About Form stability

[breast augmentation Korea]
The two key words that I share while I talk to the patients or write on this blog are “form stability” and “dual plane”.

Form stability of an implant is one of the core concepts in forecasting how the breast augmentation result would be. But, to most patients, this term would be very new to them.


Most of the information on the internet is about how the breast feels after the breast augmentation. The information is rather one dimensional.
The information is one the result such as soft implant, hard implant, implant that spreads easily while lying, and implant that feels natural.

No matter how soft the implant is when you lay it on top of the table but you feel that the breasts sag a lot after the augmentation, would you be happy with the result?

Although you were attracted to the fact that the implant balance shifts downwards and feels natural when lying down, you might suffer from rippling effect. Would you be satisfied with this?



There are some conditions that need to be met when using implants in breast augmentation.

Can we correct and control the shape of the breast as we want?
Will there be no complications or failure in the long term?

These are a few.
There are basic must-haves such as form stability and position stability in order to satisfy these conditions.
Breast augmentation has a lot of variables.
FDA statistics show that 20% of all breast augmentation leads to reconstruction due to dissatisfaction and complications. The reason for this is due to the loss of control.
We can expect any outcome if there are different results or some satisfying or dissatisfying results.

We cannot say that this was a successful surgery.

It may be impossible, but we need to estimate the outcome and control the process to result in a successful surgery. Also, there must be minimum level of complications and no reconstruction in the long term.

Of course, all these factors do not just depend on the implant itself. The surgeon needs to study the body properly, plan out the whole process properly, apply the appropriate plane method / desquamation method, efficiently close the wound with least amount of bleeding when inserting the implant, and conduct post-augmentation check-ups with proper management.

It is correct to say that the surgeon needs to select the implant that matches perfectly with the patient.




Stating which implant is the best or better than others is just a marketing tool.
All implants have their purposes in usage that determine the outcome.
It’s like selecting the right ingredients for a delicious meal.

We cannot use the same hot sauce for a pizza and soup. We need to select the right implant for a particular situation in order to derive the best result possible.
There is no one implant that leads to a successful outcome 100% of the time. The success is made by the surgeon and the implant is just one of the tools used.

One would be able to estimate and control the result with least complication by using a 'good implant'. But there is not just one implant that satisfies all these conditions.
The doctors selects the best implant possible and matches that with the patient’s body in order to achieve that goal.

The implant that we use currently is called a ‘cohesive gel’ implant

The terms such as micro texture, smooth, and macro texture are words that describe the shell of the implant. The substance inside the implant is all cohesive gel.
‘Cohesive’ means well integrated.

Many patients ask how micro textured or silk surface is. But there is no one who asks what cohesive gel is.

Why do the manufacturers use cohesive gel?

They use it because it does not leak out like the water does if there is some damage to the implant.

But more importantly, it is because of ‘form stability’.
The ability to maintain the form makes it easier for us to estimate how the shape would be and also helps us to correct the shape if necessary. Also, it helps to fill the upper block of the breast for a long period of time.

It helps to maintain the shape/form although the implant collapses. We call such characteristic form or shape stability.

But if the gel is formed similar to water, the one dimensional feeling can be good.
The state has to be close to water if you want the implant to feel more soft.

I don’t know if you would remember my writing on how using liquid silicone, illegally, can result in the best outcome possible if there is no complication. The more liquid it becomes, the gel becomes very soft and wavy leading to a very good sense of touch.

But if the implant collapses, the shape disappears as well. Your breasts would end up looking weird.

If you have breasts that need to be corrected such as sagging breasts, such result would be meaningless. You will not be able to change the shape of the breasts properly and the shape of the implant would also change.

You will suffer from complications such as rippling. Upper volume of the breast would not be filled and the gel would all move downwards.

Cohesive gel came into the market in order to be a substitute for such liquid silicone. Gel is sticky and feels a lot stronger than liquid silicone. It is more close to solid than liquid. The difference is from touching a white cream with your hand to touching rubber ball. This is the difference of liquid and solid.

The reason why "cohesive gel" was made by the manufacturers is to avoid any shape related problems due to implant collapse, less filling of the upper volume and others although the patients want the breasts to feel soft.

This is why cohesive gel was born. The cohesive implant is classified by how much cohesive the implant is. The more cohesive the implant is, we call the implant form stable. The less cohesive the implant is, we call the implant less form stable.

The most form stable implant that we use today is Allergan’s Style 410. It is an anatomical implant and is sold the most around the globe.



Form stable implants feel strong and hard. It also maintains the shape the longest and the upper breast do not loose volume as you age. The best part is that you can correct the shape of the breast easily. It is best for those patients with very short distance between the nipple and inframammary fold or the distance between the clavicle and the nipple.

The gel does not leak easily when the implant collapses and the shape is maintained for a very long time. There will not be any rippling of the implant as well.
I will share more on the details in the future but there are critics on Style 410 with the rough texturing that causes double capsuling, seroma, and lymph nodes making the doctors avoid this product.

Then which cohesive gel implant has the least form stability?
It is Mentor/Allergan smooth round type implant.

The gel’s elastomer is very thin and the shell is about 90% filled which means there is more possibility of implant collapse or folding.

The inner density level is very low therefore it feels more like water.
The implant feels very soft and wavy.

Also the implant shifts one sided when you lie down towards one side. This might feel natural to you but if you have less elastic skin or much fat then such outcome would be less welcoming.

Luckily, there are many implants that we can choose from and there are many spectrum that we can choose in between.

Bellagel, EuroSilicone, PolyTech and Cervin have micro textured cohesive gel implants that have just an average level of cohesiveness.

The implants are near to 100% filled.

The implants do not feel like gel but the shell’s elastomer elasticity is high which makes the implants feel somewhat good when you touch them.

Such implants have less texturing so they do not stick properly to the skin wall. So the implants might not be able to maintain their positions inside but move about so such implants cannot be made as anatomical type. (All micro texturing implants are round type)

I have stated previously that in principle, the implant has to match the tissue structure of the breast. It is best to select an implant that matches with the shape of the breast and helps balance the growth of the breast skin.

If you are young and before pregnancy (In the 20’s), have tight skin and somewhat good breast shape and volume, the best solution might be just to make the volume larger and maintain the shape.

If such is the case then the form stability of the implant is not important. You can use any implant that you like. We would recommend smooth, round type or micro textured implant.



If you gave birth, have less elastic skin, and upper volume is less filled then it is important to change the shape of the breast to make the breast look balanced. The implant must not collapse therefore we must use form stable one. Such implant would change the shape of the breast and provide much volume. Most of the form stable implants imported to our country are anatomical types.

We need to choose an implant that matches the patient’s breast characteristics, and the state of the breast skin tissue.

In summary,

If my breast is tight and hard, then I would need soft implant
If my breast is less elastic then I would need tight implant
This would balance out the breasts. Implants are used as a complement to the human body and what we use depends on how our bodies are.

We will share more in the next post. Thank you for reading.
 

KIES-U Plastic surgery Korea
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