Having trouble with a Gummy bear anatomical versus smooth round implant decision

The round smooth implants are better and here is why. Dr. Hidalgo proved in a scientific paper in the Plastic and Reconstructive Surgery Journal, March 2017, that a panel of plastic surgeons and lay people could not tell the difference between your choices. The disadvantage of the increased risk of a rare lymphoma from a textured anatomic implant, increased cost, and other issues precluded its use over a round smooth implant in elective cosmetic breast augmentation. You should get a very good result. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee.

Studies have shown that patients with textured implants face a higher risk of a rare form of cancer called breast implant associated anaplastic large cell lymphoma (BIA ALCL). Allergan has ordered the recall of all of its BIOCELL textured breast implants but the risk appears to be very small. You and your board certified PS need to discuss the issues remaining as the textured products clearly linked with BIA-CLCL are off the market.

Thank you for sharing your question. Each surgeon will have their own recommendations but I find it best to currently avoid all textured devices. Hope this helps.

You should not get textured implants because of the association with a rare type of lymphoma. Last I heard they were not being sold anymore.

Dear Trayceecook,
I recommend you have this discussion in person with a plastic surgeon because everyone's breasts are different but generally speaking the shaped gummy bear implants will allow more upper pole breast fullness but can diminish the amount of cleavage. I typically don't recommend these unless you have very small breasts to begin with or have had a mastectomy. I see no advantage to a round form stable implant.
Generally if you want a round implant its best to not go with a form stable implant to allow more natural look and feel. Form stable implants are much more firmer. I carry all sizes and types of implants in my office to allow my patients to get a better sense for their implant choice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I use the smooth round implants in all my patients to give the soft and natural feel to the breasts and natural movement. The gummy bear implants are harder and don't move as much. Textured shaped implants do carry higher risks of tearing away from tissue and causing swelling with fluid, and turning so that the shape is changed. Sometimes they do not turn back, and a surgery is needed to correct it. Smooth round implants can turn and even flip with no problems. When upright, all implants have a teardrop shape, some more than others.

There are advocates of both types of implants. Both may produce a good result in the appropriate patient. The perception of what is a "natural looking breast" is very individual and varies greatly from patient to patient and from doctor to doctor. The claim that the tear drop is more natural is debated by most of the plastic surgeons and in a panel presenting results to plastic surgery breast experts from around the world, they were correct in guessing which was round and which was teardrop shaped in only 50%, which is the same result you would get with a coin toss. So even experienced plastic surgeons couldn’t tell the difference which implant has been used. Most plastic surgeons feel that there are no cosmetic benefits provided by a teardrop (“anatomical”) implant.
Tear drop implants:
• Textured.
• Firmer.
• Can rotate producing a distortion requiring additional surgery.
• Don’t necessarily move as well and may not look as natural when lying down.
• Being a textured implant there is an association with an increased risk of a very rare tumor, ALCL (Anaplastic large-cell lymphoma), that can occur in the fluid and capsule around the implant.
• There is less fullness in the upper pole with a tear drop implant. Many patients use a bra to push the breast up to give that greater fullness superiorly which wouldn’t be achieved with a tear drop.
• In the standing position, the round implant assumes a more tear drop shape because of gravity.
• Shaped implants may produce a better result in some patients who have had breast reconstruction after mastectomies, but not in most breast augmentation patients.
What is more important than the specific type of implant is the experience and artistry of the plastic surgeon.

I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with who has all of the modalities of treatment available. You should discuss your concerns with that surgeon in person.

Breast surgery needs to be individualized. What would be an ideal approach for one patient is not necessarily the same for someone else. Based on the examination and discussion at the consultation, you should have a better understanding of the various options that can achieve the best cosmetic result for you.

Robert Singer, MD FACS

La Jolla, California