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

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

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.