What Are The Main Advantages Of Cohesive Gel Implants?
Though they have been used for ten years in Europe, the data from the US clinical trials has not matured to the point that we can argue any of these advantages conclusively. These are what is hoped will be proven to be the advantages, but the reader should realize that these are all unproven.
Shape - It does seem that these implants do maintain their shape, thereby making them able to impart their shape upon the breast. Non-form stable fillers, such as saline or standard silicone gel, are subject to the forces of gravity and of the breast, so that they assume the shape that the forces of the breast and the forces of gravity dictate. These implants have a distinct shape, and they will impart it upon the visible shape of the breast.
Folds and Rippling- Since the fill does not shift from one area of the shell to the other, shell collapse and folds do not seem to occur, even in long term follow up.
Won't Leak - There are two components to this issue. One is whether the shell might break, and the other is whether the gel will leak out if the shell does break. The shell is certainly physically susceptible to breakage, but since most ruptures are believed to occur along shell folds (they result in weakening of the shell, much like a folded newspaper left in a drawer will crack along its folds), it is expected that shell failures will occur less frequently. In the largest series in the world, there has supposedly been only one shell failure in several thousand implants done in Sweden. If the shell is peeled off the implant, the cohesive gel filler will maintain its shape. I have one that I did this to several years ago, and it looks just the same as the day I did it. But, that doesn't mean that in the warmth of the body, and with the forces that act upon the implant, that the situation wouldn't be different. Another issue is diffusion; though there is a layer of the implant shell that decreases silicone diffusion, some microscopic diffusion of silicone will always occur through the shell.
Capsular Contracture- The European experience has been that firm scar tissue seems to occur less often with these implants (capsular contracture.) It is not clear if this will be maintained over time, or what the cause is. Some speculate that it is related to there being less diffusion of silicone than with non-cohesive fillers, while others believe it is due to the increased firmness of the implant, which inhibits the body from contracting around it. More time and study will be necessary before we know the answer to this issue.
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