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 4th
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.
