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What are highly cohesive silicone implants?

Women who have chosen breast augmentation now have more choices than ever before. This makes the procedure highly personalized, with each woman able to choose exactly the implants that are best for her.
One of the more recent developments in the field of breast augmentation has been the development of “highly cohesive” silicone breast implants, sometimes known as “gummy bear” breast implants. The first brand of these was FDA-approved in 2012, and there have now been many thousands of these implants used in breast augmentation. Many of our patients have heard about these implants, and are interested to know more. What exactly does “highly cohesive” mean? What are the advantages and disadvantages of this type of implant?

What is highly cohesive silicone?

Silicone is a synthetic compound, which consists of many repeating units linked together. Depending on the precise type of the unit and how they’re linked, different types of silicone behave somewhat differently. Silicone can be a liquid, a gel, or a solid.

The term “cohesive” refers to how many chemical bonds there are between the different silicone units within the material. These bonds are referred to as “cross-links.” When there are more cross-links between silicone molecules, then that silicone is more cohesive.

The cohesion of silicone affects its texture. Silicone with very low cohesion is a runny liquid (this type is not used in breast implants). Silicone that’s moderately cohesive has a texture more like gelatin, while highly cohesive silicone is similar to a gummy bear. Both of these types have a fairly soft and bouncy texture, similar to breast tissue. However, the more cohesive silicone will feel a bit firmer.

What are the advantages of highly cohesive silicone?

There are several reasons that a woman might choose highly cohesive silicone implants.

Holds its shape over time

The more cohesive the silicone, the more it will hold its shape. Highly cohesive implants hold up well over time, and are unlikely to change shape much over many years. This is why anatomically shaped implants (which are thinner toward the top and fuller toward the bottom) are made of highly cohesive silicone. However, this has both advantages and disadvantages. Shaped implants won’t change shape in response to gravity, so it won’t necessarily look very natural when a woman is laying down.

With a round implant, the highly cohesive silicone will also help the implant to hold its shape. This will help to keep the upper pole of the breast filled out, which is a positive for some women. However, it may also look a little bit unnatural, particularly when the woman is lying down, as the round shape of the breast will remain.

May reduce rippling

Another advantage of the implant holding its shape is that it reduces rippling. To understand why, imagine filling a water balloon partway, then standing it up on its end. The balloon will sag a bit, and there will be some wrinkles that form along its surface as it sags. These are very similar to the ripples that women with breast implants can sometimes feel or even see. These ripples can occur with both silicone and saline implants. (Saline implants can be filled to their maximum capacity to reduce the rippling. This is like filling the water balloon up so that it’s very full. Although it won’t ripple, it will feel very firm and unnatural.)

A highly cohesive silicone implant, whether it’s shaped or round, behaves differently. Imagine standing a gummy bear on its end; it doesn’t develop folds in its surface, but rather tends to stay smooth, with only minor shape changes. Highly cohesive silicone implants can still develop a little bit of rippling, but it tends to be dramatically less than with a less cohesive implant.

Helps to avoid leakage of silicone

One last advantage of cohesive silicone is avoiding leakage of silicone into the body. If a silicone breast implant ruptures, then silicone can leak into the tissues around the implant. Although this is a rare event, and the silicone usually remains confined within the scar capsule that naturally forms around the implant, it can sometimes migrate farther and cause more serious problems. With a highly cohesive implant, if it ruptures, the silicone will not leak, because it has a more solid texture. Some women feel safer with gummy bear implants for this reason.
Older silicone implants used a type of silicone with very low cohesion, and some of the silicone molecules tended to leak through the shell of the implant and into the woman’s body. More cohesive silicone implants avoid this problem, because the silicone molecules are bonded to each other and therefore they won’t leak through the implant shell. All modern breast implants, even those not labeled as “highly cohesive,” are designed to be cohesive enough to avoid gel bleed, although we must always acknowledge the possibility that a few silicone molecules may still leak through the implant shell.

Highly cohesive silicone implants

Dr. Eric MilesIf you’re interested in breast augmentation in Charlotte, Lake Norman, or the surrounding area, and you want to discuss the advantages and disadvantages of highly cohesive silicone implants as compared to other options for breast augmentation, please contact our office. Dr. Erik Miles will be happy to discuss the various choices with you, and help you decide if highly cohesive silicone implants are right for you.

Dr. Erik J. Miles
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