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Katie Perry

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Since receiving FDA approval, cohesive gel implants have become a popular option for women who are seeking breast augmentation surgery. Nicknamed “gummy bear” implants due to their relatively stable shape (similar to the famous candy that retains its form when cut in half), cohesive gel implants can create a more predictable silhouette, and one that remains more stable over time, than their saline counterparts. Because a non-form-stable filler like saline will “flow” with gravity, it tends to accumulate at the bottom of a breast implant when the implant is positioned vertically within the breast, leading to a loss of upper pole fullness and potential rippling.

There are many reasons why the replacement of saline implants might become necessary to restore the original results of breast enhancement surgery. In addition to rippling, saline implants can fold, wrinkle, harden, rupture, and/or leak over time. A woman who is experiencing any of these issues, had saline implants surgically placed several years ago, or is simply dissatisfied with the results of a prior breast augmentation surgery, might wonder about the potential pros and cons of having her saline implants replaced with cohesive gel implants.

Advantages of cohesive gel implants

To be clear, both saline implants and cohesive gel implants are safe and sound medical devices. With the right volume and shape appropriate for a patient’s unique anatomy and proper placement by an experienced surgeon, each type of implant can provide a post-operative result that is both beautiful and natural looking. Nevertheless, cohesive gel implants offer key several advantages over saline implants:

• Stability – Because cohesive gel implants maintain their distinct shape and are unaffected by the forces of gravity, they can confer their form onto the visible shape of the breast with lasting results.

• Minimal rippling, folding, and wrinkling – Cohesive gel will not shift within the retaining shell of an implant, so distortions like rippling, folding, and wrinkling are much less likely to occur.

• Low risk of rupture and leakage – Implant shells are most susceptible to breakage along folds, which create areas of weakness. Because cohesive gel does not shift, the likelihood of developing folds that cause ruptures is minimized. Furthermore, in the rare instance that a cohesive gel implant does break, the gel is unlikely to diffuse outside of the breast capsule.

• Reduced risk of hardening, or capsular contracture – Due to the firmness of a cohesive gel implant, surrounding breast tissue is less likely to contract around it. This complication, known as capsular contracture, can occur with saline implants, resulting in a tightening of the breast capsule and the formation of hard scar tissue.

Disadvantages of cohesive gel implants

So, with all of these benefits, why would a woman ever opt for anything other than cohesive gel implants? The reason is that all types of implants, including gummy bear implants, have both advantages and disadvantages. For example, when compared to saline implants, cohesive gel implants can:

• Cost more – While prices will vary, cohesive gel implants are advanced medical devices, which tend to cost more in general.

• Require larger incisions – Because cohesive gel implants are firm and stable, they cannot be squeezed to fit through small incisions or filled after insertion like saline implants can. But, even though the incision might be larger, it can still be relatively hidden, particularly with the inframammary approach.

• Possibly rotate – Teardrop-shaped cohesive gel implants have the potential to distort the appearance of the breast in the unlikely event that an implant rotates. However, the risk of rotation can be minimized during surgery with a careful fitting of the implant within the breast pocket.

Consult with a Board Certified Surgeon

Ultimately, the decision to replace saline implants with cohesive gel implants is best made with the guidance of a trusted surgeon, taking into account a woman’s individual characteristics, body type, and goals. For more information about breast implant exchange surgery, it’s best to schedule a personal consultation with an experienced cosmetic surgeon who is Board Certified by the American Board of Plastic Surgery. An experienced and qualified surgeon can answer questions about the procedure, including its safety, cost, and associated recovery time, and determine whether a patient is a good candidate.

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Katie Perry is an online content editor in the Tampa Bay area. She posts articles about plastic surgery topics and procedures including breast augmentation, breast implants, and more.
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MLA Style Citation:
Perry, Katie "Deciding When to Replace Saline Implants With Cohesive Gel Implants." Deciding When to Replace Saline Implants With Cohesive Gel Implants. 21 Aug. 2014 20 Jun. 2018 <>.
APA Style Citation:
Perry, Katie (2014, August 21). Deciding When to Replace Saline Implants With Cohesive Gel Implants. Retrieved June 20, 2018, from
Chicago Style Citation:
Perry, Katie "Deciding When to Replace Saline Implants With Cohesive Gel Implants." Deciding When to Replace Saline Implants With Cohesive Gel Implants
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