Cohesive Gel Exchange Worth It for More Natural Feel?

Had breast implants in 1995 at the age of 23 for very small breasts. Underwent sub muscular augmentation with tear drop saline implants to make me a B cup. I have been increasingly happy with the look of them with time. They have descended to a very natural position and appear very natural and flattering but have never felt natural. Have been considering exchange for anatomic cohesive gel implants. How much softer are they than saline? Would it be worth it to exchange just for this reason?

Doctor Answers 14

Cohesive Gel Implants

Silicone implants are much softer than saline implants. If you are wanting to exchange your implants for a softer feel then it would be highly likely that you would be happier with gel implants. As far as whether or not the procedure is worth it depends on you, just remember that there are risk with any cosmetic procedure and make sure you choose a board certified plastic surgeon.

Key West Plastic Surgeon
4.5 out of 5 stars 105 reviews

Gel vs saline

The less breast tissue you have, the more important silicone becomes to achieve a more natural result. So I would always recommend silicone first versus saline.

Robert Brueck, MD
Fort Myers Plastic Surgeon
4.9 out of 5 stars 64 reviews

Exchanging To Silicone Gel Breast Implants

Most thin patients with long-standing saline breast implants will be happy with the exchange to silicone implants if they are bothered by the feel of the rippling  or if they simply feel too soft. With today's more cohesive (high strength form-stable)  silicone gels (Sientra implants currently) there will be no rippling and they will have a more firm feel. (not softer)

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 reviews

Shaped implants not the most natural feel

First a few things to know: all silicone gel implants use a cohesive gel fill, meaning that it holds together as a semisolid. The gel in shaped implants (also called form-stable, anatomic, gummy bear) is quite firm in oder to hold the shape so they are not as soft as the gel in round implants (which also naturally form a teardrop profile in the upright position.) The only form-stable implants available in the U.S. at this time are from Sientra. Round gell implants are still the best choice for most patients.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 53 reviews

Cohesive Gel Exchange Worth It for More Natural Feel?

Your anatomic Saline implants were textured and most of those didn't feel the best. The next generation of anatomic gel implants (410 Allergan, Mentor CPG) are also textured and not yet available in the US, except at trial centers. It is a bit more firm than the current Cohesive Gel implants that are not anatomic shaped but very soft...So....most women today that I see in your situation go to the current round smooth cohesive gel implants and are very happy with the feel...

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 45 reviews

Replacing saline breast implants with gel

Gel implants are softer, more natural, and have fewer wrinkling/rippling complications as compared to saline.  Gel implants conform nicely to your chest and feel natural to the touch and when you lie on your stomach.  They are warranteed for life.


Saline inplants begin to fail after about 10 years due to valve leakage and crease-folding.


Exchange to gel is a great idea for comfort and for long term stalbility.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 46 reviews

Cohesive Gel Implant exchange for saline implants

You most definitely will get a more natural feel by changing your current saline implants (anatomical) to cohesive gel implants.   Additionally, it is not necessary to stay with anatomical or "teardrop" implants, as one can get a very natural and soft result with a smooth round gel implant as well, given that the surgeon who performs the revision creates the new "pocket" appropriately.   You do not have to necessarily stay with an anatomical implant.  Explore other options as well.

Milind K. Ambe, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 42 reviews

Cohesive Gel Implants are not necessarily softer that Saline Implants

It sounds like you have a wonderful result, with which you are highly satisfied, so I wouldn't be in a rush to change your implants.

There is a lot of confusion about the term "cohesive gel implants."  All of the current generation silicone gel implants are much more cohesive than those of previous generations.  This means that if you were to cut the shell with a pair of scissors, the gel inside would largely retain its form.  In the past, with earlier generations of the devices, the gel would have been much less cohesive, and it would not stick together if the shell of the device were disrupted.

There are also shaped anatomical implants that have a highly cohesive gel that are pending FDA approval and have been involved in a number of trials.  Sometimes these are referred to as "gummy bear implants." They have good points and bad points.  On the one hand, they hold their shape and are less ripply than other shaped textured gel implants.  On the other hand, they are significantly firmer, and this might be a significant concern in your case.

I hope this helps you sort out a somewhat confusing situation.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Choice of switching out saline for gel filled implants is entirely optional at this point

You have had a good result with your saline filled implants. If you are not having any problems with them and you like the feel and shape then there is really no reason to undergo an additional surgical procedure at this time.   If one of the implants ever ruptures then you may decide to switch to a new styled gel filled implant.  Many of our patients make this choice but it is entirely optional .  If you  have sufficient soft tissue over your saline filled implants then the result can be very pleasing and appear natural.  If the implants are over filled then they can feel a bit firmer.  I have several patients whose saline filled implants were placed in the 1970's (before my time) and are doing just fine.   

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Silicone implants feel softer than saline implants

Silicone implants feel softer but how much softer is difficult to determine.  Your old saline implants can have various amounts of fill... if overfilled, they can feel very hard, if under filled they can feel very soft and watery.  It would be helpful to know whether or not your implants are overfilled or not.  Then you should see a board certified plastic surgeon and compare the feel of a silicone and saline implants and see if you feel the difference is worth the extra expense and the need to undergo another surgery.


Martin Jugenburg, MD, FRCSC

Toronto Cosmetic Surgery Institute

Martin Jugenburg, MD
Toronto Plastic Surgeon
4.9 out of 5 stars 469 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.