Silicone Gel Breast Implants – Options
*Individual results may vary
Now is probably the best time ever to consider breast augmentation. Almost everyone nowadays is choosing silicone gel filled breast implants over the older saline filled breast implants, for a much more natural look and feel. Our Long Island practice offers all the latest options in silicone gel implants. Dr. Epstein prefers the Natrelle® brand of implants, made by Allergan. He has been using them since silicone gel implants made their re-emergence in the US market in 2006. They are of the highest quality, and the manufacturer stands by their products. During your consultation with Dr. Epstein, he will discuss each option in detail and will determine what breast implant is best to achieve your desired results.
Breast Implant Options
Why are there so many options? This is a good thing. This is what gives a woman choices. This allows you to select the implant that best suits your personal preferences as a patient. Currently, only smooth surface devices are available, so all implants are round. However, there are still some very nice options available.
Isn’t silicone Just “Silicone”
The answer is categorically “no.” Silicone is a gel, and there are several different formulations of silicone gel. Having an understanding of the basic properties of silicone gel is essential for the surgeon, and helpful for the patient. The rest of this section deals with this topic. If you are not interested in this material, please skip to the next section down below.
Let’s start with the basic premise for silicone gel implants: cohesivity. A substance is “cohesive” if the molecules that make up that substance want to stay together. Saline is NOT cohesive. If it spills on the floor, its molecules scatter all over the place. There is no tendency for the saline molecules to stay together. Saline implants look and feel like a hard bag of water, sloshing around inside. Silicone is cohesive. If you drop silicone on the floor, it stays together as a single “glop” of gel. Now, cohesiveness or “cohesivity” can vary from one gel to another, just like not all brands of toothpaste have the same cohesiveness. The more cohesive, the more the molecules want to stay together and resist deformation, and therefore the gel is more “firm”. So, more cohesive, more firm. This is a very basic, and only partially accurate explanation. To learn more about what makes the different silicone gels look and feel differently, read below.
If you are really fascinated by this topic, let me go just a little further. I will introduce two other concepts – viscosity and elasticity. As a patient, I do not believe that it is essential that you understand this, but it will help you appreciate the differences in the implant choices available today and why I will recommend one over another type of silicone gel implant for you. I am a biomedical engineer by background, and I prefer to understand the scientific principals behind everything I do and every decision and recommendation that I make.
Viscosity is the resistance a gel has while under stress from a deforming force. Let’s look at a couple examples of this that everyone is familiar with. Heinz ketchup. Crest toothpaste and Aunt Jemima pancake syrup. I’ve used all three of these products. The latter is no longer on my diet, but you will soon get the point. These are all “gels.” A gel is a solid that will deform when an external force or forces are applied. The external forces in all these cases is 1. squeezing the container and 2. gravity.
Pour Heinz ketchup – the advertisements for it exclaim “it’s slow good!”. Watch the 1967 ad below which explains the difference in the viscosity of Heinz ketchup versus other brands.
What is happening is that the molecules of the ketchup (or silicone gel) are moving in sheets one on top of another as the force of gravity is acting to pull it out of the bottle, along with the internal pressure (another force) inside the bottle pushing the ketchup out. There is internal friction as these sheets of molecules move against one another. The degree of friction determines how easily the sheets of molecules can move. The more friction, the less easily there is motion and the more force is needed to these sheets of molecules. In other words, more force is required to deform, or change the shape of the gel – whether it be ketchup or silicone gel. The viscosity essentially determines how easily the gel, in this case ketchup, will change its shape from that while it exists within the bottle, to the opening of the bottle.
The other property I wish to introduce is elasticity. This is the tendency for an object, when deformed by an external force, to return to its original shape. A rubber band is an example of this. If you stretch a rubber band, upon letting go, the rubber band goes back to the exact shape it had before you stretched it. How quickly it returns to that shape will vary among different materials, including silicone gels.
So we now have two properties, viscosity and elasticity, that vary among different gels. The less viscous the gel, the easier that implant will change shape as your breast moves, or is moved or deformed by human touch. So, a low viscosity is a desirable property. The more elastic the gel, the quicker the implant will return to its original shape. A high elasticity is also a desirable property.
These are the very basics of what makes each silicone gel feel and behave differently. There are some other properties I did not discuss, and they all come together to give the implant its unique characteristics. The main point to understand is that not all silicone gels are the same.
silicone gel implants – Firmness and shape
Is firmness a good thing? Well, the firmer the gel, the more it holds its shape. The softer the gel, the less it holds its shape. The caveat here is that the softer the gel, the more it will resemble the “feel” of natural breast tissue. So a more cohesive implant will feel firmer and hold its shape better, whereas a less cohesive implant will feel softer, better resembling the feel of a natural breast but will not hold its shape as well as a more cohesive silicone gel implant. So as you increase cohesiveness, you get better preservation of shape, but at the expense of softness. And if you decrease cohesiveness, you get less preservation of shape, but increase the softness of the implant. It’s a trade-off that you balance based upon your personal preferences. There is no wrong decision here. You will achieve great results with any of the silicone gel implants, but you can optimize that result for your own personal preference now with the different options currently available to you.
Choosing the right breast implant
So which is best for you? That is a matter of personal preference. Is shape more important than feel (softness), or is it the other way around? That isn’t to say that you totally sacrifice one for the other, you can get great shape and feel with any of the silicone gel implants, but in order to optimize one, you may need to give way on the other. Feel the difference in the implants. The more natural tissue that you have to start with, the less you will be able to perceive the difference in firmness when the implant is inside your breast. A breast with more tissue to start with may also mitigate the ability to see the difference in shape as well. When I say shape, I am speaking of not only round versus teardrop, but also round versus round where one implant is soft and the silicone gel tends to settle to the bottom of the implant shell (bag), leaving the upper breast less full, versus a firmer round implant with more upper breast fullness and less fullness at the bottom. Don’t get yourself crazy here – this is I, as an experienced breast implant surgeon, will listen to your desires and help you better navigate through all the options to find the implant that best suits your needs and goals to produce breasts that look and feel as you desire that they should.
Generally speaking, for a woman with small breasts with tight tissues, I believe that any of the available choices in round smooth implants will yield a very nice, natural result. However, if your breast is lax, with less natural upper breast fullness, one of the firmer implants may be a better choice. In this case, you are sacrificing some softness for a little more shape control. Again, you can use any silicone gel you like, but I am trying to give suggestions based upon extensive experience so as to allow you to achieve the optimal result for your goals and desires.
What are the current silicone implant options?
These implants are not new – they have been available in other countries around the world for several years. I also indicate below when they became available in the United States. Teardrop Gummy Bear implants were no longer available in the United States as of July, 2019. Note: The below discussion is for Allergan Natrelle brand implants. I am not discussing Mentor nor Sientra brand devices.
- Inspira® Responsive Non-Gummy (2006)
- Inspira® SoftTouch Gummy (2017)
- Inspira® Cohesive Gummy (2016)
Watch Dr. Epstein Discuss Different Implant Options
Inspira® responsive non-gummy
.The Inspira® Responsive Non Gummy Breast Implant is an excellent implant. The gel is the least cohesive among the Inspira® implant family, which makes it the softest. On the other hand, it does not hold its shape as well as the other “Gummy” (form-stable) implants. This implant works well when there is adequate breast tissue of good or better quality. While rippling is far less frequent with silicone gel implants than saline ones, with this implant, there is the potential for a little more rippling than seen with the Gummy options in women with thin or stretched breast tissue. For this reason, I do not recommend this implant for women with very thin, stretched out, compromised breast tissue.
Click here to see before and after photos with the Inspira Responsive Non-Gummy Implant.
Inspira® SoftTouch Gummy
The Inspira® SoftTouch Breast Implant is the most recent and newly introduced implant released in April 2017. This implant is still cohesive enough to be considered a “gummy”, but its cohesiveness and firmness lie in-between the Inspira® Responsive Non-Gummy and the Inspira® Cohesive Gummy implants. It is an excellent compromise between softness and firmness and suitable for most situations. It is a favorite among many of my patients.
Inspira® Highly Cohesive Gummy
This type of implant is the most cohesive of all the Inspira® implants, making it the most “form-stable” which allows it to retain its shape. This implant will yield the greatest degree of upper breast (upper “pole”) fullness and the least amount of downward migration of silicone gel, or bottoming out. This implant is excellent when there is very compromised, thin tissue as shape is best preserved with the least amount of rippling.
Click here to see before and after photos with Gummy implants.
It’s all about choices…
Now there are several excellent options available to give you the look and feel that you so desire and deserve. I will be happy to discuss these options with you and help you to select the one that will give your breasts the look and feel you have always wanted.