Are Anatomical Shaped Implants Worth the Extra Cost?

Question

I am tall (5'8") and lean. I am super flat with very little breast tissue. I have a narrow chest and would really like a more natural look. I have had 5 consults and only 2 out of the 5 even brought up these implants as a choice, but both said that my body type is who these implants are for. It's hard to find before/after pics for comparison since they are new to the US. Could I get a "natural" look without having to pay the extra $1000 or is it worth it for what I'm trying to achieve?

Robert Cohen, MD · Answer

With regards to implants, there is a wide range of quality
and obviously the higher quality of the implant the more expensive implants
cost. I would encourage patients to make their decision based on achieving the
best possible results and not on the cost of the implants, as an extra $1,000.00
when spread out over hopefully 10-20 year lifespan of the implants ends up
being a fairly small amount. Ultimately, patients should really focus on what
is going to get them the best look with the lowest risk of complications. With
regards to the fact that 3 of the 5 surgeons did not even mention anatomical
implants as an option, this is not very surprising to me. Textured anatomical implants
are the most commonly used implants in Europe and in South America. However, in
the US surgeons are slow to catch up to the advance in technology. I have used
every style implant from alternate companies including textured round, textured
anatomical, smooth round, silicone and saline. In some of my patients, I feel
that the textured anatomical implants, in particular Sientra’s classic
anatomical implant gives the best overall results. In a tall, lean, relatively
flat chested patient, a round implant can create a very unnatural appearance.
Likewise, these implants have a higher risk in these patients for migrating, which can require revision surgery. For
somebody with this description, I would certainly be leaning towards a Sientra
classic anatomical implant, which I think would fit nicely. Patient’s have plenty of photos to look at
on-line and my website has many examples of anatomical implants. In general, I
find the look of a classic anatomical from Sientra has a very similar
appearance to a smooth round moderate plus or a Style 15 implant from Mentor or
Allergan. Ultimately, the choice of what style implant can usually be made with
you and your surgeon. However, I would lean toward surgeons who give you a full
array of options rather than those that give you a limited range of
possibilities.

Gary M. Horndeski, MD · Answer

Anatomical implants have been around for many years. The gummy bear implants have been introduced recently in the U.S. and the anatomical are textured. The surface is textured so that they can adhere in a fixed position, not rotate and become malpositioned. If you are super flat and have very little breast tissue then implants in front of the muscle would be easily palpated and feel fake. Implants are best placed retro-pectoral. In the retro-pectoral position, the profile of the implant is irrelevant since the muscle compresses it and determines the projection. I recommend round silicone gel implants since they look and feel more natural, are more stable, less likely to ripple or have complications needing revision. This will give you a natural look and natural feel, which is important in a very thin woman.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Deborah Pan, MD · Answer

Many patients even with thin tissue do fine with moderate round implants placed partially behind the muscle (dual-plane) and thus have no issue with malposition or rotation of the implant.The new shaped implants (Sientra, Mentor and Natrelle) are all firmer than standard round silicone implants which may be objectionable to some women. The important thing is to make sure the shaped implants are placed by a surgeon who has experience with both types.  They are $1000 more expensive, but are not always necessary.  Only a small fraction of women actually need this type of implant, and there are potential risks of implant malposition.  A round implant placed partially behind the muscle will naturally form a tear drop shape and will have no risk of malrotation since the implant is symmetrical in all position if it rotates.  Good luck...

Thomas Fiala, MD, FACS, FRCSC · Answer

You could get a good result from either a conservatively-sized standard implant placed behind the muscle, or a form-stable shaped implant.  Some women feel the shaped implants feel too firm.  There is also the additional risk of implant rotation (2-5%) that is not present in the standard round implant.So, it's not surprising that you are getting these answers.  Both could work, and look good. Surgeon experience with the shaped implant is key, if you decide to go that direction.

Christopher J. Davidson, MD, FACS · Answer

Great question re shaped vs round implants.  There is a small subset of patients for whom the shaped implants provide a better looking result.  I think that they look best in super thin women with minimal native breast tissue.  And also in women undergoing breast reconstruction after a mastectomy.  Best of luck.

Edwin C. Pound, III, MD · Answer

Actually, anatomically-shaped implants have been around for awhile.  Without having examined you, it is hard to tell if this is a worthwhile investment for you or not.  If you have been to five different doctors then it is not hard to believe that you received five different opinions based on each doctor's training and experience.  That is not to say that one is right and one is wrong.  They just each have their own perspective.  Personally, I am not a big fan of the anatomically-shaped implants.  I think I get nice results with the round ones.  There.  Now you have six opinions...

Michael Law, MD · Answer

Biodimensional planning principals will allow your plastic surgeon to help determine the ideal size, shape and position of the breast implant. For some women, shaped, form stable implants can be ideal.Plastic surgeons are typically passing on additional costs to patients and not profiiting from the additional costs.

Darryl J. Blinski, MD · Answer

Are you speaking about the Sientra anatomic implants??? Best to be sure these docs are not just over charging you.

Herluf G. Lund, Jr, MD · Answer

Dear BlondeMama2Three,  First, I would like to apologize for the mixed signals you are getting from both your consults and also this panel. The reason most plastic surgeons are unable to provide a clear perspective regarding the anatomic shaped, cohesive gel implants is due to a lack of experience since use of these devices was until recently tightly limited to plastic surgeons who were part of the studies needed for implant approval.  With time, as more plastic surgeons gain experience, hopefully the answers will be easier to find.That being said, having placed well over 800 cohesive gel implants over the last 10 years, I can tell you they are an excellent choice when used in the right patient and a terrible choice when used in the wrong patient.  In the right patient, a patient who wants the tear drop shape and has breast tissue that is firm enough to work with this implant, a very stable, long lasting result can be obtained.  This is not opinion but fact proven by the very detailed long-term follow up studies required by the FDA-Approval studies.  The implants are firmer than a standard gel implant but they are softer in the body than at room temperature-a feature of the cross-linking of the silicone gel.  In the FDA studies, this was not a significant issue.Ask to speak to patients who have cohesive gel implants and those who have standard gel implants and then you can decide which device is right for you.  Best of luck.

Ramon Robles, MD · Answer

Yes it is worth it to go with the shaped breast implants.They we're designed to give patients a more natural look and you are the perfect candidate.The Sientra shaped implants give you a natural look and are soft, even though the gel is a high strength cohesive gel. The benefit of the gel being highly cohesive is that it maintains its shape better, and if they were to rupture the gel does not bleed or extrude out of the implant.