What's your advice regarding teardrop vs round implants to get a natural result for me? (Photos)

Hi rjf04,

Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 

The two main types of implants are silicone and saline. The shell of the implants can be either textured (which reduces capsular contracture) or smooth. A textured implant sometimes requires a larger incision. The shape of the implant can be either round or tear drop shaped (gummy bear). Both have their advantages and disadvantages.

The different types of implant offer different pros and cons. For instance, the pros of silicone implants are that they look and feel more natural and ripple less.

On the other hand, the pros of saline implants are that they do not require as large of an incision as silicone, less expensive, they have less incidence of capsular contracture (scarring around the implant), one can tell immediately if there is a rupture, the size can be slightly adjusted, and they can be used for women less than 22 years of age.

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.

Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.

Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Your breasts are low on the chest wall and asymmetrical.  Simply adding implants will result in low hanging breasts.  You would benefit from a lift more than implants.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

Hello and thank you for your question. You are a great candidate for a breast augmentation using a dual plane technique.  I recommend a smooth round implant.  Teardrop implants can result in malposition due to malrotation of the implant.  The size, profile, and shape of the implant is based on your desired breast size/shape, your chest wall measurements, and soft tissue quality.  There are several advantages and disadvantages to over vs under the muscle.  Under the muscle has the advantage of lower capsular contracture rates, less risk of rippling, and better visualization with future mammograms.  Most patients say that under the muscle also has a more natural look and feel.    This decision should be based on a detailed discussion with equal input from both you and your surgeon.  Make sure you specifically look at before and after pictures of real patients who have had this surgery performed by your surgeon and evaluate their results.   Best wishes and good luck.


Richard G. Reish, M.D. FACS

Harvard-trained plastic surgeon
 

Tear drop/anatomic/shaped implants are a variant of silicone implants. The difference being a form stable gel fill which imparts the anatomic shape. The "gummy bear" gel is the most cohesive/firm available. It is form stable and will hold a shape thus the shaped/gummy bear. Additionally, these devices are textured as orientation is crucial (a tear drop is only a tear drop when oriented appropriately). The texture acts as a sort of velcro holding the implant in position.
In my practice most patients will choose a smooth round device. When placed in the submuscular plane, the aesthetic differences are minimal. The downward pressure by the muscle across the upper pole of the round device forces it to assume a more tear drop appearance. Recent studies have shown that both patients and surgeons have difficulty distinguishing between the 2 implant types post-operatively. Additionally, shaped implants are more costly and have an increased risk of rotation.
Finally, although very rare, the few documented cases of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) have all been in cases of textured devices. Until more data is available many are shifting their practice back to smooth round devices.
Studies have shown most cannot tell the difference between the shaped and round devices when placed submuscular. In light of the added cost (2x), larger incision, and BIA-ALCL risk...most will opt for round devices placed beneath the muscle.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

The choice of implant shape usually depends on the pre-existing shape of the breasts. based on the photo, you already have a good breast shape to start with, and you seem to want to have an upper pole fullness. Round implants may be the best choice as it will give fullness evenly on the upper and lower poles. However, an in person examination would still be needed before the optimal breast implant can be suggested. 

Many thanks for your question. As you have reasonable breast development and body weight,  require significant upper pole filling, and have a nice chest wall shape you will probably be best suited to a round silicone implant. I would generally tend to use a moderate profile implant placed in the dual plane in a case like yours. However you should be fully assessed in clinic by an experienced plastic surgery, be fully measured, and try both round and anatomical sizers in a trial bra of the sizes you’re interested in to be sure.Good luck with your treatment.

The best way to pick implant size is based on your breast and chest width and not the volume. As the implants get bigger, they get wider. When the width of the implant fits the width of your chest, it will look nice and fit your frame. If the implants are too small, you will have a gap between them and they may look too far apart. If they are too wide, they will make you look top heavy as they may be too wide and stick well out past the sides of your chest. There are ways to get a bigger or smaller look. This can be done by picking a different implant profile. The higher the profile, the narrower the base width of the implant. If someone has a very narrow chest and wants to be big, they should consider a higher profile implant. If someone has a broad chest and they do not want to be too big but want to avoid the gap and still have cleavage without projection, they should consider a lower profile implant such as a moderate. There are options in between these such as the moderate plus.  A consultation with a board certified plastic surgeon who takes careful measurements and talks to you about your cup size goals will be able to assist you in your decision. I prefer the underarm incision so there is no scar on the breast. Good luck!
Dr Ennis  Boca Raton Fl

Thank you for the question. I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery, assuming you choose your plastic surgeon carefully and communicate your goals carefully as well. 


These days there are a variety of breast implants available; the variety of breast implant available raise a lot of questions from women considering breast augmentation surgery. Personally, I think that for most patients considering breast augmentation surgery, careful selection of plastic surgeon and careful communication of goals, far outweigh the specific type of breast implant utilized (when it comes to the success of the breast augmentation procedure).


Anatomical breast implants were designed to better simulate the natural breast shape; the problem with these implants is that if they shift or rotate, the entire breast will change shape as well. This change in breast shape may require further surgery to correct. Round implants, on the hand, can shift or rotate without changing the shape of the breasts. Overall, I find that beautiful outcomes can be achieved with the use of round saline or silicone gel breast implants for the vast majority of patients.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with. 

There have been a number of studies showing that there is little to no difference in postop appearance with round vs teardrop implants. Most surgeons in the U.S. use round, most in Europe use teardrop. It is part surgeon preference, and also patient decision in the course of a consultation. Depending on whether you want to correct the nipple height asymmetry, a breast lift may be justified.Sincerely,Thomas C. Wiener, MDHoustonthis information is not a substitute for a consultation with a board certified plastic surgeon