The Surgeon Minute

Cohesivity of Breast Implants

Cohesivity of Breast Implants

There are so many things to consider when choosing the perfect silicone implant for your breast augmentation: size, and shape, yes, but also the cohesivity of that implant. This refers to the density of the gel on the inside of the breast implant. Different consistencies will deliver different results, but all of this choice can also be really confusing and scary for many patients.

Dr. Brian Brzowski of Murray, UT talks about what’s new in terms of the cohesivity of breast implants as well as the pros and cons of each in order to help you make a more informed decision.

Cohesivity of Breast Implants

Every silicone implant is filled with a cohesive gel. However, breast implant manufacturers have lately started seeing the benefit of adjusting the density of the cohesivity in not just their shaped implants – a requirement for that implant – but in their round implants as well. They’ve added variables to their round offerings so that there are now several levels or degrees of cohesivity, each of which delivers a different result for the patient.

The original cohesive gel implant is a bit under filled so it’s soft with a loose, gooey feeling gel on inside. From there, breast implant manufacturers leap-frogged to a round implant with a much firmer, stiffer gel filling. Now, there is the Goldilocks option: a round implant that maintains that middle ground between loose and soft and what some patients might call hard. All of these new options can be a bonanza for the plastic surgeon. It’s “definitely a very exciting time to be a breast augmentation surgeon. We have so many choices,” says Dr. Brzowski.

But this smorgasbord of choice can often be terrifying and overwhelming for the patient. How do you figure out what all of these different options mean for you? You start by seeing a board certified plastic surgeon with great experience performing breast augmentations. During your consultation, the surgeon will examine your anatomy, taking detailed measurements, while also asking in depth questions about your goals. What “look” are you trying to achieve? Then he or she will walk you through the best breast implant options for delivering that result. Cohesivity is one thing to consider.

Soft Fill Breast Implants

The oldest player on the cohesive gel implant team is soft. The filling resembles shampoo and is overfilled by about 95%. An earlier generation of this device was only filled to about 85%. By pumping up the implant with extra fill, breast implant manufacturers helped improve not only the rippling, but also the support in the upper part of the implant. These have long been the two main problem areas with these softer fill implants.

Breast implant cohesiveness - soft fill.

Improving the rippling issue, a particular concern with thinner patients, is not only a good thing from an aesthetic standpoint, but it also helps prevent a failure in the device. Failure is when the implant breaks or tears and some of the gel migrates out of the shell. This implant is ideal for a patient who has a little bit more of her own breast tissue and doesn’t require a lot of upper pole fullness because when you rotate this device, the upper third can collapse.

Medium Fill Breast Implants, Like Inspira Soft Touch

The newest breast implants, like the Inspira Soft Touch, hit a middle ground in terms of cohesivity. The gel filling is thicker, more like the consistency of jello, which makes them smoother than the overfilled option so that they don’t collapse as much. These implants are best for someone who needs a bit more fullness in the upper pole, and for patients who are long-chested.

Breast implant cohesiveness - middle fill.

The thicker consistency also means less rippling. While it has yet to be proven in studies, surgeons like Dr. Brzowski believe that this difference in terms of rippling will have a significant impact on the life span of a breast implant; they may last longer. “As we begin to merge into this style of implant with a more cohesive gel and a smoother shell… we are starting, potentially, to get into a new category of lifespan of devices,” he explains.

Firm Fill Breast Implants

The most firm of the breast implants, released a few months ago, acts almost like a shaped implant. Because the fill is stiffer, like a marshmallow, there is very little rippling or migration of fill into the lower part of the implant. This breast implant, then. will deliver a lot of upper pole fullness. In the past, upper pole fullness was literally impossible to achieve without increasing the size of an implant to a point that was often bigger than what the patient wanted or needed, which would lead to stretching of the breast tissue until the implant fell. These firmer fill breast implants help to make this no longer issue.

Breast implant cohesiveness - firm fill.

There is a price difference between all of these devices, but once a patient understands why a particular implant will best deliver a happy result, money is rarely an issue. As Dr. Brzowski likes to say, “While money may not buy you love, the price of happiness is always a bargain.”

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