Breast Implant Selection Needs To Be Individualized For Every Patient

Breast implants are made in many shapes and sizes, with different inner and outer materials. The outer, pliable shell of an implant is thin, solid silicone, and its surface may be either smooth or textured. Textured surface is designed to lessen the formation of scar tissue around the implant. Smooth-surface implants have a slightly softer shell and are less likely to be felt through the skin and tissue. You should discuss the different implant surfaces with a plastic surgeon to make sure you choose what is right for you. Saline (salt water) is commonly used to fill the breast implant shell. Saline naturally comprises most of the human body, so if the implant should leak which is infrequent (less than 5%) its fluid can be easily and safely absorbed. Recently approved by the FDA November 2006 these implants are now available as an option for breast augmentation.

The standard implant in the United States has been saline filled, ever since the FDA moratorium on silicone gel filled breast implants in 1992. The type of implants that were available before the ban are available today as part of an "adjunct study," which is open to patients with congenital deformities or having a revision for particular reasons. What distinguishes cohesive implants is that the silicone gel is firmer, essentially a soft solid. If a cohesive implant is cut in half, there is no gross movement of gel, and the implant maintains its shape. The way these are made is that the company uses more "crosslinker" in the making of the implant. The ingredients are the same, but with more crosslinker added, it makes the gel firmer.

The term "cohesive" has been bastardized in recent years. Cohesive breast implants implies form stability, or form retention. That means that in any position, the implant maintains its shape. That is an important distinction, because it means that the shell should not fold, and that it will maintain a particular shape. Unfortunately, given the recent media attention to cohesive implants, many are using the term to describe "regular" silicone gel implants. Technically, they are correct; all silicone gel is cohesive to some degree. But the term cohesive has always meant form stability, and when patients ask for cohesive gel, it is because they are looking for an implant with those particular characteristics of durability and shape retention. Hopefully, the terminology will be clarified in the coming years. Different implant shapes and textures are available; however, no one implant can work best for every patient, and selection needs to be individualized for every patient.