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. 

Pricing for Breast Augmentation

Breast augmentation ranked first in the most commonly performed cosmetic plastic surgery last year, with about 307, 000 procedures conducted in the US, or an increase of 4 percent since 2010.

The price for breast augmentation varies, sometimes significantly because it is affected by the surgeon’s fee, location of the surgical center or hospital, and type of implant used during the surgery.  Meanwhile, patients should always bear in mind that the cost should not be the sole factor when choosing a doctor.

Nevertheless, the most expensive breast augmentation plastic surgeon does not necessarily mean that he is the best one to conduct the surgery.

If the surgery uses saline breast implants, the average cost is around $7,000—this already includes all the pre- and post-operative visits, anesthesiologist, surgical facilities, and body garments.  But if the procedure uses silicone implant, the price would be $800 to $1,000 higher.

Silicone is more expensive than saline implant because making it involves a higher manufacturing cost.  Another consideration to make is the plastic surgeon’s fee is usually higher if this implant type is used.

Patients should always bear in mind that the cost of cosmetic plastic surgery is higher in large cities than in most areas because the demand for such procedure is quite high.

People should always be cautious with extremely cheap or discounted plastic surgery because this is often a red flag; the surgery is most likely to be conducted by a non-specialist, or it may be an attempt to fill an empty O.R schedule—which should be a concern.  And in some cases, a very low price is just an advertising hype and may not be the inclusive cost of surgery.

Because breast augmentation and most cosmetic surgeries are quite expensive here, some patients are tempted to go abroad (in Thailand, the cost of breast implant surgery is said to be 50 to 70 percent less).  While there is nothing wrong with “medical tourism,” they should be extra careful since not all countries are as strict as the US.

Patients should always bear in mind that in case their surgery abroad leads to botched results, it may be difficult—or sometimes even impossible—to go after the doctor.  By contrast, the US is very strict when it comes to medical malpractice law; in fact, the records of doctors who have been sued or charged with a disciplinary action can be easily accessed via Internet, although some states require a letter of request before they disclose such information. 

Saline Breast Implants—Overfilling Vs Underfilling

Saline breast implants are filled with a sterile mixture of salt and water while their shell is made of solid silicone that is durable.  However, there is no guaranty that the device can last a lifetime because it is still subjected to the natural wear and tear; for this reason, there is always the possibility of needing a revision surgery at some point in a patient’s life.

One advantage of saline implants over silicone version is that in case of a leak, they will not lead to inflammation of the tissue although patients have to remember that the affected breast will appear deflated right after the rupture.  To correct this problem, the implant must be replaced with a new one during a revision breast augmentation.

However, saline implant has its shortfall; because of its watery consistency, it is prone to sloshing effect, which is attributed to the higher risk of downward displacement. 

One way to prevent the sloshing effect is to overfill the implants with a saline that is more than the amount recommended by the manufacturer.  Patients should remember that overfilling the implants does not lead to a bigger size but only firmer appearance.

For instance, implant manufacturer Mentor recommends its device to be filled with a maximum amount of 300 cubic centimeter or cc, but a plastic surgeon inflates it with 325cc.  Aside from making the implant firmer, the technique has also been said to reduce the sloshing effect.

Another probable advantage of overfilling saline implants is that the need for a revision breast augmentation can be postponed.  Because saline has a natural deflation rate of 1 percent every year, putting content more than the recommended amount of the manufacturer may help prolong the “viable volume” of the implant.

But one downside of overfilling saline implants is that it gives manufacturers the right to cancel the warranty of their products.  However, it does not mean that they will automatically void it, but the technique gives them that option.

While overfilling saline implant is a common practice, underfilling its shell is not since it can lead to a wide range of problems including higher risk of rippling and implant failure; this is because the constant “rubbing” of the folds can affect the integrity of the device.

Another common problem with underfilled saline implants is the visible ripple, which is more of a concern if the breast tissue and fat is limited.