What's the difference between HSC and HSC+ gel filling of the Sientra implant? Online demos seem to be of textured shaped ones

Thank you for your excellent question.  The Sientra shaped implants are filled with HSC+ gel, which is slightly more cohesive than the round Sientra implants.  I feel that the Sientra implants, both styles, are slightly more cohesive than Natrelle, i.e. they are a little more "gummy" feeling.  Choosing between the two is largely up to patient preference, guided by the information supplied by your plastic surgeon.  Both outer shells are similar, and current silicone implants are all very resistant to silicone seepage due to the cohesiveness of the gel.

The term "cohesive" means that the gel holds together as a semi-solid, so more cohesive doesn't necessarily mean better or safer. Shaped implants have a higher degree of cohesivity because they have to be firmer in order to hold the shape. Softer gels are used in round implants and may feel more natural. I use shaped implants (also called form-stable) in about 15% of cases where the patient's anatomy is such that this type of implant fits better.

The modern silicone breast implant is a cohesive gel. Sientra currently has the most cohesive gel round, smooth implant available on the market. This is called the HSC+ or the style 107 implant. The potential advantage is that in a standing position, the style 107 fights gravity a bit better and can maintain the most fullness possible in the upper breast above the nipple.