Round vs. Teardrop? (Photo)

Question

I am 38, less than a AA and 106 lbs. I've had two kids that I nurses for a year. I have little breast tissue and what little volume I do have sags. My doctor and I discussed a teardrop shape and I am having second thoughts. I like the upper pole fullness a round implant can provide. I like the natural look a teardrop provides. Surgery is schedule for Thursday. Thoughts?

Jaime S. Schwartz, MD, FACS · Answer

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. You should
choose a board certified plastic surgeon that you trust to help guide you in
this decision.

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

S. Larry Schlesinger, MD, FACS · Answer

The answer to your question is choose your surgeon and not the particulars of the surgery.Every plastic surgeon has his or her own feelings about teardrop vs. round, over or under the muscle, through the armpits vs. through the belly button, etc.  A surgeon's preference indicates his or her comfort zone.  Just like you would not tell a chef how to prepare coq au vin, it's not a good idea to take a surgeon out of their comfort zone.That being said, you stated that you and your surgeon discussed teardrop implants.  This would indicate to me the possibility of this not being the only breast implant shape your surgeon feels comfortable with.  You need to ask for another pre-op consultation asap to discuss your concerns and get to a level of comfort with whatever the final decision is.  Both teardrop and round implants have their pluses and minuses.  At a famous meeting in Dallas back in the '90's, a plastic surgeon put up a whole slew of lateral mammograms showing that round implants placed partially subpectoral appear to be teardrop.  This would indicate round can be teardrop while still maintaining many of the attractive qualifies of a round implant.  As you can see, this is a complex subject and one you must discuss with your plastic surgeon prior to surgery.

Keith Hodge, MD · Answer

You are a young woman with very little breast tissue. If you want more upper breast fullness, I would suggest a smooth, round implant. I think the teardrop implant is a more mature look. You will most likely be happy with either implant. Good luck!

Jed H. Horowitz, MD, FACS · Answer

Your doctor will work with you to choose the
best implant #shape and #implantprofile based on your goals and measurements.In my practice, about 15-20% of the patients
are good candidates for silicone #shapedimplants.The profile is determined by the amount of
projection versus roundness that the patient desires, as well as the size of
the implant and size of her chest. The profiles are usually described as high,
moderate plus and moderate.

Kirk Moore, MD · Answer

The Round Base High Profile implant from Sientra is made for you. Gives more roundness with its high profile, but has a slight slope to the upper pole which can add an element of 'natural' otherwise not achieved with a round implant. Mentor has similar, but slightly oval (wider than tall), and Allergan implants, imo, are too stiff/hard in their shaped versions. Best.

John Michael Thomassen, MD · Answer

You can have a natural look with a smooth round implant placed under the muscle without sacrificing upper pole fullness.

Ram Kalus, MD, FACS · Answer

You have undoubtedly discussed this in some detail with your plastic surgeon, including the advantages of each. Once the optimal implant has been selected based on measurements, and good precise operation has been performed, a very pretty and natural appearing augmentation can be achieved with either implant. The shaped anatomic implants to have a bit more power in achieving more of a lift effect, which can also be achieved with a "dual plane" approach using a round implant, yet the round implants can give a slightly greater degree of upper pole fullness or roundness. It ultimately depends on pricking the properly sized implant, and placing it in the optimal vertical and transverse location beneath your breast. If you have second thoughts, discuss this with your surgeon and consider delaying your surgery until you are feeling confident about the plan. Best of luck to you.

Jerome Edelstein, MD · Answer

Hello, Thank you for your question. Depending on your goals and body type, you may be suited to anatomical implants. Anatomic implants are shaped more like natural breasts and keep their shape regardless of whether you’re lying on your side or back, standing up, or reclining. They’re often recommended for patients with droopier breasts that require a lift — sometimes making a breast lift unnecessary. One of the possible drawbacks related to teardrop implants is rotation. If the implant is positioned inside an internal pocket that is too large, there is a risk that it can begin rotating over time. This will not only make your breasts look misshapen, but can also cause fluid to develop in the cavity (a seroma) that must be surgically corrected and drained.Round silicone cohesive gel implants are typically used because they are softer to the touch and capable of creating creating the look you desire, from very natural appearing proportionate breasts, to very full and high breasts. Since their shape changes depending on your position — flatter when you’re lying down, settling into a more teardrop shape when standing — they also tend to look more natural during movement. There is no risk of rotation and seroma development. This factor makes them a more common choice in breast augmentation. In fact, a study was published where plastic surgeons were shown patients either with round or anatomic implants, and were asked which shape of implant each patient had. The results showed that the plastic surgeons could not tell which patient had which shape of implant!Choosing whether to receive round or anatomically shaped implants is usually a matter of personal goals and physiology. Your board certified Plastic Surgeon should work with you to not only discuss the type of look you hope to achieve following your enhancement treatment but to provide advice based on your anatomy as well. All the best.

Steven L. Ringler, MD, FACS · Answer

Thank you for your question and photos.  Based on your photos, I think your preference for a round implant would be a good choice for you.  Many surgeons don't offer tear-drop implants because of higher complication rates with rotation and displacement of the implant.  Typically in patients who have had a pregnancy and have nursed their babies,are not good candidates for tear-dropped implants because of the skin laxity following nursing, which it sounds like you may have.  I think you'll be very happy with a round implant if done properly.  Computer imaging can be very helpful in terms of final size.  Best of luck to you.

John Zannis, MD · Answer

I suggest a round, smooth, silicone gel implant under the muscle.  This will provide you with upper pole fullness, yet still a natural shape and no worries about the implant being rotated or malpositioned.  Plus, it should be cheaper.  Don't see an indication for the shaped implants in you.

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