What is the squishest most natural feeling breast implant? Please be specific on brand as well.

Question

I heard "silicone gel" is the best. Not sure if silicone gel is different from just normal silicone or high cohesive silicone? Thank you

Elisa A. Burgess, MD · Answer

Some people like the feel of softer, squishy breasts and others like firmer breasts. But I think the softest implants are the 4th generation silicone gel implants. Mentor and Allergan have these. However most patients are trending toward the 5th generation silicone implants since they are more cohesive and cross linked. These feel slightly firmer but still soft and they call them the gummy bear implants. The leak rate is thought to be a little less possibly because of the cross linking. Mentor, Allergan and Sientra have these.  I think Sientra may feel like the softer gel fill for a 5th generation implant but they are all good products. Best of luck to you and make sure to see a board certified plastic surgeon.

Stephen T. Greenberg, MD, FACS · Answer

Thank you for your question.  This question is one that I am asked on a daily basis during consultation and it is important to note that while most plastic surgeons (myself included) find the new generation silicone gel implants to be much more natural looking and feeling than the saline implant alternatives, that a saline implant can provide for a natural enhancement in the right patient as well.  One of the biggest considerations in selecting an appropriate implant is the patients pre-operative anatomy.  This includes careful consideration of both anatomical measurements and soft tissue coverage (or amount of native breast tissue).  To help provide for the most natural look and feel, I also recommend a submuscular implant or one that is placed beneath the chest muscle.  It is also important to be deliberate when selecting an implant type to ensure that you do not go too large on an implant volume or select a poorly matched implant profile, as this can complicate the ability to achieve a natural enhancement.The silicone gel implants currently on the market are highly cohesive memory gel implants.  There is some debate amongst surgeons and patients as to which of the three major manufacturers silicone gel implants are the 'most natural' feeling, but in my experience they all feel quite similar.  With that said, it is critical that surgeons and patients spend a good amount of time discussing the patients cosmetic goals and that the final implant selection for a given patient is deliberate and individualized.  If you are considering a breast augmentation procedure, I would recommend scheduling a consultation with a board certified plastic surgeon who specializes in breast enhancement procedures.  Many surgeons, myself included, offer complementary consultations and various imaging technologies to help patients visualize what a breast augmentation would mean for them and I think that this would be invaluable to you.  I hope you find this helpful and I wish you all of the best!

Urmen Desai, MD, MPH, FACS · Answer

I like to use Allergan (Natrelle) or Mentor or Sientra Silicone 'Gummy Bear' Implants.  The implant selection should be based on a combination of your desired size, soft tissue dynamics, breast base diameter and skin elasticity.  I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery, a member of the American Society of Plastic Surgery (ASPS) and the American Society of Aesthetic Plastic Surgery (ASAPS).
Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic Surgery

Donovan Rosas, MD · Answer

Cohesive gel?…Form stable?...Gummy Bear?…what do these terms have in common? With the recent introduction and FDA approval of the next generation of devices, the attention of patients, physicians and the media has been focused on these terms. While these devices have certainly captured the public’s attention, an in-depth understanding continues to evade most.
Following the FDA moratorium on the use of silicone gel filled breast in 1992, “cohesive gel implants” were introduced to the market. How do these devices differ from their predecessors? The silicone gel of a cohesive gel implant is firmer (via the addition of proprietary cross-linker). The greater the cross-linking the firmer the device will feel. The result is a filling that doesn’t leak when the shell is compromised in the way that a traditional liquid does. This quality is best illustrated when cutting a device in half…it doesn’t yield a gooey mess but instead two stable halves. 
  
Generally speaking today’s silicone implants are all “cohesive gel implants.” This broad term has been inappropriately applied to the next generation of “highly cohesive gel implants.” However, the recent media attention on “cohesive gel implants” is not warranted and is in fact misplaced.
  
These newest devices to reach the market are form stable implants.  These higher strength silicone gel implants were approved by the FDA in March 2012. They contain a more “highly cohesive gel.” This increase confers upon these devices the ability to maintain shape irrespective of position. This quality has earned them the informal nickname of “Gummy Bear” implants. Imagine cutting into a gummy bear candy and the effect is the same.
  
While these implants are new, “novelty” does not necessarily equal “better.” There is a device for every patient. Form stable implants have both advantages/disadvantages. The advantages are: shape retention, no shell folding/wrinkling, no leakage, decreased capsular contracture. The disadvantages include: increased cost, limitations related to access incision, increased technical difficulty, device rotation.
  
There are currently 3 devices with FDA approval available to the public at large. They are the Allergan/Inamed 410, Mentor Memory Shape, Sientra. Each represents a different point along the cohesive gel spectrum, the former being the firmest and the latter the softest. 
  In general, traditional silicone implants are preferred over saline implants by many patients and surgeons for their more natural feel. As when making decisions about any form of surgery, patients should have an in-depth consultation with their board certified plastic surgeon before selecting the type of implant to use. While form stable anatomic implants are newer, they may not be suitable for all patients. With regards to your specific question, the available smooth round cohesive gel implants from all three major manufacturers would likely suit your "soft and squishy requirements." The majority of my patients choose an Allergan Natrelle Inspira (higher fill ratio) but the Mentor Memory gel is an equally good option. You should be able to feel/sample all the options at your consultation.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Thomas Fiala, MD, FACS, FRCSC · Answer

Hi.  There are several different types of silicone gel available now.  For example, there are now 3 levels of gel firmness available in the Allergan Inspira range.  Both the Mentor Memory gel and the softest of the Allergan Inspira range would meet your criteria for "soft & squishy".

Alexander Q. Ereso, MD, FACS · Answer

Thanks for your question. As someone who has used all three major manufacturers implants, I don't think that I could state that one brand in particular feels any more "natural" than the other. Everyone has their own opinion of what feels "natural" to them and I think that they are all very similar and equivalent when it comes to softness and pliability. The current generation of silicone implants are all highly cohesive implants. When considering getting the most natural result, I recommend placing the implants underneath your muscle. By doing this, you would feel (as you go from outside to in) your own skin, your breast glands, and your muscle before you felt your implant. Nothing is more natural feeling than your own tissue. Thus, if you have very small breasts to begin with, having that extra layer of muscle interfaced between your breasts and your implant will give your breasts the most natural look and feel.

Jerome Edelstein, MD · Answer

Hello,Thank you for your question. My patients say that cohesive, silicone gel implants look and feel more natural- most like a real breast. They also tend to show rippling a little less. The cohesivity is fairly consistent- some slight variations exist. I use Allergan Natrelle Inspira and Mentor silicone Implants. I recommend that you talk about the look and feel that you are interested in with your Plastic Surgeon and let them show you options.All the best

Samuel Maurice, MD, FACS - Account Suspended · Answer

That is a great question. In my opinion, the silicone gel implants are the "squishest" most natural-feeling implants. That being said, there are newer more cohesive implants (sometimes referred to as gummy bear implants) that are also available. Allergan has also recently come out with a new implant that is between these 2 options. Both Mentor and Allergan carry the standard silicone gel implants. I recommend consulting with a board certified plastic surgeon in your area. You should have the opportunity at his/her office to feel the different implant options.

Brooke R. Seckel, MD, FACS (retired) · Answer

Opinion will vary among different plastic surgeons-each has his/her own preference. In my opinion smooth walled round cohesive silicone gel implants are the most natural feeling. I only use Mentor breast implants-the only ones made in the US. For what it is worth-one survey revealed that 83% of plastic surgeons use smooth round silicone gel implants.

What is the squishest most natural feeling breast implant? Please be specific on brand as well.

Answers (9)

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