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

Question

I know in the long run, gummy bear implants would be better for me as they retain their shape due to the highly cohesive gel. And I've read that the anatomical gummy bear have a natural feel even though they're firmer due to the textured shell being "velcroed" to the tissue. However I'm scared of getting a textured implant due to the risk and recall, and am wondering if a smooth round implant won't feel as natural as regular silicone? Should I just go for smooth round silicone instead?

Ted Eisenberg, DO, FACOS, FAACS · Answer

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.

Kenneth Hughes, MD · Answer

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.

Robert Singer, MD · Answer

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

Nelson Castillo, MD · Answer

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.

Ronald J. Edelson, MD · Answer

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.

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

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

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

Answer: Anatomic implants

Answer: Anatomic implants

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Everything you need to know about Breast Implants

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

Answers (7)

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

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

Answer: Anatomic implants

Answer: Anatomic implants

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Recommended reading

Everything you need to know about Breast Implants

Our mission is to create a world where every investment in modern beauty is Worth It.