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Cohesive silicone gel breast implants are composed of a textured silicone elastomer shell and are filled with cohesive silicone gel. Cohesive gel is formed by increasing the number of cross-links between gel molecules, which results in an implant that has better retention of shape and is less likely to fold or collapse, especially in the upper pole.The initial 150 consecutive patients who received cohesive gel breast implants by the senior author (Brown) were included in the study. A retrospective chart review was carried out to analyze patient demographics, diagnosis, indication for cohesive gel selection, procedure performed, implant selected, and complications. All implants were manufactured by Inamed Aesthetics and were either style 410, CML, or CMH.One woman underwent unilateral augmentation for breast asymmetry and 117 women underwent bilateral breast augmentation. Of the 235 implants used, all were model 410 anatomical implants, with the majority being MM, MF, FM, or FF styles. Complications occurred in four of 118 patients (3.4 percent). There was one immediate postoperative hematoma, two cases of unilateral Baker II contracture, and one case of asymmetry related to excessive lowering of an inframammary fold. There were no cases of rotation, malposition, infection, rippling, or loss of implant integrity. Thirty-two women underwent breast reconstruction with cohesive gel implants. A total of 50 implants were used in the 32 patients (27 style 410, 19 style CML, and four style CMH). Complications occurred in six of 32 patients (18.8 percent), although five of the six were minor and only one of 32 patients (3.1 percent) required a secondary procedure. There were two seromas, three capsular contractures, and one implant exposure following a skin-sparing mastectomy.Cohesive gel implants have the potential for providing a natural breast shape, minimizing the risk of postoperative rippling, and providing a greater degree of safety should the implant lose its integrity. The wide variety of implant shapes and sizes allows for great flexibility in reconstructive surgery, in cases of breast asymmetry, and in primary breast augmentation. Results in our initial 150 patients have been excellent, with a high degree of patient satisfaction, excellent aesthetic outcomes, and very few implant-related complications. Cohesive gel implants are likely to play an important role in aesthetic and reconstructive breast surgery when silicone gel implants are reintroduced into the North American market.