“I want my breasts to look natural.”
I hear this all the time from women seeking breast augmentation. They don’t want to look like they have “fake boobs” or look “done.” And so when they come into the office, I have patients who say “I want a tear drop implant, so my augmentation looks more natural.”
This begs the question, do tear drop / anatomic / shaped implants look more like a natural breast than a round implant does? It seems like it should- just the name sounds more natural. But the studies have shown over and over again that there is no shape advantage. (The only exception I think for this may be in mastectomy patients where there is minimal tissue over the implant.)
So do you need a tear drop implant to make a breast implant look like a natural breast? The answer is NO.
Why do we know this? They did a study on us at one of our meetings. It was the Aesthetic National Meeting, and we had a room with thousands of Board Certified Plastic Surgeons who specialize in aesthetic cosmetic breast surgery. We had these little boxes that let us “vote,” and they showed slide after slide of women with breast implants. The question? Are the implants shaped anatomic implants or are they round implants? And we had to vote. What did they find? We, a super educated group of plastic surgeons, were right 50% of the time. That means we couldn’t tell the difference between shaped and round implants. This is not the only study which shows this. They have done other studies, looking at MRI scans of patients with implants, asking if the implants are shaped or round. They could not tell the difference. Then there was another study:
This was a study done by Dr. Hidalgo published in Plastic and Reconstructive Surgery Journal in 2017, “Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation: A Randomized Controlled Trial,” where they had 75 patients who were first time breast augmentation patients. The study? Patients during surgery had two different implants. On one side, they put in a round silicone gel breast implant. On the other side, they put in an anatomical silicone gel implant of similar volume. Intraoperative photos were taken. (The patients didn’t keep two different kinds of implant- after the intraop photo they removed the shaped implant and put in a round implant so the two sides were equal). They they used a survey given to 10 plastic surgeons and 10 lay people.
Findings? No difference was observed between the aesthetics of the two groups. When a difference was perceived, neither group preferred the anatomical side more than the round side. The plastic surgeons thought the anatomical shaped implants were superior in 51% of cases versus round in 49% of cases. The lay people liked the round side better- 53% vs the anatomical shaped implant in 46.7%. Plastic surgeons identified the implant shape correctly in only 26% of cases.
So what does this mean? Per their article, “The study provides high level evidence supporting no aesthetic superiority of anatomical over round implants. Given anatomical breast implants have important and unique disadvantages, a lack of proven aesthetic superiority argues against their continued use in breast augmentation.”
What are my thoughts?
All the photos on my website are round implants, and they look and feel super natural. I have some people who tell me how their friend/significant other/doctor can’t believe they are breast implants. So the theme that round implants always look round and fake is just simply not true. There are differences which can make implants look more natural or more “fake,” like how much natural tissue you have, how the surgeon places the implant, the volume of implant, and what profile of implant. There are different profiles of round implants, and the lower profile or medium profile implants tend to look really natural.
Historically, I have never used shaped implants often. (Since ALCL, Allergan has removed its shaped implant the style 410 from the market.) This is because I agree shaped implants offer little shape advantage, and they have issues:
- Shaped implants don’t move as much, so they feel firmer and don’t have the bounce and natural movement of round implants
- They can rotate, form double capsules, and other issues
- They have textured surfaces and (rarely) are associated with the ALCL cancer. For this reason, the Allergan style 410 Gummy Bear implant was removed from the market.
But I do think there is a role for textured implants in certain cases. Mentor and Sientra still have brands on the market.
- Women with a ribcage which slants downward laterally, causing implant migration.
- Women with super thin tissue coverage (this would include mastectomy patients) or very stretchy tissue
- Women with issues with implant migration previously
The workhorse of breast augmentation surgery is the round silicone gel implant. There is a reason for this. And know round and shaped implants look super similar- if you were in a room with a bunch of naked women you would not be able to tell who has shaped anatomic implants versus round ones. The scientific studies support they look the same.