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

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.

Doctor Answers 11

Breast implant choice

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. 

Scottsdale Plastic Surgeon
5.0 out of 5 stars 12 reviews

Why use teardrop-shaped implants at all? They are NOT "natural" when reclining!

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

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

It depends

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.

Donald W. Kress, MD, FACS
Frederick Plastic Surgeon
4.1 out of 5 stars 12 reviews

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

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

Jaime S. Schwartz, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

Implant selection

First, the good news is that no liquid silicone is still on the market in the U.S. So that means, currently, every FDA approved silicone implant in the US is silicone gel.
Second, the term gummy bear impants is not technical and has no specifications (I am an engineer so I like universal, clearly defined, industry wide specifications). Therefore, it has no useful meaning and just confuses patients. It was coined by a plastic surgeon to differentiate between older generation liquid silicone and the then new gel implants he was trialing. It now is inaccurately used by some to refer to the thickest "form stable" gel, but since that is inaccurate the confusion only deepens.
Now for the complex details: Silicone breast implants can have 1) Varied gel thickness or cross linking of molecules, 2) Round or Anatomic shape, 3) Smooth or textured shell and 4) Variable fill ratio.
Silicone Gel ThicknessAgain all silicone gel implants in the U.S. are cohesive by definition. Then there are highly cohesive (thicker gel) or ultra-highly cohesive “form stable” gel.
Cohesive Gel << Highly Cohesive Gel << Ultra Highly Cohesive Gel
Softer more natural -------------------------->Very Firm and less natural
Higher rippling potential ------------------------> Less Rippling potential
The thicker the gel, the less rippling potential, but the firmer and less natural the breast. So in the case of gel thickness, when most women don’t have to worry about rippling in their textured silicone implants, more is not always better.
Silicone Implant ShapeThen there are round and anatomic shaped implants. Each patient will have their own view on these and it has a lot to do with their age range, demographics and desired result. The vast majority of breast augmentation patients want full round, cleavage and therefore they would be disappointed with an anatomic shape. If you desire a more discreet look of silicone breast forms they may be a consideration, but they only come in thicker gel condemning you to a firm less natural feeling breast, when a lower profile round silicone implant can still give the natural teardrop shape, but more natural feel.
Smooth vs. Textured ShellTextured silicone breast implants were introduced in an attempt to reduce capsular contracture by "disorganizing" the scar. Studies have been mixed about whether this theory is true in patients. Now texture has more to do with trying to keep anatomic devices in the proper orientation! Imagine an upside anatomic teardrop implant. The textured shell itself is thicker and less pliable when manufactured and the devices move less so it can be a firmer and less natural breast implant, many times a negative, but in the case of a lift may be beneficial. Although EXTREMELY rare it bears noting that all cases of ALCL reported have been with textured implants. So because it's, in my opinion, still just a theoretical benefit for the vast majority of primary breast augmentation patients, and may cause problems, I use mostly smooth unless a patient requests the textured or if I am trying to have the texture hold an implant in place on a large lift.
Fill RatioThe Allergan Inspira line and Sientra 106 line is the same gel and shell as the Natrelle line and 105 line respectively (meaning cohesive) but is filled approximately 5-7% more giving a “fuller” look without as much volume as the next style up. It also has less rippling potential, a big positive in extremely thin patients, without as much increase in firmness as thicker gel. My thinner patients are really moving towards the Allergan Inspira and Sientra 106 implants for less rippling and more fullness than mod+, but not quite as much volume as the high profile.
Ultimately, no breast implant manufacturer has proven that their device looks or feels better once implanted despite all the marketing hype. Anytime there are many choices, it is because they all have positives and negatives. The implant manufacturers prey on the unknowing consumer to pick a device with flashy advertising, or the “newer is always better” marketing campaign strategy.
I make specific recommendations to each and every of the 500+ augmentation patients I see annually based on: 1) dimensional planning 2) expressed goals 3) amount and quality of tissue to hide the implant.

Evan Feldman, MD, FACS
Texas Plastic Surgeon
5.0 out of 5 stars 88 reviews

Choosing shaped implants

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. 

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews

Round vs teardrop implants

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.

William Andrade, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

Go on more consultations for breast augmentation


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

Michael J. Brown, MD
Ashburn Plastic Surgeon
4.8 out of 5 stars 33 reviews

Breast Implant Style

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.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

HP round implants

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.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 136 reviews

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.