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.
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.