Highly cohesive Sientra vs regular silicone. What's the pros and cons?

The primary reason to choose a highly cohesive form stable round implant is to achieve upper pole fullness.

All of your questions are excellent and I'm pleased to see that you are doing your research.  The more highly cohesive or "gummy bear" implant is definitely more firm, but ultimately once implanted, usually doesn't have a  great difference in feel.  Sientra has just introduced a line of round implants with the more firmly adhesive gel (their 107 line) with the thought that the implant can help to reshape the breast in a similar manner as the shaped implant. The shaped gummy bear implants are always textured to prevent rotation of the implant while the round implants can either be smooth or textured.  There is some thought that the texturing of the implants decreases the risk slightly of developing hard scar tissue around the implant (capsular contracture), especially if the implant is placed under the breast tissue (over the muscle) rather than under the muscle.  Feeling the implants in person in a plastic surgeon's office may be helpful for you as well.  Best of luck and kudos for your thorough research!

Thanks for the question. The more highly cohesive silicone in implants like the Sientra HSC implants has a consistency more like a "gummy bear," compared to other silicone implants that have a bit more fluid consistency. In terms of "issues," both implant types have undergone an extensive amount of testing and clinical trials, and complication rates between the two types do not vary significantly. It really comes down to a matter of personal preference. I'd encourage you to have a consult with a board-certified plastic surgeon who can show you the implant types. Actually feeling and seeing them will really help you to understand the differences.Textured implants have a textured outer shell that is designed to discourage implant rotation. This is really only a concern for shaped implants, where you would not want the implant, which has a teardrop shape to simulate an actual breast, to rotate within the breast pocket.

As I've said in other posts, you're picking the person who cuts your hair based on the brand, shape, length, and color of comb that they use.  It ALWAYS most important to pick your surgeon first.  That way, you two can have a candid conversation about all of these considerations.  He or she will detail exactly which implant they suggest for you and why.Texturing is great if you don't want your implant to move (either it is a gummy bear shaped implant or you have a very sloped rib cage).  Otherwise, the texturing is probably not of much benefit and it could put you a risk for some other problems that we've recently discovered.Although I'll make a quick, generic comment about HSC, and HSC+ silicone, none of this matters in your case without an examination and a careful dedicated determination as to your anatomy, personal goals, and realistic limitations in what can be achieved.HSC+ silicone gel is the most cohesive silicone gel available in a round implant. Yes it is firmer, but slightly so.  As an aside, I've never had a patient tell me that they don't like firm feeling breasts.  "Hard" breasts - NO!  But nearly everyone equates "firm" breasts with youthful breasts.  So don't be discouraged by comments that they're firmer.The HSC+ gel in the round implant will likely prove to be the least rippled of all the round implants.  This will likely consequently lead to the lowest risk of rupture.  Furthermore, we have good evidence already that the risk of contracture will be at an all time low.Now, get out there and meet with a caring and trusted plastic surgeon who will take the time to tell you what they suggest in your specific situation.Best of luck.

Smooth round 'regular' gel implants are recommended in the majority of cases as the gel is still cohesive and stays in a blob rather than leaking like a fluid.  If you wanted super fake,  you could get the newest generation of smooth round implants the the HCG.  If you wanted above the muscle, then I would recommend the textured shaped HCG implants to help with diminishing risks for contractures and preserving a longer term result at the expense of the breast not being as 'natural' as it will be firmed and the implant won't move.  I personally do not see any role (and there will be some who disagree with me) for round textured implants.

Thank you for your questions. Ultra highly cohesive silicone gel breast implants are used mainly in tear dropped breast implants. These are shaped implants there is more projection on the lower part of the implant and less fullness on the top. In order to maintain this shape the implants need to be a highly cohesive gel, this gives a firmer feel to the implant. The reason the implant is textured is to minimize the implant from rotating around in the breast. I hope this is healpful and answers all your questions.

Thank you for the question. All currently FDA approved silicone gel breast implants are “cohesive”. This “cohesiveness” makes it so that the silicone material is less likely to leak, if/when there is a failure of the surrounding shell.The “gummy bear” silicone material is a more dense material chemically. The term “gummy bear” has been used, almost as a slang term, to encompass all silicone gel breast implants; thus the confusion. None of the types of breast implants you mention are necessarily “better”; there are pros/cons associated with each type of implant.Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant type/size/profile selection) is:

1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "small D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.

I hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

All silicone implants in the U.S. are cohesive.  these devises are highlly controlled by the FDA.  Highly cohesive implants are fifth generation gels.  The advantage of fifth generation gels plays out in their rupture and contracture rates.  Highly cohesive gels are also used in form stable shaped implants...a mainstay of breast reconstruction.  Sientra gels have higher fill ratios then other gels, and this may reduce rippling and improve implant to breast interface.  That means it's harder to tell where you stop and the implant starts.  I use fifth generation gels all the time, and I am a big fan.  Recently, I have ceased even offering my augmentation patients fourth generation gels. Texturing has a long and interesting history.  Some surgeons think that it may decrease contracture rates.  Others think it may contribute to implant visibility and rippling as the implant is integrated into the pocket.  Form stable implants must be textured to prevent rotation, and the creation of an "implant caused" deformity.  The jury is still out on the use of texture in augmentation.  It may have value in the correction of implant malposition.

Doing your research is wise but at a certain point you need to discuss options with your chosen plastic surgeon and choose whether to trust his recommendation based on what you hear and see during your consultation.  Like many others, I favor partial subpectoral placement of smooth round cohesive gel implants after gaining some experience with "anatomic" and textured implant.  I have seen both good and bad results with all types of implants so the choice of implant is probably less critical than the choice of surgeon.  Be certain to see before and after photos that match your size goals and of course it's essential that you also have realistic and reasonable expectations as to what your doctor can accomplish.  Also, I'd strongly suggest that you prepare for your surgery and the post surgery recovery period in advance (ie, avoid blood thinners presurgery, avoid excess upper arm use post surgery while healing) to reduce the risk of complications and give yourself the best chance for a soft and natural result.  Good luck with your endeavor and enjoy your results.