Are there more risks associated with the cohesive gels compared with saline?
It would appear that risks associated with saline and cohesive gel implants are very similar. Two
potential reasons for reoperation after breast augmentation are for implant rupture or capsular
contracture. Early studies would suggest that the capsular contracture rate with cohesive gel
implants are equivalent or less than those with saline implants. With respect to rupture, if a saline
implant ruptures it will deflate and require replacement. If a cohesive gel implant were to rupture,
it typically would be confined within the surrounding capsule and because of the cohesive nature
of the gel, immediate replacement would not be necessary.

Saline is measured in ccs, how are gels measured?
Saline implants are measured in ccs which are equivalent to milliliters. Cohesive gel implants are
measured in grams. The conversion rate between grams and ccs are almost equivalent.

The gels are prefilled and inserted, how large is the incision line and what is the best incision site?
Because saline implants are inserted while they are deflated and then filled once they are positioned
under the breast, they can be inserted through a very small incision. Typically, the incision used for
a saline breast augmentation is 3cm long. Common approaches for saline breast augmentation are
in the fold under the breast, around the areola or in the armpit.
Cohesive gel implants are inserted intact, and therefore they require a slightly longer incision.
Typically, the incision needs to be 5cm in length. Because of this, the approach is usually in the
fold under the breast although it can be done around the areola or in conjunction with a mastopexy
(breast lift). Cohesive gel implants cannot be inserted through the armpit.

If placed under the muscles, do the cohesive gels really feel any different than saline?
Whether the implants are placed under the muscle or above the muscle, cohesive gel implants
have a softer and more natural feel than saline implants. They are less likely to produce rippling.
As well, it is common for saline implants to fall to the side when a woman lies in a supine position.
Cohesive gel implants tend to maintain their position nicely giving a more natural appearance in
the supine position.

On average, how much more than saline do the gels cost?
On average, saline breast augmentation will cost between $5000.00 - $6000.00. This includes the
surgery, anaesthesia, facility fees, implants, taxes and follow up care. Cohesive gel implants will
typically cost between $7000.00 - $8000.00.

As the cohesive gel implant is textured, is it less likely to bottom out?
Bottoming out depends on a number of variables including the quality of a person’s skin type,
positioning of an implant, size of an implant and surgical technique. As a general rule however,
textured cohesive gel implants properly selected for a natural and proportionate breast augmentation
will be very resistant to bottoming out.

Are cohesive gel implants likely to last longer than saline?
Because cohesive gel implants have only been used since 1995, there is a lack of very long-term
data looking at the longevity of the implants. Research studies looking at 6, 7, and 8 year follow ups
would suggest reoperation rates equivalent to or less than has been seen with saline implants.
It is important for women to know that any type of breast implant is not a life-time device. Women
should understand that at certain times in their life, an implant may need to be replaced or
repositioned. On average, this will be necessary every 10-15 years.

Please note: The answers in this section are for general information purposes only and do not replace a
consultation with a plastic surgeon.