Breast Implant Guide

Woman lying down holding her breasts

Since their inception in the 1960s, breast implants have gone through many variations. What started as either a water balloon or silicone gel in a rubber sac has evolved into a highly advanced technology, both in terms of packaging and filler material. After a huge media scare in the 1980s, implant manufacturers began to focus on shell coating and gel consistency to decrease implant leakage. The end result was the form-stable implant, commonly known as the “gummy bear” implant. Both standard silicone implants and the newer form-stable silicone implant are used today, each with its own benefits and potential complications. In order to know which is the best implant for you, it’s important to be familiar with the different breast implant types and their pros and cons.


Standard silicone gel is soft and mushy. It has a shape, but that shape is easily distorted as the soft gel rolls around within its coated shell. It gives to the touch and moves with gravity, effectively mimicking breast tissue in many ways. The properly chosen gel implant in the properly formed pocket can often pass for nature’s own, to the delight of surgeons and patients alike. But innovation has led to a new generation of implant, where shape and consistency take on a new form.


The form-stable gel implant offers several advantages over traditional breast implants. The first is that the gel is cohesive, which means that it sticks together instead of running like jelly. The obvious advantage to this is that if the implant shell ruptures, the inner filling won’t get all over the place.

All implants form a capsule—or scar layer—around themselves, and a leaking implant tends to stay contained within that capsule. A ruptured traditional gel implant can become a terrible mess. The cohesive gel implant, on the other hand, reacts more like a gummy bear if broken. It will crack into pieces, but there’s nothing runny to get around. Given that silicone gel ruptures are often “silent”, contained ruptures can avoid significant complications.

The second benefit to the form-stable implant is, not surprisingly, its stable form. Because the gel is not runny, it holds its shape. This means that the implant can create the shape of a natural breast, even in a patient who has very little of their own breast tissue to make that teardrop shape in the first place.


The problem with the anatomic shape of the form-stable implant is that, if it’s not sitting exactly upright, it can look very strange. Traditional round implants can rotate freely, and still look the same. But when an anatomic implant rotates, it needs to get put back into position. This means another operation at the patient’s expense.

In order to prevent rotation, anatomic implants have a textured coating that sticks to the tissues. In addition to helping prevent rotation, this texturizing may also prevent some implant-related complications like scar contracture that can deform the implant and sometimes also require reoperation. But the textured coating can also cause the body to produce more fluid around the implant—and this is a possible cause of other types of complications, ones that are particularly problematic in the setting of elective cosmetic surgery.


Many surgeons who routinely use the form-stable implants for breast augmentation believe that the harder gel gives the breast a more firm, youthful feel, and that the anatomic shape looks more natural. However, blinded studies show that the look is not significantly different, especially over time. And I would argue that not everyone wants a really firm breast. But the bigger issue I have with using these implants for breast augmentation is that it would mean adding possible complications to a totally cosmetic procedure, where any complication is a grave concern.

In terms of movement of the implant, I find that most of my patients prefer the softer gels that float with the breast tissue, and move with it in all directions including down. As time goes on and the breast slowly succumbs to gravity, so does the smooth coated implant, and the end result is more natural. That is why I have long preferred traditional gel to cohesive implants for my patients. After a thorough evaluation of the two, my patients tended to do the same.


For many years, I was a dedicated gel user. When my patients held a silicone implant in one hand and a saline implant in the other, they almost always chose the former. The softer, more tissue-like feel was usually a winner. I always imagined that it would take a revolution in saline implants for the game to change, and I was right.

In 2014, the Ideal Implant was approved by the FDA. This new device is a saline-based, structured breast implant with multiple compartments. The different chambers mean that the forces distribute throughout the implant, limiting movement within the shells. This translates to more stability, both in terms of holding its shape and in terms of limiting ruptures. The Ideal Implant is the only implant that has multiple compartments, and this represents the latest in technology when it comes to breast augmentation: structured support.

Although saline and gel will always feel somewhat different, the Ideal Implant does offer a natural feel. It is slightly firmer than silicone, but it holds its shape upright, which translates into a perkier and more supported contour. But its biggest benefit is the lack of silent rupture, which means that these implants require no monitoring. And the lack of potential health-related complications also means more peace of mind in the short and longterm.


Not everyone will choose the same implant, but everyone should know their options. Whether you lean toward gel or saline, one thing is clear: structured support is the wave of the future. Lower rupture rates and better contours do translate into an overall improved experience, as innovation continues to drive the market.

The key is to find a surgeon who is open to newer implants and passes on the appropriate information to his or her patients. As a patient, you should always consider your health, safety, future maintenance, and possible complications, in addition to the aesthetic result. It is only with all the information available to you that you’ll make the right choice for you.

Dr. Sophie

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