I'm not sure whether to have round based or oval based teardrop implants.

Question

I have been to two plastic surgeons who have both suggested teardrop implants for me. One suggested I should have round base, 315cc, 11.3; the other suggested oval base, 265cc, 11.4 (w), 9.4 (h). I am 160cm tall, 50kgs. I have a somewhat bony, very flat, chest and I want to look as natural as possible. Can someone please let me know what they believe would look best. Thank you.

Richard H. Tholen, MD, FACS · Answer

Breast implants come in round or
teardrop ("anatomic") shapes, and the "teardrop" implants can have numerous configurations, base dimensions, profiles, and can be silicone or saline. While some plastic surgeons prefer the
teardrop-shaped implants in some situations, smooth round implants are
generally the softest, most natural in appearance (upright and lying down),
least likely to be felt externally, and (for saline implants) least likely to
leak. They also cost less than teardrop-shaped textured implants.

Textured surface implants have a
thicker shell, are more likely to be felt externally, and have a somewhat
higher leak rate (saline implants) because of the thinner or weaker areas in
the tiny peaks and valleys of the shell surface. Since teardrop-shaped implants
must have proper positioning and must stay in that position (sloped part up,
rounded part down) to take advantage of their innate shape, by necessity they
are textured so that the body's tissues can adhere to and maintain the proper
position of the implants. (Upside-down teardrop implants really would look
weird.) Even less major malposition asymmetries are “stuck” and remain a bit
“off” in appearance. This adherence also makes initial positioning
critical—textured implants do not settle or drop over time. Post-op tissue
swelling and tightness diminish, giving a softer feel, but position (by
definition) is determined by the initial placement and adherence.

Teardrop, “anatomic,” or
“gummy-bear” implants cannot and do not move very much at all as the patient changes
from a standing to a reclining position. Teardrop implants remain
teardrop-shaped when the patient is lying down, whereas the natural breast
flattens out and assumes a round appearance.  Teardrop, “anatomic,” or
“gummy-bear” implants are also more costly than round smooth implants. The
smooth round implant does just what a natural breast does: it is
teardrop-shaped when the patient is upright, and flattens and drops slightly to
the side when the patient reclines. Thus, the round implant is actually more
anatomically realistic than the teardrop, “gummy-bear,” or so-called “anatomic
implant.”

Some implant manufacturers and
plastic surgeons have suggested that the “anatomic” or teardrop-shaped breast
implant has a more natural look than a round implant, and much advertising and
marketing has been used to promote “anatomic” implants to the public. These
implants are perfectly good devices, but are more expensive than smooth, round
implants, and whether or not they are truly more "anatomic" is
questionable.

A recent study compared actual
women with smooth, round implants to women with textured, teardrop-shaped
implants. Mammograms were performed in upright and supine (lying-down)
positions, and digital tracings computerized and compared. Both the round and
teardrop-shaped implants had a sloped, teardrop shape when the women were
upright. In fact, in upright patients, teardrop and round implants were
indistinguishable on X-ray. But when a woman is lying down, the natural
non-augmented breast flattens, drops to the side of the chest, and assumes a
round shape, as does the round smooth implant. The teardrop-shaped implant
stays teardrop-shaped in the lying-down position, which makes this unusual
appearance actually less anatomic than the round implant!You would be best to consider extra-fill cohesive silicone gel implants (like the Allergan Natrelle Inspira, or Sientra style 106) to reduce visible rippling since you are so thin and bony, but going with teardrop-shaped implants will require absolute position perfection at the time of surgery, since they do not drop, and if they are "off," they stay that way. Plus, they require larger incisions, cost more, do not flatten and drop to the sides slightly like natural breasts do (you DID want "as natural as possible" did you not?), oh, and did I say they cost more?Which of those do you really like? The higher cost must make them "better," right?I think you should obtain another couple of consultations and consider other (perhaps better) options. IMHO, of course! Best wishes! Dr. Tholen

Gary Lawton, MD, FACS · Answer

HP round implants, which are a more modern shape than moderate
profile implants, fit most women better.  They have a more appropriate
base diameter and can be made to look very natural or very augmented, depending
on where in the range the implants are filled to achieve a particular volume.
 High profile implants are the first choice in my opinion.  I rarely
find an indication to use moderate or moderate plus implants.  The
subtlety in the final outcome is not achieved by which profile implant is used,
it is determined by the skill in the creation of the pocket, the choice of
volume, and where in the range the implant is filled.

William Andrade, MD · Answer

Hello, as you have found from your consultations, different surgeons will have a unique approach to breast augmentation.  Sight unseen it is not possible to provide specific advice to you, but in my practice for most slim patients with a flat chest I prefer to use round implants.  The majority are very pleased with the outcome.

Jaime S. Schwartz, MD, FACS · Answer

I appreciate your question.

The size of implant best for you is dictated by your
chest wall measurements.  Once we determine that we can choose the profile
based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant
should be equal to or, more ideally, smaller than the width of your breast. The
breast width is a measurement of how wide your breast is at the base, which
should be measured at the level of the nipple. Choosing an implant that is
smaller in diameter than your breast width will avoid the "side
breast" fullness that is often associated with a more artificial
appearance.  Other than that, you should choose the implant based on
volume, not on the dimensions of the implant.

Silicone will give you a fullness at the
top (upper pole fullness).

Silicone implants come pre-filled with a
silicone gel and are the softest implant available. They feel more natural,
which makes them a good option for women with less natural breast tissue; but
they require a larger incision. It may be more difficult to realize if this
type of implant has ruptured, so it is important to monitor them with annual
follow-up visits. Additionally, because this implant contains a more liquid silicone
(less cross-linked), if this implant should rupture, it will leak only into the
scar capsule formed around the implant but may cause some discomfort or implant
distortion.

Anatomic gummy bear implants might be a
good choice to give you volume.

These highly-sought-after, anatomic
implants offer a look that more closely resembles the natural silhouette of a
breast, and, therefore, are a very attractive option for individuals seeking a
natural-looking, aesthetic primary breast augmentation. Additionally, these
implants are an especially excellent option for patients undergoing restorative
or corrective breast surgery because they provide more stability, shape, and
reduced incidence of capsular contracture. Compared to other types of silicone
gel implants, the silicone in the cohesive gel implant is more cross-linked;
therefore, should the implant shell “rupture,” it maintains its shape and
silicone does not leak.

During your breast augmentation
consultation, you should feel the different types of implants available, and
try on various implant sizers in front of a mirror to help you to get an idea
of how you will look following the surgery. You should also bring pictures of
the look you would like to achieve, as well as a favorite top to wear when
trying on implant sizers.

The best way to assess and give true
advice would be an in-person exam.

Please see a board-certified plastic
surgeon that specializes in aesthetic and restorative breast surgery.

best of luck!

Dr Schwartz

Jed H. Horowitz, MD, FACS · Answer

This question is difficult to answer without pictures or an examination. There is not much difference between the two implants that you have outlined in terms of base width so  you will not notice much appreciable difference between the two. I would follow your surgeon's recommend about what implant is best for you based on examination. #PlasticSurgery #BreastAug #Breastimplants #choosingimplants

Cheri A. Ong, MD, FACS · Answer

Making an implant decision takes many things into consideration including chest wall , amount of breast tissue and your current breast shape. Sometimes the differences are small in placing a round or tear drop anatomic implant. Sometimes, placing a anatomic implant can help create better outcomes based on your physical exam. There are also other reasons if you are comparing the different type of gel implants, cohesiveness or saline in terms of longevity and safety profile. If you have visited with two board certified plastic surgeons and they both recommend  tear drop anatomical implant, maybe that the better choice for you. Would not hurt to ask them why they would recommend that instead of  a round based implant so you understand.

Michael J. Brown, MD · Answer

Hi,

Thanks for posting your question. I am happy to try and help you. It is
important to remember that a board certified plastic surgeon will be your best resource
when it comes to an accurate assessment of your situation, and concerns.

Having said that, there is really no way to accurately predict what size you
would like without an examination. During your examination and consultation,
you should try on some sample sizes and see what you are comfortable with. This
is an accurate approximation of what you would get. If in doubt, go up one size
from the one you like. Then the PS can help explain with the size and current
condition of your breasts the effects of those sized implants will have on you.

If you have accomplished this step, then trust your plastic surgeons advice as
to what would be the best size for you. They have the experience. If you are
uncomfortable, go on another consultation.

Best wishes,

Dr. Michael J. Brown 
Northern Virginia Plastic Surgeon

Donald W. Kress, MD, FACS · Answer

First of all, if you're not talking about cohesive gel implants the difference is meaningless. With the cohesive implants the shape of the implant can make a dramatic difference. Nationally only about 15% of implants used are tear drop. In my practice I base the round vs tear drop decision on the amount and quality of the chest muscles (pectoralis). With normal or strong muscles, the tear drop implant can emphasize the muscle and be less feminine. With minimal chest muscles the tear drop can give a very attractive upper pole to the breast which would otherwise be too round.

Ronald V. DeMars, MD (Retired) · Answer

Unfortunately no one on this site is going to be able to answer your question without an exam and seeing photos of what your goal look is. But the difference between the two implants you mentioned is quite minimal. I doubt you could tell the difference.

Marc J. Salzman, MD, FACS (retired) · Answer

I would find it most difficult to recommend which of these two implants replace without seeing you personally. I usually recommend an oval base implant when there is a wide space between the breasts. The taller implants such as the round base have been useful in my practice for patients who have a little bit of droopiness of the nipple. I would suggest, trying to find a plastic surgeon with a Vectra 3-D imaging software platform that can show you the subtle differences on an image of you. Good luck.

I'm not sure whether to have round based or oval based teardrop implants.

Answers (10)