In defense of shaped implants: The doctors who advise against shaped implants are generally those with no experience using them
There have been a number of answers on this thread touting both the positives and negatives of shaped implants, so most of what can be said about the implants themselves has already been said. I would like to weigh in with just a few general comments to add to the discussion. First, I will only direct my discussion toward breast cosmetic surgery, as that is primarily what I personally do these days, and I think the vast majority of the participants on this website, doctors and patients alike, are oriented that way too. Reconstruction is an entirely different game with different considerations, goals, and limitations. The main benefit to shaped implants in the aesthetic population, and thus the whole reason for their existence in my opinion, is that we can use them to create a full breast shape without the unnatural roundness and projection that accompanies round implants, especially in those ladies with thin tissues and little camouflage for the implants. Thus, many people, myself included, feel that this allows for a more "natural," "non-artificial" look to the breasts. This of course is a subjective judgment, but it has been supported by a number of large series of patients reported by a number of very well-known, internationally reputable plastic surgeons in this country and abroad, all of whom have had vast experience with these implants - over 1000 cases in some series - and it is clear that the currently available shaped implants, when used properly by someone who is properly trained and experienced in their usage, can deliver the advantages that they are supposed to with extremely low incidence of the problems that are often discussed in relation to them, including rotation and rippling. It follows that a doctor who has little or no experience with the implants will not feel comfortable using them, and therefore he or she will advise against them. This doesn't mean that the implants are not good or that they don't deliver the results they're supposed to. Remember, there are large series reported in peer reviewed medical literature by surgeons who actually DO use these implants and DO have experience with them, and they report that they are beneficial in the right patients. So, I would ask you: if you believe in the evidence-based practice of medicine, by which we pay the most attention to scientific data and proper statistics and experience in order to make our decisions about treatments, as opposed to the opinions and biases of people who have little or no actual real world experience, why would we be so quick to judge against these implants in the face of all of the evidence that supports their use? Now, there is a learning curve that comes with using these for sure. There are some subtle differences in planning and technique that a surgeon will have to familiarize him/herself with in order to use these implants successfully. In addition, these implants aren't for every patient either. Like all "tools," there will be some applications for which they aren't the right tool for the job, and a round implant will do better. But for those patients who would do well with a shaped implant, it sure is nice to offer them the option. As someone who does have experience using these implants, and who has many, many happy patients and very, very few problems with shaped implants, I can tell you that the concerns with these implants, including rotation and rippling are often over-exaggerated and do not happen frequently at all. These implants do not just "flip flop" around in a properly made space, and cohesive gel that is used today by and large prevents much of the rippling and other similar concerns that people hypothetically discuss. In any event, my main point is that any surgeon that argues 100 % against using tools and techniques like this that have been proven to be of benefit in large numbers of patients is limiting your options. You would do best to find an experienced board certified plastic surgeon, one who has experience in ALL of the available procedures, to evaluate your breasts in person so that he or she can guide you regarding your selection of implants and have all options available to offer you in order to assure that you will get the best shot at reaching your goals. Good luck.
Anatomical Breast Implants - The New Generation of Shaped Breast Implants Rotation is NOT an issue with these breast implants
For some women form stable, highly cohesive breast implants are an ideal choice. Creating a natural looking result with shaped, form stable implants, or traditional, round breast implants requires expertise and surgical precision. My breast augmentation before and after gallery includes many of these images (link below)
Is implant rotation a problem with the new generation of shaped or tear dropped breast implants? The answer is absolutely and unequivocally no Actually, one of the shaped implant manufacturers’ recently reported a series of almost 1800 patients in which the rotation rate was ZERO. Using careful pre-operative planning and meticulous surgical technique when creating the implant pocket, I've encountered no cases of implant rotation in the years I've been using these devices. Rotation was a problem with the older generation of shaped implants available about 20 years ago. There were other problems as well which led to those implants being taken off the market.
Patients are best served by selecting a plastic surgeons who are interested in, and have an open mind about new technology, but who evaluate all new technology with a critical and scientific eye. Not everything new is necessarily better. But, for some patients, this new generation of shaped, form stable absolutely provide superior outcomes.
The newest shaped or ‘anatomic’ breast implants are completely different medical devices than those that were available twenty years ago. Previous generations of shaped implants were both silicone gel and saline implants, and none of them performed well over the long term.
The older generation of shaped implants came in both saline and silicone gel versions. The saline implants had a high rotation rate and also had a fairly high failure rate. The implants also felt firm and unnatural and fell out of favor pretty rapidly. The silicone gel devices that were briefly available also had a high failure rate. The shell of the implant was fairly thin and the gel could actually bleed through the surface of the implant without the implant failing; and those implants quickly went off the market as well.
The new generation of shaped form stable highly cohesive implants has a number of advantages over the ones that have been previously available. These implants are not only shaped but they are form stable and highly cohesive, so if you cut one of these implants in half you’re holding two halves of a solid device. The implants are available in a wide variety of shapes and sizes and a custom fit can be therefore found for just about any patient. The implants have a much lower failure rate than what’s seen historically and they also have a lower capsular contraction rate and of course that varies by implant manufacturer.
Don’t let concerns about rotation that was the experience with the older generation of breast implants steer you away from the new generation of shaped implants, which does not have that problem. These are great devices, they’re not the perfect breast implant for everyone but if you would benefit from a shaped device don’t worry about rotation. If the implant is placed by a skilled, experienced, board certified plastic surgeon the rotation rate should be close to zero.
Breast implant technology has advanced considerably since the days of the first ‘anatomic’ implants, and the new generation of shaped silicone gel implants has many advantages over the older versions:
1.The new ones are highly cohesive, meaning the gel is in a semi-solid state. Cut one of these implants in half and you’re holding half of a solid implant.
2.The shells are much more durable, producing lower implant failure rates.
3.A wide variety of shapes and sizes are available, meaning a ‘custom fit’ can be found for each patient.
4.The rates of capsular contracture are much lower (varies by manufacturer).
Women seeking a natural look should find a plastic surgeon with experience and expertise creating a natural looking result in women with very limited breast tissue.
The following are a few things that can distinguish some surgeons from others
1) Graduating from a top tier medical school at the top of their class.
2) Membership in Alpha Omega Alpha. This is the medical honors society. Alpha Omega Alpha is to medicine what Phi Beta Kappa is to undergraduate universities
3) Formal surgical training from prestigious medical universities. The minimum number of years of surgical training for plastic surgeons to be board certified is five years. Some physicians have as many as ten years of formal surgical training. There simply is no substitute for stelar academic and practical surgical training.
4) Very experienced surgeons with meticulous surgical technique and natural looking outcomes will have photgraphic evidence of their work. Patients should be able to view many photos of the surgery of interest, photgraphed from three different perspectives all with similar lighting, distance from the camera and cropping
The elite experience extends beyond the surgeon to the facility, and the surgical team. You should be able to see the surgical theater and know who else will be in the OR with you during surgery. The Joint Commission (JCAHO) is an organization that provides certification to hospital OR's. The Joint Commission and AAAASF are two of the organizations that can provide certification to surgical suites. Some plastic surgeons elect to have their surgery centers dually certified.
The anesthesia experience is critical to a safe and comfortable surgical experience. A board certified anesthesiologist can administer general or MAC anesthesia. My preference is to have a board-certified anesthesiologist at the bedside of my patients for the duration of surgery.
Plastic surgeons who cater to high profile individuals who place a high value on privacy will have a private first floor entrance and exit so patients never need to be in a public lobby or elevator for pre-operative or post operative visits.
Tear drop breast implants versus round implants
Both anatomical "tear drop" implants and round implants are considered perfectly acceptable for breast augmentation surgery. Tear drop or anatomical implants can be great in certain patients. However, in general, my preference is to use round implants. This is for several reasons:
1- Round breast implants are softer than anatomic implants when palpated.
2- If a tear-drop implant rotates or migrates over time, the breasts are no longer symmetric. If a round breast implant rotates, there is no change in appearance.
3- Beautiful, natural results are achievable with round implants because they take on a tear-drop shape when a woman is standing.
Tear drop vs round implants for petite built
Since your are a petite girl with a size A cup size, the shape of the implant will certainly be a factor for you. If you are looking to go up to a C cup bra size, then the difference between a shaped implant vs round implant will make a difference on your final shape. The real questions is, what shape do you feel is most appealing. If you are someone who wants to look as natural as possible, the shaped implant is likely the better fit. However, if you like upper breast fullness, then round implants will achieve this for you. I will typically have the patient bring pictures of people's breasts that they find attractive and use these as references. I will also have them look on the website loveyourlook as a resource. I'm often surprised to see how many patients who wanted to look "natural" like the full, rounded appearance of people's breasts that only a round implant can give. Make sure you have a thorough discussion with your plastic surgeon.
Round vs. tear drop implants
Tear drop implants can look better in certain individuals. Round implants can work very well with patients of your size as well. Without examining you and discussing your desires about your breasts, it is very difficult to advise you. I believe that either implant placed correctly by a proficient plastic surgeon can give you great results. Most plastic surgeons believe, including myself, that a round implant will give more fullness in the top half of the breast as the implant is shaped this way. As a tear drop implant is shaped so that there is less volume in the top half of the implant, there will be less fullness. Fullness of the top half of the breast is desired by some but not by other patients.
Tear Drop versus Round Breast Implants
Thank you for your question. The perfect breast implant style selection is largely determined by the patients anatomy at the time of consultation. For some patients, anatomical shaped implants work well but I find in practice that for a majority of women seeking a breast augmentation that smooth, round breast implants work the best. In short, there are pros and cons to both options and having not conducted a physical examination, it is hard to make a true style recommendation. Since you are debating back and forth between tear drop shaped implants and smooth, round implants, I would highly recommend consulting with a board certified plastic surgeon who has experience working with breast implants of all styles. You might also consider bringing some photographs of what "look" you are hoping to achieve from your breast augmentation procedure to your consultation to help guide this discussion. Best of luck!
Round vs. Anatomical Implant
Thank you for your question. Regardless of whether a patient is petite or particularly
large, it is important for the surgeon to make sure a patient’s implant fits
appropriately into each of their bodies and are proportionate and natural. Obviously,
patients have different ideas of what ideal look they want. However, the goals
and the reality of their anatomy must be matched up by an experienced Board
Certified Plastic Surgeon. In general, I prefer textured anatomical implants
for most of my patients as I feel they give the patient the best of both
worlds. They make a natural shape, while at the same time having a more
stable implant with highly cohesive gel and a textured shell which reduces the
risk of capsular contracture and lowest chance of implant migration. I find
that the anatomical implants look great on most of my patients and provide a
natural look with plenty of upper breast fullness. From the side view, a round
implant tends to give a more convex or shelf-like look and that is why I
generally prefer anatomical implants. I use Sientra classic anatomicals as my
most common implant because I believe in the overall soft feel, the best balance
of adherence with the texturing and an excellent shape. Round implants would
not necessarily look bad. However, in a very petite patient the risk is having
excessive upper pole fullness, which can create a matronly or top-heavy look.
What style of implant needs to be discussed with your
plastic surgeon, as in certain cases the higher profile round implant could be
appropriate based on your goals. However, if you are looking for a more natural,
softer look, an anatomical might be an excellent way to go.
One of the potential advantages of "tear drop" or anatomic shaped implants is the potential lessening of an overly full upper "pole" of the breast. This "unnatural" upper fullness may create the "fake" look that may be undesirable. It is a completely personal preference and choice that you shouod discuss at length with your plastic surgeon.
The truth is that a shaped implant is not required to prevent that overly fake look as long as the appropriate size and profile of round implant is chosen and it is place properly, you can still achieve a very natural look.
Round Gummy Bear implants are an excellent choice
As a first-time breast
implant patient, round, textured, highly cohesive gel implants from Sientra
might be the best choice. These "Gummy Bear" implants are the latest technology with the lowest
deflation and contracture risk - as well as best warranty - in the industry. Regarding appearance, in most instances, the round implant can offer an
excellent, natural look if the implant diameter matches are slightly smaller
than the breast width.
Beginning your research on Real Self is a great first step in your decision-making process. Continue to gather information and ask questions. Please be sure to consult with and ultimately select a board-certified plastic surgeon who specializes in breast implant surgery. All the best to you.
Which Implants Should You Choose?
More than 90% of women have smooth round silicone implants. A recent presentation at the plastic surgery society meeting disclosed that 50% of plastic surgeons could
not tell the difference between gummy bear and conventional silicone implants following breast augmentation. One thing is certain: gummy bear implants are harder than round silicone implants. Some women like this better, and some women prefer the softer feel. This is the #1 method I use to help women choose between these two implants. The second involves the desired breast shape: If women want to have an "augmented" look with a high "shelf" to their breast, I advise women that this is more likely to result with the smooth round silicone implants.In my current practice, I use about 3 pair of round implants for every 1 pair of
gummy bear implants.In terms of going with a larger size, make sure your plastic surgeon is board certified and has experience with breast augmentation. Your breast fold may need to be lowered to accommodate implants of your desired size range. If your chest and breast width is narrow, gummy bear implants will likely be too wide for your breasts. You may need to consider ultra high profile breast smooth round silicone implants if you want to go on the larger side (narrow width, but large volume).