Are tear drop implants better than smooth round when there is very thin breast tissue, skeletal, and muscular asymmetry? (photo)

I'm 35.2 breast-fed children.5'8" tall.145 lbs. Would like natural looking D-cup. Because sternum on the left side has much more projection, maybe it won't be possible for me to get a symmetrical look? Breast tissue is thin so my PS suggested silicone tear drop textured implants under the muscle (using higher projection and cc on right) he said it would be the best way to get a natural, gradual slope. I know smooth rounds feel softer so I'm nervous about that and the tear shape shifting. Advice?

Doctor Answers 24

The problem isn't the implant.

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 In cases like yours, there is inadequate soft tissue to cover device and there is also breast and chest asymmetry. Too much focus is been placed on what implant is correct. The problem is not implant selection. The problem is soft tissue coverage. 

several years ago, we published the first series and defind a new technique in breast surgery called Composite Breast Augmentation.   this utilizes breast  implants and your body's natural fat, harvested from areas of liposuction and placed over the implants to give you a more natural look. This is the operation you need. When composite is done, there is less dependence on which type of  implant is used, because the natural look will come from the fat not the implant below.You should try to find a surgeon was had a large experience with this operation – someone was performed over 100 of these would be a good place to start.I have attached a link to the paper that we wrote for your review.Best of luck,Dr. Delvecchio

Are Tear Drop Implants Better Than Smooth Round When Breast Tissue is Thin?

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The person who benefits most from a shaped (Tear drop) implant is someone with very little breast tissue. For this type of person the final breast shape is largely determined by the shape of the implant, and a shaped implant will have a much more natural appearance than a round implant which will look like a round ball sitting on your chest. 

On the other hand, you don't appear to be as lacking in breast tissue as you suggest. The tissues in the upper part of your breast may be thin, but if the implant is placed under the muscle then that should not be a problem. Yes, a smooth round implant will be somewhat softer but that is obviously not the only consideration. Shaped implants do not shift if your surgeon knows how to do the operation properly. This is a false concern that is repeatedly raised by surgeons who do not know how, or do not want to take the time, to do the operation properly.

In your situation I think the decision on type of implant should revolve around what sort of breast shape and implant position you would prefer. Your photos suggest that your breast sits lower on your chest wall and thus the distance from your sternal notch to nipple may be somewhat long for your height. If that is the case, then a smooth round implant can look somewhat low and round without the fullness many women desire in the upper chest. There are shaped implants which are taller than they are wide so they actually provide extra fullness higher up your chest wall. So this type of implant is very well suited to the person whose breast is located lower on their chest wall. In general it is true that a shaped implant will create a more gradual and hence more natural slope off the chest wall, however some women prefer the slightly more augmented appearance of a round implant. So there are no completely right or wrong answers here.

In your situation I would be concerned that a smooth round implant would look a little low and unnatural and only the very upper portion of the implant would be covered by the muscle. In this sort of configuration a smooth surface implant will tend to slide out from under the muscle when it is contracted and thus cause the implant to move down and out over time. On the other hand, a shaped implant which has a textured surface so that it adheres to the tissues so as not to rotate, will be more stable and predictable, and more durable over time. So on balance I would say that your PS suggestion of a shaped implant is very reasonable and potentially preferable based on your anatomy.

Autologous fat transfer is certainly another useful technique to deal with issues of thin or inadequate tissue coverage, and it can be a great way to "fine tune" the results of breast augmentation. The problem is that it adds complexity and significant expense to the operation that most women are unwilling incur for a variable degree of improvement. Today we have an extensive array of implant sizes, shapes, and profiles which can be thoughtfully applied to the various breast tissue and chest wall anomalies to achieve aesthetic outcomes in breast augmentation. I find that autologous fat transfer is only needed in the most challenging cases. 

Asymmetric pectus deformity

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I am pleased to read your surgeon has identified the asymmetric pectus deformity you describe. This can be overlooked frequently! I am not a fan of the textured anatomic devices as they can rotate, don't flatten when lying down, and are too firm but some surgeons utilize them often in reconstruction of thin patients. I would probably recommend differential style or sizing with a high fill ratio an Allergan Inspira device as they will feel softer and wil not be at risk of malrotation vs textured anatomic. However there are many ways around the mountain so weigh the pros and cons of each style of implant with your surgeon. Best of luck. 

Tear drop versus smooth round?

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I'm not a fan of using textured tear drop implants in very thin women because if there is any rotation at all, it will be very noticeable. Also, they feel much more firm and when you don't have a lot of tissue coverage, that can be bothersome for some women. I prefer to use round, smooth implants of a moderate plus profile to give my patients a "natural" look. Feel free to discuss your concerns with your PS so you both are on the same page prior to surgery! Good luck!!

Implant plan

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Although there is no definitive right answer for any given situation, I believe your doctors recommendation is an excellent one. Based purely on your photos it seems as if you are a very good candidate for an anatomical shaped implant. This will provide you with an extremely natural result and differential projections will be helpful to try and produce as much symmetry as can be achieved.  (You should know going in that no one can achieve perfect symmetry)  if you are seeking a larger cup size, like a D which you mentioned, while still achieving a natural "slope" up top, anatomical shaped implants are the only real way to achieve this. A round implant, while slightly softer and more mobile overall, will produce a visible step off or "bump" up top which you may find to look unnatural in order to achieve the size you desire. The anatomical implants taper upwards and do not produce this effect as much or at all. There is definitely very small lifetime risk of implant rotation with these and some of that risk has to do with technical aspects of the surgery. Make sure to discus this concern with your surgeon and ask how often he or she has seen this. National rates are less than 1 percent.  Although initially much more firm in feel and less mobile, I have found that the anatomical implants get extremely soft and move enough to produce desired cleavage. Hope this was helpful!  Good luck with your surgery

Brian S. Glatt, MD, FACS
Morristown Plastic Surgeon
5.0 out of 5 stars 59 reviews

Smooth Round

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I would use a smooth round implant for you.  You lack upper pole fullness which needs to be replaced with a round implant.  You may not achieve this effect with a shaped implant.

Best result

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IMO, shaped,textured implants would be best for you. 

I have been using textured implants almost exclusively for 4-5 years and my incidence of rippling is no higher than it was before, and it was negligible then. 

If you are looking for a larger size, though, not sure you will get that with shaped implants, whereas round high profile implants will probably be more likely to achieve a larger size.

On the other hand, it's not realistic to have a 'natural D' with your body will always look augmented with your thin shape, your size and overall body shape.

Best advice is to try on sizes with a bra and t-shirt, tank top, and look in a full length mirror; don't pay any attention to CC size/volume, but go for what YOU like--the look you are going for. After finding that 'look' that you like, look at the size of the implant, add about 10% and use that size, if its appropriate for your breast width---I only let my clients try on implant sizes that are within their breast width, just for that reason.


Kirk Moore, MD
Salt Lake City Plastic Surgeon
4.2 out of 5 stars 46 reviews

Breast Augmentation with tear drop implants

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I appreciate your concern, and physical exam is optimal,but I am not sure you absolutely need tear drop implants, as you do have some breast tissue. The issue with those implants is that they are somewhat firmer, and can rotate out of position, requiring revision. I believe that utilizing moderate to high projection silicone round smooth implants under the muscle will give you a very nice result with reasonable symmetry. Remember it is rare to see perfectly symmetrical breasts. Be sure to consult with a board certified plastic surgeon with lots of experience with breast surgery. Good luck!

Robert M. Tornambe, MD
New York Plastic Surgeon
5.0 out of 5 stars 33 reviews

Implant type

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As you can see from my colleagues answers below, there are many differing opinions. Since you are unsure about the teardrop, I would suggest that get a second opinion from another board certified plastic surgeon in your area and see if the two doctors agree. Best of luck, Dr. Nazarian

Sheila S. Nazarian, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 56 reviews

Size of implant important in getting a natural result.

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I think you are taking more risk with an anatomic implant.  A moderate plus shape implant would work best for you.  You should have a range of sizes estimated prior to the operaiton.  Then the right size of implant should be determined during the operation with the use of sizers.  I do agree that fat grafting to improve upper pole volume would improve overall shape.  This could be done at the same time as the operation or after you see how your breasts look with the breast implants.  I would advise you to get a second opinion by a board certified plastic surgeon.   Good luck!

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.