*Disclaimer: This blog was written and published in Spring 2016. Since that time, surgeons have shifted away from using textured implants due to connections with BII (Breast Implant Illness).
1.) Longer shape predictability
Over time, saline breast implants can fold and lose their shape creating an unflattering appearance. This ultimately can lead patients to breast revision surgery to correct the problem. Breast revision surgery increases both the costs and the risk of complications to the patient. Saline and liquid silicone implants lose their shape faster than textured cohesive gel silicone implants due to the difference in their respective composition. The new generation of textured cohesive gel silicone implants is firmer than the traditional saline or liquid silicone implants, but is still soft to the touch. Textured cohesive gel silicone implants used for breast augmentation at the Philadelphia area’s Chapin Aesthetics retain their shape longer and exhibit improved longevity when compared to saline and liquid silicone implants.
2.) Decreased rupture rate
The newest generation of gel silicone implants is comprised of a strong silicone shell that surrounds the cohesive silicone gel filler that is solid yet soft and rubbery. This cohesive silicone gel has been dubbed the name “gummy bear” as its consistency resembles that of a gummy bear candy. Amazingly, this cohesive gel implant will not leak, even if the implant is cut in half.
This feature is thought to make these implants safer and easier to remove even if there is a tear in the outer shell. Cohesive silicone gel implants are advantageous in the rare event of implant rupture. Should a saline implant rupture, the implant will typically deflate completely. Although the body harmlessly absorbs the saline, the patient will require immediate implant replacement due to the significant cosmetic discrepancy that is created. A cohesive gel implant on the other hand will retain its shape even if there is a significant tear in the implant shell. Patients with cohesive gel implants who are noted to have a tear in the implant shell (usually noted on MRI) have the option to pursue replacement or simply observe the implant over time. This eliminates the financial and emotional burden of immediate reoperation in the case of implant injury.
Research and testing has shown conclusively that saline implants have a much shorter shell life compared to cohesive gel silicone implants. There is no doubt that cohesive gel silicone implants offer a longer shell life, and consequently minimize the number of reoperations you are likely to require over time.
3.) Decreased capsular contracture
Capsular contracture occurs when the scar tissue around the implant becomes inflamed and creates a thickened, hard shell around the breast implant. Below are the most common capsular contracture symptoms that patients may experience:
- Breast becomes hardened and loses a soft, natural feel
- Breast changes in appearance and becomes distorted
- Feelings of tightening and discomfort
Capsular contracture is an unpredictable complication. Presently, we do not know exactly why capsular contracture may form in one patient and not in another or even why capsular contracture may only occur in one breast and not the other. Capsular contracture may require patients to undergo surgery to remove the scar tissue and exchange the implant. However, there are some proven operative techniques that have reduced the risk of capsular contracture in our patients. The use of textured implants is one way to decrease the risk of capsular contracture. The rough surface of textured implants deters a hard capsule of scar tissue from forming around the breast implant. The use of antibiotic solutions, the Keller FunnelTM and inframammary (under the breast) incision all contribute to a decreased chance of developing capsular contracture. I routinely employ all of these maneuvers during surgery to decrease this chance.
4.) Decreased migration
Breast implants can migrate or move, medically known as malposition, laterization, or supine shift from their original placement at the time of surgery. If the implant has shifted in the breast pocket the patient may notice a change in appearance of the implant or a change in location of the implant. When laterization has occurred the patient may need to undergo surgery to correct the placement of the implant. Additional surgery causes the patient to endure more costs and risks of complications that can occur with surgery. The risk of laterization can be reduced with the use of textured cohesive gel implants. Textured cohesive gel silicone implants provide a more stable position to the implant over smooth implants, which reduce the risk of the implant shifting over time. Smooth implants have an increased risk to shift out of position because they do not adhere to the tissues and do not have a coefficient of friction that prevents them from sliding around in the pocket. Textured implants help to stabilize the position of the implants, as they are less likely to migrate out of position over time.
Breast implant rippling refers to folds or wrinkles in breast implants that are visible through the skin. Typically, rippling is the most noticeable on the bottom or sides of an implant, but may also occur in other areas such as the middle or near the cleavage region. Although rippling can happen to any patient there is research to support what factors increase the chance of implant rippling.
Overfilling of the breast implant: this can only occur with saline breast implants as silicone breast implants are prefilled and cannot be “overfilled.” Overfilling occurs when more saline is inserted in to the breast implant than what was recommended by the manufacturer. This can cause the edge of the breast to pull, which can induce a ripping.
Underfilling the breast implant: underfilling can also only occur with saline due to silicone implants being prefilled. When an implant is underfilled it leaves the shell emptier than intended, resulting in wrinkling and folds in the implant.
Poor tissue coverage: this can occur with saline or silicone breast implants but is most often seen in women with small breasts. It is more noticeable to see rippling in those with small breasts simply due to the fact that there is not as much breast tissue to cover the implant. Those with more breast tissue provide more coverage of the breast implant, consequently lowering the risk of rippling that is visible or felt.
Subglandular (over the muscle) breast implant placement: breast implants are most often placed under the muscle for a variety of benefits. However, in rare situations it may be recommended to place the implant over the muscle. Breast implants that are placed over the muscle provide the least amount of coverage for the implant, which increases the chance of visible rippling.