Form-Stable Cohesive Gel Implants: Advantages and Technical Essentials

The advent of form-stable cohesive gel implants represents a significant device-related advance in the history of breast implants. Perhaps even more significant, however, are advances in the non–device-related process of breast augmentation itself, which have redefined the outcome and patient experience for this procedure.1 These refinements in breast augmentation technique have been particularly salient for ensuring optimal use of form-stable breast implants. Form-stable cohesive gel implants are a small subset of implants currently available in the United States, and they are available only through FDA premarket approval (PMA) clinical trials. There has been some confusion regarding what a cohesive gel implant actually is. Although all implant fillers are cohesive in the physical sense (whether saline or gel) the term cohesive gel implant has traditionally implied a form-stable device (e.g., Inamed 410, Mentor Contour Profile Gel [CPG]). Interestingly, even these devices are not truly form stable and exhibit different degrees of stability or cohesiveness in the various subgroups. These differences are cogent, because the benefits of form-stable implants that have been realized are a function of the form stability of the filler. There is also no uniform opinion regarding the number of silicone implant generations that there have been. This is not the focus of this article, however, and in the end it is not truly important what generation an implant is. What is important are the device characteristics that ultimately impact soft tissue dynamics and patient outcomes. Form-stable cohesive gel implants have been used internationally for longer than 10 years and have gained in popularity for aesthetic and reconstructive breast surgery. These implants may be available in the United States as soon as 2007 and will provide patients and surgeons with enhanced results if used properly. However, for most plastic surgeons in the United States there will need to be a transition from the technique used for smooth round saline implants to a more comprehensive approach.