Breast Implant Developments

Breast implants have changed a lot over the last 50 years. Some changes have been good, others less so, and developments continue to be made. The first breast implants were introduced to the market in the 1960s. These are now termed ‘generation one’, and they had thick outer layers (the shell) and a thick silicone gel inside. They were superseded in the 1970s by ‘generation two’ implants with a very thin shell, and a very thin almost watery consistency silicone gel. In the 1980s the design improvement was to add a barrier layer to the shell to reduce silicone bleed through the outer layer. Silicone bleed is a subtle seepage of some gel through an implant shell that has not ruptured. This is analogous to a balloon that gradually deflates as air molecules escape through the latex of the balloon. The barrier layer greatly reduced this problem and the gel in the implant was also made more viscous, with refinements and improved consistency in the molecular chain size of the silicone molecules. In the 1990’s the 4th and 5th generation silicone implants had even thicker more cohesive gels, with the firmest type called ‘form stable’ so that the anatomical tear drop implants could be produced.The shell of the implants was also slightly thicker than the previous generation.

 

High Cohesive Implants

Cohesive gel implants have been designed to feel much more like normal breast tissue compared to saline implants, and to further improve the aesthetics of breast augmentation. They provide control over a breast augmentation to change breast size proportionately, to enhance the cleavage area and to provide natural volume to the breast area.

Patients who come to see Mr Turton usually want the breast to be augmented in a natural way. Some prefer a bigger fuller look, others a proportionate look. Some prefer the upper breast to be flat, others to have a subtle fullness. And although most patients dislike the much more rounded ‘fake’ unnatural upper breast fullness, were the upper breast has a ‘half-grapefruit shape’, a few patients specifically request this look. It is therefore important to be able to cater for all desires, and to be able to indicate what can (or what cannot) be achieved. I use several techniques which can produce a much more natural breast augmentation. This is the type of breast augmentation that I prefer to do as it is intrinsically more satisfying. I call it the proportionate augmentation. The implants are chosen after a detailed consultation and measurement schedule that is referred to as the bio-dimensional assessment. I use the most advanced and unto date 3D imaging system and Crisalix software in the patient consultation  to produce a realistic simulation of outcome.

 

How do Cohesive Implants differ from Runny-Gel Implants?

Cohesive gel implants have been in use in England since 1995. These are silicone implants that are filled with a thicker material than standard runny gel implants. If you cut into a standard gel implant, the runny silicone escapes like runny honey. This would be completely undesirable in real life as the silicone gel escapes into the surrounding space. In contrast, when you cut into a cohesive gel implant, the implant itself maintains its shape and integrity as the high cohesive gel is rather similar to the inside of a jelly baby (what the American’s refer to as a “gummy bear”).

Because breast augmentation with cohesive gel implants is designed to focus more on proportions and dimensions rather than volume, it is particularly indicated for women who are looking for a natural-shaped and proportionate-sized breast augmentation. Cohesive gel implants are not indicated for women undergoing large breast augmentations who desire a non-proportionate upper pole fullness.

 

What are the advantages and disadvantages of cohesive gel implants?

Advantages of cohesive gel implants:

  • proportionate-sized breast augmentation
  • very soft and natural-feeling
  • maintains its shape in an upright position
  • decreases the incidence of folding of the implant shell
  • decreases development of rippling
  • If an accident occurs and the implant is ruptured, the shape and integrity of the implant is usually maintained, and gel leak is minimised
  • very extensive product range: all variations in height, width, projection, volume are catered for

Disadvantages of cohesive gel implants:

  • require a slightly larger incision for insertion (but still well hidden in crease under breast)
  • more expensive than standard runny gel or saline breast implants

Disadvantages of saline implants:

  • many women feel they produce a less natural augmentation
  • there may be a sloshing sensation, or they tend to look more rounded particularly in the upper pole of the breast where this isn’t desired
  • more prone to spontaneous deflation causing sudden loss of volume, due to saline leak from the valve (see pictures below)
  • very rarely used in the UK, and decreasingly so in USA due to popularity with newer generation silicone gel implants
  • the membrane is still made of silicone and it is largely regarded as absurd to use saline which is regarded as an inferior filling material now that the Independent Review Groups have so extensively reviewed the studies on the safety of silicone implants

Ruptured Saline Implant

What are the complications associated with cohesive gel implants?

Please review my information sheet in the “Support” Section on Breast Augmentation

Please also read the section on my website on Mentor Breast Implants including the patient safety brochures that Mentor provide, which are on this page. Please also read about the rare occurrence of BIA-ALCL

Potential short and long term complications, future need for revisional surgery and its limitations, costs and a potential permanent deterioration in cosmetic results must be understood. They should be read about and discussed at a detailed consultation.

The type of complications that can occur with cohesive implants are similar to those in any breast augmentation. The largest published study looking at complication rates with cohesive gel implants showed an overall capsular contracture rate of <5%. The majority of these contractures were minor in nature with only 4/600 patients having a severe (Baker IV) contracture. Infections occurred in 2/800 patients and improper implant position was noted in 1.1% of patients. Of note, half of these were in secondary breast augmentations. (Breast augmentation with anatomical cohesive gel implants, Per Heden, MD, PhD, et al, Clinics in Plastic Surgery, Vol. 28, No. 3, July 2001, pp 531-552).


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