Cohesive gel implants more prone to rippling?

In a recent study published in the Aesthetic Surgery Journal, Dr. Mark Jewell, a well respected plastic surgeon from Orgeon, reported 6 years worth of data on the use of form-stable “gummy-bear” breast implants. This was part of a clinical trial. (Currently, these implants are still awaiting FDA approval, and are not currently available to the public.)
While overall the patients did well, with outcomes that were generally very good, I was disappointed in the surprisingly high percentage of patients that had post-operative problems with rippling – those undesirable wavy contours where implant folds and wrinkles may show or be felt through breast tissue.
Classically, all other factors being equal, we’ve always thought that the ripple rate for a breast implant is directly related to the thickness (viscosity) of the filler material. Thinner fillers, like saline, ripple more. Thicker fillers, like silicone gel, ripple a lot less often.
Therefore, we all expected the really thick cohesive gel filler to hardly ripple at all. Turns out, at least in this study, that assumption was incorrect.
Here’s the data on ripples:
Mentor round standard gel implant, 3 years — <1%
Allergan round standard gel implant, 3 years — <1%
Mentor round saline implant, 3 years — 20%
Allergan round saline implant, 3 years — 11%
Mentor CPG cohesive gel implant (Jewell study) — 37%
Allergan 410 cohesive gel implant (Jewell study) — 7.6%
The ripple difference was not statistically related to body weight, or use of the subglandular position. It appears to be device-related.
Bottom line: the cohesive “gummy bear” gel implant is not the magic answer to implant ripple problems. This data shows the current gel design significantly outperforms the gummy bear implant in this area.