In the last few months, two new implants have become available, to our patients’ benefit!  In the United States, we previously had the 5th generation of silicone gel breast implants, available from the mid-1990s onward.  Learn about the history of augmenting breasts with all sorts of foreign material to the 1st through 5th generations of silicone gel breast implant devices.

Our previously available silicone implants were filled approximately 85% full and therefore were subject to mild “rippling” (or “wrinkling”), with folds of the implant being visible through the skin.  This would mostly occur in extremely thin women or in cases of breast reconstruction where the implant was placed on top of the muscle – also known as the “pre-pectoral” position.  Rippling has always been most severe in saline implants, as they flow like water as opposed to silicone, which is a more viscous gel.

Image from a presentation I gave in Atlanta on subglandular breast augmentation. I demonstrate how a smooth round gel implant lies flat when you lie down, but is a teardrop shape when upright. What is most noticeable is mild rippling in the older style implants (85% full).

RIPPLING was the only potential trade-off of placing silicone implants on top of the muscle in thin patients or after mastectomy – until now!  

Dr. Horton’s breast augmentation patient using the previous silicone gel implants that were approximately 85% filled. All of Dr. Horton’s patients have implants placed in the subglandular position. This patient was extremely thin – notice the rippling in her cleavage.

Excitingly, the 85% full silicone gel implants have been replaced with a 96% full implant, with much less rippling.  See these examples photographed in my office today:

Side-by-side comparison of an 85% full silicone gel breast implant with a 96% full implant.

The newer higher-fill implants greatly reduce the incidence of rippling – even in very thin patients where the implant is placed on top of the muscle.

The new implants are 96% filled have less empty folds and consequently less rippling, even in very thin, athletic patients seeking breast augmentation but who do NOT want to look fake (most of my patients).

So – are these new devices the “gummy bear implants”?  Aren’t all silicone implants gummy bears?  Yes and no.  It really is just semantics.

Previously, the breast implant that marketed itself as the “gummy bear implant” was a stiffer, highly cohesive gel implant that had a textured surface.  The texturing promoted in-growth of scar tissue into the implant surface, creating a Velcro-like effect and stiff, non-mobile breasts that were not appreciated by patients or their Plastic Surgeons.

I was trained in Canada, where these implants were available nearly 20 years ago and I can say with experience that I did not like the outcome using these textured cohesive gel implants, mostly because of the texturing.  It does not matter if they are shaped or round.  I have not been a fan of textured, highly cohesive implants because I feel we are “trading softness for structure”.  We should have both!

Additionally, with recent reports of a potential association with BIA-ALCL, I would not recommend a textured breast implant to most patients.  Read my blog post for your education.  If you do have a textured implant, you are fine as long as you are happy with your cosmetic results and you do not develop late swelling with fluid collection around the breast.  In those instances, visit your Plastic Surgeon for an evaluation.  Thankfully, we now have a second higher-fill implant with highly cohesive silicone gel that is a little more expensive but is worth the cost – which is usually covered by insurance companies – since I use this implant for breast reconstruction when the implant is placed on top of the muscle.

There is not an advantage to using this more highly cohesive implant in breast augmentations, as it is costly and the slightly stiffer texture is not beneficial when there is natural breast tissue over top as soft padding.

This new implant (the 7th generation) has the same highly cohesive gel implant as the previous “gummy bears” but it has a SMOOTH shell (“round goes gummy”), which eliminates the Velcro effect and preserves a soft, mobile result without an increased risk of BIA-ALCL.  I reserve its use for breast reconstruction, since the increased stiffness really is most important after mastectomy, since there is loss of all padding over the implant.

My patient underwent a breast revision to the higher-fill, more cohesive silicone gel implants to alleviate rippling and provide the very best cosmetic result.

With these new silicone gel implants:

• 6th generation (96% fill, softer silicone – used for augmentation)
• 7th generation (higher fill, smooth shell, stiffer, more cohesive silicone gel – used for breast reconstruction)

we can continue to offer our patients the very best cosmetic results with implants placed ON TOP OF THE MUSCLE, without rippling!  HOORAY!  I have been using these implants (which have replaced the previously available ones) for several months now, and I am happy to say that they are wonderful!

To learn more about these new implants, please call our office at 415-923-3067 or complete our online consultation request form for an appointment with Dr. Horton today.