic the natural slope of the breast. Maintaining this precise orientation is important for the aesthetic success of the procedure, since rotation of a teardrop-shaped implant would result in an unnatural appearance.
For this reason, form-stable implants have historically been manufactured with a textured surface to physically adhere to the tissue and prevent rotation. The texture was considered a necessary component to lock the anatomical shape into its intended position. The functional necessity of fixation to maintain the anatomical shape drove the initial design pairing of cohesive gel and textured shell.
Health Concerns Associated with Texture
The use of textured breast implants has come under scrutiny due to its link with a rare but serious medical condition known as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is a type of non-Hodgkin lymphoma, a cancer of the immune system. This condition develops in the fluid or scar tissue capsule surrounding the implant, typically with a mean time of onset of approximately 7 to 10 years after implantation.
Research suggests that the textured surface, particularly the more aggressive macro-textures, may contribute to chronic inflammation and bacterial biofilm formation, which are believed to be factors in the development of BIA-ALCL. The estimated lifetime risk of developing this lymphoma is considered a very low-incidence disease. Due to the confirmed association, the U.S. Food and Drug Administration (FDA) requested a worldwide recall in 2019 of specific textured implants, including one brand of highly cohesive, anatomically shaped devices. This regulatory action highlighted the safety concerns associated with specific textured surfaces, making the texture of any implant a major consideration for patients and surgeons today.