Breast augmentation has come a long way since the first silicone implants were introduced in the 1960s.
Cohesive Gel Implants: Advanced Breast Augmentation by Philip Turton in Leeds
Those original implants are now termed ‘generation one’, and they were teardrop shaped, had thick outer layers with a seam (the shell) and usually a patch at the back made of a material called dacron to aid impregnation and fixation. There was a somewhat viscous silicone gel inside. They were superseded in the 1970s by ‘generation two’ implants which were round, floppy, and had a very thin shell. Inside was a very thin almost watery consistency silicone gel. There were lots of problems with capsular contracture, rupture and gel bleed without rupture.. 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 1990s the 4th and 5th generation silicone implants had stronger shells with better quality assurance, thicker more cohesive gels- with the firmest type called ‘form stable’ so that the anatomical teardrop implants could be produced. The shell of the implants was also slightly thicker than the previous generation.
Modern cohesive gel implants represent a significant leap forward from the 1970’s, offering women enhanced aesthetics, durability, and what is regarded by the MHRA, as acceptable safety.
Leeds-based oncoplastic breast surgeon Philip Turton is a leading expert in this field, providing bespoke consultations and surgical solutions tailored to each patient’s goals.
A Brief Summary of the History of Silicone Breast Implants with Mr. Turton in Leeds
The evolution of breast implants spans over 60 years, with significant advancements in materials and design:
- 1960s (Generation 1): Thick shells and viscous silicone gels (not cohesive). Lacked a natural feel, had excessive capsular contraction.
- 1970s (Generation 2): Thin shells and a more fluid silicone gel. While they were softer, they were prone to complications like silicone seepage and leakage.
- 1980s: Introduction of a barrier layer to reduce silicone bleed and a more cohesive gel for greater stability.
- 1990s (Generations 4 and 5): Highly cohesive gels of more unified medical grade silicone; thicker shells allowed for the creation of round and anatomical “teardrop” implants, offering a more natural look and feel.
Today, cohesive gel implants from the FDA-approved manufacturers, including those referred to as “gummy bear” implants, are the gold standard in breast augmentation.
What Are Cohesive Gel Implants?
Cohesive gel implants are filled with a thicker, sometimes form-stable silicone gel that better retain shape even if the outer shell is compromised. But remember they are never to be regarded as life-time devices and the material can rupture and leak, as borne out through all studies with all manufactures.
This unique composition better mimics the feel of natural breast tissue, making them a popular choice for women seeking a subtle, proportionate enhancement.
Unlike traditional runny-gel implants, cohesive gel implants better maintain their integrity when cut or ruptured, ensuring initial minimal leakage. This feature makes them safer and more reliable than earlier silicone implants. Breast examination by a specialist and Silicone Sequence MRI can be used to look for signs of leakage and is recommended every few years, especially once the implants are older than 10-years when the silent rupture rate is at least 10% and increases with time.
What are the advantages and disadvantages of cohesive gel implants?
Advantages of cohesive gel implants:
- proportionate-sized breast augmentation planning
- generally soft and natural-feeling in some breast types
- Xtragel variety maintain better shape in an upright position
- decreases the incidence of folding of the implant shell
- may decrease severity of rippling
- If an accident occurs and the implant is ruptured, the shape and integrity of the implant is usually maintained for a period of time, and gel leak is initially minimised
- extensive product range: multiple variations in height, width, projection and volume are catered for
Disadvantages of cohesive gel implants:
- require a slightly larger incision for insertion (but still well hidden in the crease under the 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 is not desired
- more prone to spontaneous deflation causing sudden loss of volume, due to saline leak from the valve (see pictures below)
- rarely used in the UK for breast enlargement, but used as a tissue expander for the initial stage of a “2-stage breast reconstruction expander-implant technique”
- The biggest market used to be the USA during the silicone moratorium until it ended in 2006. Now the popularity of silicone gel implants has far surpassed the use of saline implants
- the membrane is still made of silicone
Discovering High Cohesive Implants with Mr. Philip Turton
Cohesive gel implants have been designed to combine increased safety with a feel to more closely match normal breast tissue compared to saline implants; this is to further improve the aesthetics of breast augmentation.
They can provide greater control over a breast augmentation to change breast size proportionately, to enhance the cleavage area and to provide better 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. A lot of patients tell Mr. Turton that they want “naturally appearing, but bigger breasts to boost my feminine appearance.”
Some prefer the upper breast to be a little flatter than others, but most want to have a subtle fullness as seen in his before and after images of his augmentation gallery, and instagram pages (@turtonphilip). And although most patients dislike the much more rounded ‘fake’ unnatural upper breast fullness, where the upper breast has a ‘half-grapefruit shape’, occasionally 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. Mr. Turton has vast experience from thousands of operations of this type, and uses several techniques which can produce a much more natural or optimised breast augmentation.
This is the type of breast augmentation that he prefers to do as it is intrinsically more satisfying. He calls this the proportionate augmentation. The implants are chosen after a detailed consultation and measurement schedule that is referred to as the bio-dimensional assessment.
He also can use the most advanced and up to date 3D imaging system and Crisalix software in the patient consultation to produce what is usually a reasonable and realistic simulation of outcome.
How Cohesive Implants differ from Runny-Gel Implants
Cohesive gel implants have been in common 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 and could more quickly permeate the surrounding tissues.
In contrast, when you cut into a more cohesive gel implant, the implant itself maintains its shape and integrity; the high cohesive gel is rather similar to a properly set jelly taken out of the fridge. For teardrop implants which are the firmest, it is like the inside of a jelly baby (what the Americans 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.
Anatomical shape gel implants are not indicated for women undergoing large breast augmentations who desire a non-proportionate upper pole fullness.
Personalized Breast Augmentation with Philip Turton
Philip Turton is renowned for his meticulous approach to breast augmentation.
During your consultation, he conducts a detailed bio-dimensional assessment, considering your anatomy and aesthetic goals to recommend the best surgical approach and implant options.
Using advanced 3D imaging and Crisalix software, he provides a realistic simulation of the expected outcome, empowering you to make an informed decision.
Tailored Aesthetics for Every Preference
Whether you desire a fuller, more dramatic look or a subtle, natural enhancement, cohesive gel implants offer unparalleled versatility.
Some patients prefer a flat upper breast profile, while others opt for a slight fullness or more pronounced cleavage.
Philip Turton prioritizes your vision and uses techniques to achieve results that better align with your expectations.
What Sets Cohesive Gel Implants Apart?
When used by a specialist, the correct techniques combined with the unique properties of cohesive gel implants make them ideal for patients seeking proportionate augmentation.
They are particularly suited for women who value natural aesthetics over exaggerated volume, ensuring a balanced and harmonious result.
Not Suitable for Larger Non-Proportionate Augmentations
Women seeking a highly augmented upper pole with a rounder appearance may need to consider alternative options.
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 provides, 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. You should have a detailed consultation and you should read the information sheets and mention anything you do not understand.
The type of complications that can occur with cohesive implants are similar to those in any breast augmentation. One of the largest published studies 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).
However, I would regard some of these studies as incomplete for one reason or another and the capsular contraction rate is best regarded as around 10-20% of all patients during the first 10-years after augmentation.
Once it has happened once, we estimate around a 40% recurrence rate with a replacement implant. If someone keeps getting capsular contraction it is probably advisable to plan for permanent removal of your implant and not to keep going.
The Cohesive Gel Implant Advantage
Cohesive gel implants represent the pinnacle of breast augmentation technology. They offer more natural-looking results, exceptional durability, and safety features that surpass older implant types.
With the expertise of Philip Turton, you can achieve your best assessment and the best surgical techniques. This is important to achieve the desired aesthetic confidently and securely.
Get Started Today
Ready to explore your options for breast augmentation with cohesive gel implants? Contact Philip Turton’s clinic in Leeds to schedule a personalized consultation.
Let us guide you on your journey to a natural, confident, and beautiful you.
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 better in an upright position
- decreases the incidence of folding of the implant shell
- may decrease development of rippling
- If an accident occurs and the implant is ruptured, the shape and integrity of the implant is usually maintained for a period of time, and gel leak is minimised
- extensive product range: multiple 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 the crease under the 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)
- rarely used in the UK for breast enlargement, but used as a tissue expander for the initial stage of a “2-stage breast reconstruction expander-implant technique”
- biggest market used to be the USA during the silicone moratorium until it ended in 2006. Now the popularity of silicone gel implants has far surpassed the use of saline implants
- the membrane is still made of silicone
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). However, I would regard some of these studies as incomplete for one reason or another and the capsular contraction rate is best regarded as around 10-20% of all patients during the first 10-years after augmentation. Once it has happened once, we estimate around a 40% reoccurrence rate with a replacement implant. If someone keeps getting capsular contraction it is probably advisable to plan for permanent removal of your implant and not to keep going.