Very Asymmetric, Tubular Breasts. What's the Chance of My Implants Rotating?

I have extremely asymmetric breasts. One is a mildly tubular A cup, the other a soft and saggy C cup which slightly points downwards. I'm thinking of having a breast lift on the C cup and breast augmentation on the A cup. I really want a natural look so I would like to have a tear drop shaped implant because I'm not too convinced that a round one can look natural. I know the tear drop or anatomical implant has a tendency of rotating. Is it more or less likely to rotate with tubular breasts?

Doctor Answers 11

Implants rotating

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I would suggest that you have an implant placed on both sides. So called anatomic implants can rotate, though the textured Sientra implant is less likely. Round implants become "anatomic" when you are standing or sitting up without fear of malrotation. You should expect a good result from an experienced board certified plastic surgeon. Note that it usually takes a month or two before the final result is apparent.

Asymmetrical breasts are best treated with implants and a lift on both sides.

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First of all, if you have very asymmetrical breasts (and a tuberous breast), you are best advised to have implants and a lift on both sides.  Otherwise your larger breast will not have the nice upper pole convexity that your small breast will have after an implant is inserted.  So we use a large implant on your smaller side and a small one on your C cup side.  Next, you need a vertical lift on both sides, with removal of much more tissue on your saggy side and correction of the excess periareolar breast tissue on your tuberous breast side.   I almost never perform a breast lift on just one side because it is impossible to mimic a natural areolar border.  Plus you need the vertical lift for your tuberous breast anyway (to correct the areolar fullness).  But don't take my word for it.  On my website I have some examples of asymmetrical breasts treated using this approach (Check patient R.Z.).  The least important consideration is whether your implant is round or shaped.  Stick with round.  There is no advantage in shaped implants and your concern about rotation is valid.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 62 reviews

Very Asymmetric, Tubular Breasts. What's the Chance of My Implants Rotating?

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Having fixed a considerable number of malrotated anatomic implants from the previous generation (before the early 190ies), and hearing that the problems are coming back, I am not excited about their use when there is no real advantage to them. 

Except for a small number of patients in trials, almost all implants used in the past 20 years are round, and most have excellent results.  Best bet will be an in person consultation.

When you are ready for an in person consultation, RealSelf has listings of surgeons in your area. You should consider cross referencing the listings from the The American Society of Plastic Surgeons (plasticsurgery dot org). A listing in the ASPS website assures you that your surgeon is not only board certified,  but also is a member in good standing of the major plastic surgery organization in the U. S. Thank you for your question, best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Tubular breast correction

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Dear JoJo,

Your plan for your correction of asymmetric tubular breast deformity sounds very plausible.  There is one flaw in your reasoning.  Round implants have been the only shape implants available in this country for the last decade at least until the Sientra anatomic implant FDA approval this past year.  There are many tens of thousands of women with round implants that look VERY natural.  Good luck!

Teardrop shaped implants and rotation

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Dear jojo1313,  Having placed over 700 anatomic teardrop shaped implants, the rotation issue is way overblown, particularly by those who had little experience with them.  The newer generation teardrop implants if properly placed with precise pocket creation and hemostasis have very low roation rates and provide excellent long-term results.  These implants also work well in tuberous breast deformities but as with all devices, the device only works as well as the surgeon placing it and the technique used.  There must be something right about these devices if the Europeans who had access to them for years use so many of them.  Do your homework.  Find a good plastic surgeon who has experience with all the different types of implants and find the right choice for you.  Hope this helps.

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Anatomic Breast Implants

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I am a big fan of "Anatomic" Breast Implants. However, you have to use the right implant. It has to be soft enough to shift with your position changes, including reclining, and it has to have a very good texturing so that it is incorporated into the body and does not rotate. There is one new anatomic implant available, but I have no experience with it yet. Presently I am using round silicone implants and getting very natural breasts. With the right implant, the fact your breast is tuberous should make no difference.


Robert T. Buchanan, MD
Highlands Plastic Surgeon

Tubular breasts and tear drop shaped implants

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I am not a big fan of tear drop shaped implants because they can flip. I prefer round implants for that reason.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Tear drop does not mean natural

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Hi there,


Naturalness of your final result is the consequence of a number of factors.  Probably the least important is whether the implant is round or tear drop.  Personally, I think the teardrop implants often lead to an unnatural appearance in certain positions, and the rotational problem is a real one.  

There are certainly indications for a teardrop implant, but they are fewer than you'd think. 

What is a breast?  It is a symmetric, saucer shaped, round structure plus gravity!

All the best.

Anatomical shaped breast implants

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In order to avoid the rotation of the tear drop shaped breast implants the original pocket of the breast implant needs to be precise and not large pocket as used when using smooth round implants. The form stable anatomical shaped implants are not for everyone but have a specific place for patients that want minimal fullness at the upper portion of the breast. Around the world these implants have been used for an extended period of time and only recently approved in the US for Sientra and Allergan. Speak to your surgeon about the positive and negetive aspects of the different implants.

Good luck

Round Implants or Anatomic Implants and Lift for Tubular Breasts

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   The round implants are preferred by most plastic surgeons as there is a rotational problem with anatomic.  The lift is reasonable for the other side.  Matching two breasts is an art.  Find the plastic surgeon with ELITE credentials who performs hundreds of breast augmentations and breast lifts each year.  Kenneth Hughes, MD Los Angeles, CA

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.