Breast Implants: Consideration #3: Round v. Tear Drop

Breast implants can be shaped in two common configurations:

• Round (on the left)
• Tear drop (also known as, anatomical) (on the right)

Ideally, a breast itself is shaped like a tear drop...

• Its upper half is full but not protuberant.  The upper profile is straight, not round.
• Its lower half contains the bulk of the breast volume, but is not droopy.  Its profile is round but tight.
• The nipple should point parallel to the floor.  It is located at the peak of the fullness.

If the ideal breast is shaped like a tear drop, why do 96% of Board Certified Plastic Surgeons (including me) prefer round implants?

Is it that we and our patients have grown to prefer Pamela Anderson's "Baywatch breasts," which are...

• round, both in the upper and in the lower halves.
• look more like cantaloupes than tear drops.

I should hope NOT!

We prefer round implants (in the vast majority of patients) because they tend to augment the upper pole proportionately more.  The upper breast is what deflates after pregnancies, breast feeding, and menopause.  Check out Kate Winslet, who has had a couple of kids, and who acted nude in The Reader...

Not that I am pushing breast implants on Ms. Winslet, but using a non-anatomically-shaped implant would restore youthful contours more effectively.

There are at least four other major problems with shaped implants:

1. Bigger incisions:  Placing a tear-drop-shaped implant obviously requires that the upper, less protuberant part is on top, and the lower, fuller half is at the bottom.  To ensure this proper orientation, a surgeon needs a bigger incision.  Mini incisions (just 3-4 centimeters) are usually not possible; 6 cm is more typical.
2. Possibility of rotation:  If a round implant rotates around, so what?  It's round.  If a shaped implant rotates, trouble.  The protuberant part might not be at the bottom of the breast.  The resultant breast could look bizarre.  But you're thinking, "If my surgeon is good, this won't happen."  Well, that's usually true, but no guarantee.  Rotation can happen to even the most compliant patient with the best surgeon.
3. Shaped implants are always textured:  Because of the risk of rotation, the manufacturers have textured the implants, so that the tissue sticks to the implants better.  Thus, texturing does minimize rotation.  Unfortunately, texturing leads to more rippling relative to smooth surfaces.  (I will discuss the smooth v. texture issue in a few days.)
4. Shaped silicone implants are not available in the USA:  Currently, the FDA has approved tear-drop-shaped saline implants, as well as round saline and round silicone.  Tear-drop silicone implants are not available.  If you agree that silicone are superior in most cases (as I did a few days ago), then you must use round.