Significant advances in technology provide plastic surgeons today with more breast implant options than ever before. These choices allow surgeons to customize an implant’s look and feel to a patient’s desires. Without the guidance of an experienced plastic surgeon, determining which implant is right for you can be a very confusing process.
When Dr. Patricia McGuire began her private practice as a board certified plastic surgeon in 1991, silicone implants were very different from the implants available today. “Silicone gel, when I first went into practice, was the consistency of oil,” shares McGuire. Couple this liquid consistency with implant shells that were prone to tearing, and you have a recipe for implant failure and a messy implant removal surgery.
“In 1992, silicone gel implants were taken off the market because of concerns about autoimmune diseases,” continues Dr. McGuire. “They were studied. As a result, silicone breast implants are one of the most studied medical devices of all time. What they found was patients were not being made ill by the implant, but the implants were not as well made as they could have been. This led to the development of much stronger shells and changes in the gel consistency.”
What’s In A Breast Implant?
All breast implants have a silicone shell on the outside and a fill on the inside. Saline implants are filled with saline solution, and silicone implants are filled with silicone gel. In the past, the only decision to be made when a patient chose a silicone implant was the amount of volume, or size of the implant. As breast implant technology has improved, the choices expanded. Today, patients can choose between a smooth or textured implant shell and a shaped or a round implant. From there, the options continue to expand into the consistency of the silicone gel within the implant.
From Jell-O to Gummy Bears and In Between
Unlike the messy oil consistency of silicone implants in the 80’s and early 90’s, today’s implants contain more cohesive silicone gels. The more cohesive a gel is, the less runny it is. If an implant’s shell is disrupted, the more cohesive silicone gels will remain contained within the breast pocket.
The most commonly used silicone gel implant fill used today is known as responsive gel. “It’s like the consistency of Jell-O,” explains McGuire. “So, even if there is a disruption in the shell, the gel doesn’t ooze out over the body. These are very nice implants that feel very soft.”
Slightly firmer than a responsive gel implant, but still soft to the touch, is the newest silicone gel option: soft touch gel. Allergan’s Inspira SoftTouch implant was recently approved by the FDA for use in the United States. To increase cohesivity, the chemical bonds between the silicone molecules are engineered to have more cross-linking. The more the silicone is cross-linked, the tighter the molecules cling to each other. The result is a slightly more firm, less oozy gel.
The third option for silicone fill is the highly cohesive gel. “Those are the true gummy bear implants,” shares McGuire. “Cut them in half, pull them apart, you have the inside consistency of a gummy bear. These have the advantage they can hold shape, if a patient would like a shaped implant, but the trade-off is the implant feels a little bit firmer.”
Levels of Silicone Gel Cohesivity:
- Responsive Gel – Softest Cohesive Gel
- Soft Touch Gel – Slightly Firmer than Responsive
- Highly Cohesive Gel – Firmest Gel Providing both Shape & Control
The Key to Breast Implant Decision Making
Which level of firmness is best for you can depend on a lot of things. Patients who have very soft tissue may not want a firm implant. Younger breasts tend to be firmer, so a firm silicone gel may be better suited for a younger patient.
Dr. McGuire’s experience and familiarity with all of the latest implant options available allow her to choose the best implant for each patient, rather than make a patient fit a particular implant. “We like to try and match the consistency of the gel to the consistency of the patient’s natural breast,” says McGuire. “I’ve used all three of the Inspira implants: the responsive, the soft touch, and the highly cohesive. If you feel these implants, they don’t feel that different. The differences are subtle. You need someone experienced to help you decide what’s best for you.”
Breast Implants Are Not Lifetime Devices
While the average life expectancy of silicone gel implants is longer than that of saline implants, even the most technologically advanced implants will not last forever. A common question in Dr. McGuire’s office is, “Do I have to have my implants changed every ten years?” The answer she gives is, “No. If it’s not broken, don’t fix it.” She does, however, like to closely follow her breast augmentation patients. Her office schedules annual or biennial follow up visits in order to detect any changes or possible implant failures.