What Are The Main Disadvantages Of Cohesive Gel Implants?

Shape- It is listed here for the same reason that it is listed as an advantage. Since it will impart its shape upon the breast, the patient and surgeon had better be sure that they are choosing an implant shape that they want the breast to have. While implant selection certainly matters with old style silicone gel and saline implants, since their shape so so affected by gravity and forces of the breast, there is a great margin for error. This is not a problem per se, but rather, this is an issue in which one must be aware of. For instance, women preferring "Baywatch"-grapefruit looking breasts may find the teardrop shape of this implant will not meet their expectations. I think this problem becomes significant only in "disproportionate" augmentations, situations in which the implant size chosen exceeds what is optimum for a patient's soft tissues.

Feel- These implants do feel a little bit firmer than old style silicone gel implants (though if the old ones get a capsular contracture, they will feel firmer…some believe that the cohesives are less likely to get such a contracture, but that is not yet known.) How significant this is in a given patient depends upon how much breast tissue they have relative to how large an implant will be chosen, and how firm or loose their tissue feels. A rare patient will complain about the firmness, but for most patients, particularly those getting implants that are not oversized, this is not an issue.

Cost- These implants do cost significantly more than saline, and several hundred dollars more per pair than old style silicone gel implants. However, if part of the study, patients will be reimbursed most of the implant cost over a period of ten years.

Incision Size- Since these implants are not deformable, they cannot be squeezed through little incisions. Depending upon the size of the implant, incision length must be between 4.5-5.5 cm. It also can make insertion from around the areola difficult (I usually use the underneath incision with the cohesive implants.) Armpit incision is possible, but exceedingly difficult.

Rotation- These implants only come in anatomical shapes, meaning that they project more on the bottom than they do on the top. One of the risks of such a design is that if the implant rotates in the body, it will create a distortion. Care is taken during pocket dissection and insertion in order to minimize this. It is a very rare, but very possible complication. The only way to fix it if it occurs is to remove them and replace them with a round implant. Rotation is at greater risk when the tissue is loose, for instance in a revision when a patient wants to go smaller.

Gel Fracture- Since the gel is almost a solid, it can actually crack. I have only seen this happen from excessive manipulation of the implant outside of the body, but it can theoretically occur in the body. No one knows if this can actually occur, or what the consequences would be if it were to occur. My speculation is that it would not be noticed, but the answer to this is not yet known.

Learn more about Cohesive Gel Breast Implants or Dr. Steven Teitelbaum and Dr. Bill Adams.

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