Are anatomical implants a bad choice if you want soft breasts (tubular)?

Question

I am in my early twenties, My breasts are tubular. I'm after a small but nicely shaped natural looking breast. My PS told me I have only 2cm of breast tissue and so would only use anatomical implants on me. I was initially happy with this until I felt one and felt how hard it was. I started to read more and became concerned that I would have hard immovable breasts. Should I get round implants? I don't want beach balls. My surgeon also said I need to go over the muscle to fix my tubular problem?

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. This is difficult t answer accurately without evaluating you in person.  I have used both anatomic and smooth round silicone implants for tuberous breast augmentation.  It depends on your individual anatomy and desired outcome.  The size and profile of the implant is based on your desired
breast size/shape, your chest wall measurements, and soft tissue
quality.  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.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Urmen Desai, MD, MPH, FACS · Answer

Even for Tuberous Breast Deformity, I use a smooth round silicone breast implant. Depending on how much breast tissue you have to cover the implant determines the degree of "softness" and natural feel. I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with and who is a board-certified Plastic Surgeon certified by the American Board of Plastic Surgery.

Best wishes!

Dr. DesaiHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

Best wishes!

Dr. DesaiHarvard Educated, Beverly Hills & Miami Beach Trained, Double-Board Certified Plastic Surgeon

William B. Rosenblatt, MD · Answer

I use round silicone implants and do not like the anatomic ones. The round ones work very well in my hands for tubular breasts. Without a full examination it is impossible to state for sure what is best for you.

Steven Wallach, MD · Answer

In the  majority of patients I prefer to place smooth round implants under the muscle. If you are not sure about anatomics then seek a  second opinion or discuss it with your surgeon. Good luck.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question. It is difficult to answer without pictures, however, in general I find anatomic or shaped implants to be particularly good for patients with Tuberous breasts. I like placing implants under the muscle however to provide llongevity, decreased rate of capsule contracture and a more natural look. In terms of feel, I find Sientra shaped implants to have a particularly soft feel as compared to the other two manufactures very similar to round silicone gel implants.

Ross Farhadieh MD, FRCS, FRACS · Answer

Hi there,An interesting question and one that comes up as a somewhat controversial topic at talks. Here are the facts:1) tuberous breasts are defined by hypoplasia of breast tissue to varying extents with noticeable or unnoticeable Nipple areolar changes2) implant insertion and often breast tissue scoring allows expansion and an aesthetically superior outcome 3) most common area of hypoplasia is the lower pole 4) long term and pretty much all reputable implant studies suggest that smooth implants or soft implants are associated with a higher capsular contracture rates (even tho it is acknowledge that they feel softer and more natural but have higher gel bleed rates)5) anatomical implants by definition are more nuanced and harder to surgically place and are as you said harder (designed so to decrease the capsular contracture rates) and designed to open up the lower poles.So everything else is heresay personal opinion not supported with the weight of evidence. I would suggest for longer lasting results and one that takes the evidence and clinical results into consideration your Plastic Surgeon is giving you the right advice. Good luck

Pedro M. Soler, Jr., MD · Answer

Form stable breast implants, also known as gummy bear breast implants, maintain their shape even after the integrity of the implant’s shell has been compromised. The consistency of the gel inside the implant is thicker than the traditional silicone breast implants. These implants are less likely to rupture and tend to be somewhat firmer than the older silicone implants. Being shaped, they have more projection on the bottom of the implant and tapered towards the top, giving it a tear dropped construct for a more natural contour and youthful feel of the augmented breast. They are designed to resist moving and should not shift , as long as the pocket was created correctly. They are great implants for patients who want a normal appearing breast but with skin that will not stretch easily.The round implants, while softer, will move and shift with your body's position. They also tend to bottom out more with time and can form ripples when the patient bends over.Regardless of the implant you choose it is important to remember that there is no one perfect implant.  Every implant style has its own pros and cons.

Tom J. Pousti, MD · Answer

Thank you for the question. 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, under 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.  In my practice, I generally recommend the use of round silicone gel breast implants placed in the sub muscular (dual plane)  position for almost all patients who present with constricted or tuberous breasts. You will find many examples on the attached link.

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 “very 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 (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with.

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