Cohesive gel implants; Are they the Emperor's New Clothes of Implants?


For years, cohesive gel implants were the like the holy grail of implants. We'd talk about the wonders they could perform and pray for the day in the distant future when they'd finally receive FDA approval. From capsular contracture, to rippling, to deflation  -we (plastic surgeons and a few devoted patients) waited for the day when all these problems would be things of the past and we would live in a world of cohesive gel bliss.

So its been a year now, and the world quite honestly doesn't look a lot different than it did a year ago. Yes, a few patients came in and either went primary augmentation with cohesive implants or had specific problems corrected with the new implants but the vast majority of life goes on as we previously knew it.

Not that there's anything wrong with cohesive implants. Its just like so many things, the "problems" they are promoted to "correct" aren't problems that need correction to the majority of patients. Let me explain. Cohesive implants are great for a patient who wants a very modest enhancement (not the majority of patients) and don't want to have any fullness of what we call the "upper pole". The upper pole is the area of the breast that lies between the collar bone and the top of the breast. Most patients that I see specifically WANT something to fill this area after childbirth or a lifetime of small breasts. Its rare for a patient to come in with an A cup and only want a full B. I'm sure those patients exist - maybe along the coasts - but here in the Midwest its a rarity.

The phenomenon of "silent rupture" of the traditional gel implants which cohesive implants were purported to end, has yet to show itself as a real concern and not the stuff of overly anxious FDA commissioners and breast implant foes. Even my most anxious patients (and I have some doozys) find other things to worry about besides silent rupture of their breast implants.

The implants are expensive too. Much more expensive than their predecessors and, while I'm sure patients wouldn't mind the expense if it meant a world of difference, as a surgeon, its frequently hard to make that argument.

We will continue to see the slow roll-out of more cohesive sizes and styles as they work their way through the FDA approval process. Maybe once we have all the sizes and shapes that plastic surgeons in other countries enjoy, the choice of a cohesive implant will seem more palatable but, for now, for better or worse, it doesn't look like cohesive implants will cure all our implant ills.
Article by
Munster Plastic Surgeon