Cohesive Breast Implants—Benefits and Disadvantages

In March 2012, the US Food and Drug Administration has approved the cohesive breast implants which use a form-stable gel; this means that unlike the 4^th generation silicone implants, they do not leak in case the shell cracks.

The cohesive silicone implants, also referred to as gummy bear implants due to their firm structure (just like the popular sweet candy), have benefits over the ordinary silicone- and saline-filled implants.  However, they also have shortcomings, which must be considered.

The Main Benefits of Cohesive Breast Implants

*  Less prone to shell collapse

Because the filler material is form-stable, it does not shift from one area of the shell to the other (which is the case in saline and traditional silicone implants).  For this reason, the folds and wrinkles—which are known to affect the device’s durability in the long run—do not occur.

It is safe to surmise that cohesive breast implants can last longer than the other types since they are not prone to folds and wrinkles.

*  Leak is almost not a concern

While the shell is susceptible to breakage, leak is not a problem since the filler material maintain its shape; however some microscopic diffusion of silicone will always occur, but some experts believe that it will be somewhat harmless.

*  Lower risk of capsular contracture

Some studies—while not as extensive as they should be—conducted in Europe suggest that capsular contracture occurs less often with cohesive breast implants.

Capsular contracture happens when a layer of scar tissue becomes too dense and thick that it squeezes the implant.  Some experts say the implant’s cohesiveness, firmness, and/or less diffusion of silicone (than traditional silicone implants) are the reasons why there is a lower risk.

The Disadvantages of Cohesive Breast Implants

*  They only come in teardrop shape

Because the cohesive breast implant is form-stable, it does not come in round version and is only available in teardrop shape, which has more volume at the bottom than the top.

By contrast, ordinary silicone and saline implants are available in round shape because their filler material is affected by the gravity and forces of the breasts.

While teardrop implants provide natural results, some women still prefer the round version which can give them the dome-shaped breast in which there is an exaggerated fullness in the upper poles.  

*  Feel

The cohesive breast implants do feel a little bit firmer than the traditional silicone implants, although the level would depend on how much breast tissue a patient has, how supple or flaccid the tissue is, and how large or small the implant is.

However, most patients—particularly those who would choose implants with an “appropriate” size—do not have problem with the firmness of cohesive breast implants.

*  Cohesive implants require longer incisions

Because the filler material is form-stable, these implants need longer incisions (between 4.5-5.5cm) to squeeze through inside the breast pocket.  For this reason, plastic surgeons rarely recommend the areola incision site when using this type of implant.

Armpit incision is also difficult when using cohesive breast implants, which is why doctors prefer the breast crease technique.

*  Risk of rotation

With the teardrop shape of the cohesive implants, rotation can result to deformity.  Fortunately, this can be prevented with the right pocket dissection and insertion.

But still, rotation is more of a problem for patients wanting to replace their teardrop breast implants with smaller ones.  Meanwhile, round implants do not result to distortion even if they rotate inside the pocket because their sides are all symmetrical.

*  More expensive

As with most new technologies, cohesive breast implants are hundreds of dollars more expensive than older designs. 

Gummy Bear Implants Seen to Create a New Trend

In March 2012, the US Food and Drug Administration has finally approved gummy bear breast implants (from implant manufacturer Sientra) after several years of clinical trials.  Meanwhile, the new devices have already been around for 10 years in Europe.

Compared to earlier versions of silicone implants, gummy bear implants have a more cohesive silicone gel that even if their shell is cut in half, the filling would not leak.  And with this characteristic, many plastic surgeons around the world believe that the new devices are probably safer than other types of breast implants.

Plastic surgeons coined the term “gummy bear” because the implants’ soft but firm structure is somewhat similar to the sweet candy.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili believes the recently approved breast implants may further push the popularity of breast augmentation surgery in the country.  Last year, the procedure ranked first on the list of the most commonly performed cosmetic plastic surgeries.

In terms of advantages, Smaili said that gummy bear implants are “quite notable” particularly when it comes to safety.

“With the cohesive silicone gel, the possibility of rupture and leak is close to nothing.  Another advantage is that the implant is form-stable and would not lose its shape,” Smaili said.

And because the risk of leak is almost not a concern, regular MRI screening is no longer needed.  (This is a requirement for women with traditional silicone breast implants because their somewhat fluid gel would seep out in the event of rupture.)

Another advantage, Smaili said, is the lower risk of capsular contracture which happens when the surrounding scar tissue squeezes the implant shell to the point that it causes breast deformity, pain, and other complications.

The newest implant is also called “type 5 gel” because it is the fifth generation silicone implant in the market since 1962.  Meanwhile, silicone implants currently produced by Allergan and Mentor fall under the category of “type 4 gel” which is cohesive but not form-stable.

But because gummy bear implants are firmer than the earlier versions of silicone implant, they require a longer incision. Fortunately, patients can choose from four incision sites which are designed to make the scar less visible.

Another consideration is the risk of rotation.  Since the implants come in teardrop shape, they may result to deformity in case they rotate inside the breast pocket (though the textured or “grainy” surface can prevent this problem from happening).

Smaller Breast Implants—A Growing Trend These Days

In the 1990s, Pamela Anderson arguably popularized the “larger than life breasts” and was even flaunting them in Baywatch with her scanty, one-piece, red swimsuit.  But after two decades, the blonde beauty has downsized her breast implants in an effort to achieve a more natural look.

Plastic surgeons have noticed that smaller breast implants are the new trend these days.  In fact, many Hollywood stars have been reported to have “downsized” including Victoria Beckham, Drew Barrymore, Denise Richards, and Dolly Parton.  Also, Beyonce and Kate Hudson have been rumored to have had breast augmentations using small implants.

Take note that in the past, big-bosom celebrities were popular and frequently represented in the media.

In terms of aesthetic results, leading Los Angeles plastic surgeon Dr. Tarick Smaili believes that smaller implants look more natural especially when used by women with small frame.

“Smaller implants look very flattering on petite women simply because they add curve to the body without creating the heavy top look.  They also look natural that it would be hard to tell if someone has them,” Smaili said.

According to a recent survey, most breast augmentation patients today choose breast implants size between 200cc and 300cc because of the growing popularity of “natural look.”

However, women with a relatively large body-frame can also benefit from smaller or at least moderate-sized breast implants which can give a slimmer appearance.

Aside from giving a natural look, smaller breast implants also make it easy to do physical activities and exercise; in fact these are the popular choice of athletes and women with an active lifestyle.

Because of the risk associated with extremely large breast implants, US implant manufacturers Allergan and Mentor do not produce sizes that are over 800 cubic centimeter (cc), and while there are bigger saline implants, rarely these are used because of the potential problems they can cause.

In fact, no ethical board-certified plastic surgeon would use extremely large breast implants for cosmetic reasons as doing so can lead to a wide range of health problems such as chronic back pain, shoulder strain, bad posture, and difficulty in moving—symptoms that Sheyla Hershey, the woman who holds the world record for having the largest breast implants, are experiencing.

According to reports, Hershey, who is from Houston, Texas, has undergone several breast augmentations to achieve the 38KKK bust size.  But because no US doctors would dare to operate on her, she traveled abroad just to receive surgeries.    

Myths Prevent Women with Breast Implants to Successfully Breastfeed

One of the most common misconceptions about breast implants is that they prevent women to successfully breastfeed their babies.  However, a study presented at the American Society of Plastic Surgeons showed that patients’ wrong belief is the main culprit rather than the devices themselves.

Mothers with breast implants who failed to breastfeed believed it can affect the appearance of their breasts.  However, pregnancy alone may cause some level of sagging because the ligament, skin, and tissue are stretched and may not be able to retract to their original position.

Women should bear in mind that the more pregnancies they experience, the more likely the appearance of their breasts is affected.  This simply means that even if a mother breastfeeds her baby or not, it does not make any difference in the appearance of her bust.

Dr. Norma Cruz, the lead author of the study, said that “breastfeeding won’t harm their [women] breasts, and it has significant health advantages for both mother and baby.”

The study involved 160 breast augmentation patients who were breastfeeding their babies.  Successful breastfeeding was defined by two weeks or more of exclusively providing natural milk.

The researchers have chosen women with almost similar demographics particularly in age, body mass, incision site during their breast augmentation surgery, and implant size; with this consideration, it is safe to surmise that their findings are quite accurate.

Among the 63 mothers who had successfully breastfed, only 13 percent believed it could adversely affect the appearance of their breasts.  By contrast, about 86 percent of the 97 women who were “unsuccessful” thought that it could result to negative impact on the aesthetic quality of their bust.

While Cruz understands that some breast augmentation patients were concerned with the appearance of their bust—after all, they have invested time and money for the surgery—she reiterated the importance of breastfeeding not just to babies but also to mothers.

“Evidence shows that although breasts sag more with each pregnancy, breastfeeding doesn’t seem to worsen these effects in women with or without breast implants,” she added.

While there is nothing wrong getting breast implants before pregnancy, leading Los Angeles plastic surgeon Dr. Tarick Smaili believes that women who are concerned with sagging may consider postponing the procedure.

“Pregnancy may have a slight effect on the appearance of the breasts, but not always to the extent that you will need revisions.  But if you are truly concerned about this, perhaps postponing the surgery is a good choice if you’re considering having babies in the future,” Smaili added.  

Real Housewives Star Admits Plastic Surgery

While most celebrities deny having plastic surgery even if the result is too drastic and blatant, Real Housewives star Brandi Glanville has no qualms admitting going under the knife to improve her appearance.  In fact, she even said that in a town where “everyone is perfect, it is important to look good.”

In a previous interview, Glanville, 39, said she had breast augmentation surgery, a procedure necessary to regain the volume loss associated with pregnancy, in addition to increase her bust size.  And aside from breast implants, the star also admitted having regular treatments of laser to address her skin problems including “adult acne” and Melasma, a condition in which the skin produces too much pigmentation.

The TV personality also admitted to be receiving weekly spray tan to maintain her skin’s glow without damaging it, in addition to Botox injection and fillers to fight the early signs of aging.

Because she grew up modeling, she said that she is extremely aware of her physical appearance and knows the areas which need some improvements.  Another reason for her penchant for plastic surgery is the fact that she is now back in the dating scene.

To Glanville’s detractors who called her “plastic,” she said that “everyone has the right to do anything that can make her feel good.”

The good thing about Glanville is that despite having several cosmetic procedures, both surgical and non-invasive in nature, she looks naturally beautiful.  This is probably due to her belief that “less is more” which is her approach in plastic surgery.

Her breast augmentation is a clear example of Glanville’s “less is more” approach in plastic surgery.  While many celebrities have chosen large breast implants that gave them the “heavy top” look, she opted for smaller ones that perfectly fit her slender frame, thereby the result is a very natural appearance.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili, who did not treat Glanville, said he is noticing a shift to a “more natural appearance.”

“Celebrities nowadays are choosing smaller breast implants that will give them a more natural, sexy look.  For example, Kate Hudson and Victoria Beckham have been rumored to have had breast augmentation using smaller implants, while Dolly Parton and Denise Richards have downsized their implants,” Smaili said.

Aside from giving a natural appearance, the renowned plastic surgeon also cited other advantages of small- to medium-sized breast implants including faster recovery, lower risk of downward displacement and sagging, and less chance of developing stretch marks.

Breast Implants Save Woman’s Life During an Attack

Yes, the headline sounds comical but it is true.  A woman in Florida has claimed that her saline breast implant saved her life after it prevented a pocket knife from piercing her lungs and heart.

Meanwhile, doctors believe that the victim’s breast implant really saved her life.  The woman, who did not want to be named, said she was stabbed by her ex-fiance’s new girlfriend several times using a pocket knife.

The suspect, Amy Winter, stabbed the 41-year-old victim several times in her left chest. 

Because the breast implant absorbed the deadly blow, it prevented the pocket knife from piercing the victim’s vital organs.  In fact, doctors said that without the synthetic device, she could have sustained fatal injuries such as collapsed lungs and heart failure.

The incident happened outside the victim’s apartment in Melbourne.  According to police report, Winter scratched her car and stabbed her repeatedly during confrontation.

The victim said the attack happened so fast that she found herself covered with blood—and also saline (or simply saltwater solution) from the ruptured breast implants, which she got three months ago.  For this reason, she said that her breastaugmentation, which cost $6,000, is probably the best investment she ever made.

Meanwhile, the breast implant manufacturer said it will provide warranty because the patient is a victim of a crime.

Dr. Tarick Smaili, a breast augmentation doctor who did not treat the victim, said that he heard a few cases of breast implants “inordinately saving a woman’s life.”

“A few years ago, I read a news about a woman in Los Angeles who was shot in the chest but the bullet fragments, as shown by the CT scan, were prevented by the implants from reaching the heart and other vital organs,” Smaili said.

“So this news about a woman with breast implants who survived after being stabbed in the chest no longer sounds incredulous or impossible to me.  I hear such stories from time to time so this one no longer surprises me,” the Los Angeles plastic surgeon said.