Breast Implant Shapes, Profiles & Textures
Implants come in basically two shapes, round and anatomical. The anatomical implants are also known as teardrop implants. Currently, both saline implants as well as silicone gel implants are available in round and anatomical shapes. The silicone gel implants in an anatomical shape are also known as “Gummy Bear implants” by their resemblance to gummy bear candy if you were to theoretically take a bite out of the implant (but don’t do so – they won’t taste as good as the candy!).
What is the difference between round and teardrop (anatomical) implants?
When choosing breast implants, shape is an important consideration. The two basic breast implant shapes are round and teardrop. Breasts differ greatly from woman to woman, so the ideal breast implant shape for each patient must be determined with care. Let’s discuss the difference in shape, round versus teardrop first. Next I will address profile and surface (smooth versus textured). Afterwards, I will compare round saline, teardrop saline, round silicone and lastly, teardrop saline.
Round Breast Implants. Of the two breast implant shapes, the round breast implant is the most common type used by most plastic surgeons for breast augmentation. Round implants are easier for the surgeon to work with. If a round implant is turned, it is still round. Many women choose round implants because they believe that they tend to provide the greatest amount of lift, fullness, and cleavage. This is in fact, not entirely true. When the implants are overfilled, they may see these characteristics, but there is loss of the naturalness to the overall look of the augmented breast. Some women, however, feel that the results produced with round implants appear artificial, so they seek out more natural-looking alternatives (anatomical or “teardrop” implant). Some women may prefer the "artificial look" and want to look like they have implants - this is the minority of my patients. Due to a round implant’s symmetrical shape, the shape of the breast is not compromised should the implant rotate. If the implant should rotate, the shape is still exactly the same, round.
Teardrop Breast Implants. As the name indicates, a teardrop breast implant, also known as a contoured or anatomical breast implant, is shaped like a teardrop. Breasts attain a more gently sloping contour with teardrop breast implants. Teardrop implants better resemble the natural shape of the breast. There is greater preservation of the contour and fullness of the upper portion of the breast, and less overstretching, also known as "bottoming-out". They require much more care in placement. When inserted, they are often tilted to better follow the natural contour of the breast. The degree of tilt requires more attention if the degree of symmetry is to be optimized. The teardrop-shaped implants often provide greater projection by volume. For women who want more naturally shaped teardrop breasts, these implants may be the ideal choice. Breasts with teardrop shaped implants typically excel in appearance in women who have loss of fullness and stretching secondary to pregnancy and lactation.
Which implant gives the breast a better shape, round or teardrop?
A generally held belief is that round implants give more fullness in the upper pole (part) of the breast. This couldn’t be further from the truth. If one takes a saline round implant, and a saline teardrop shaped implant, and inflate them (outside the body) to the manufacturer’s recommended fill volume, and you hold it in the palm of your hand so that the bottom of the implant is down against your palm (simulating the position the implant will have in the body when a woman stands upright), the round implant will exhibit more collapse at the top than the teardrop shape. This is due to the difference between the biomechanical forces within each implant. The teardrop shape was specifically designed to retain its fullness at the top. So why do so many people believe round implants have more upper breast fullness? The reason that some women think that a round implant gives you more upper pole breast fullness is threefold: an implant larger than desirable for that person’s tissue may have been selected and that person was over augmented, the implant was overfilled making it tense which will retain upper pole fullness at the expense of implant shape as the contours of the beast become distorted and lastly the person’s tissue envelope may have been tight to begin with, which will result in more upper pole fullness than a lax tissue envelope (see the previous discussion about type I vs. type II breast types). If you examine the shape of these breasts out of clothing, they will not look as natural as a breast with a properly filled teardrop implant.
In November, 2006, the FDA granted approval to round silicone gel filled implants, after a 15 year hiatus when these implants were unavailable, pending further study. As of February, 2013, highly cohesive teardrop silicone gel ("Gummy Bear") implants became available in the U.S. for the first time (although they were in use in other countries for about 15 years prior). With regard to round and teardrop SILICONE gel implants, when compared out of the body there is far superior preservation of upper implant fullness in the case of the teardrop implant. When implanted into the breast, there is much more preservation of upper breast fullness with the teardrop "Gummy Bear" implants than with the round silicone gel implants. As of this writing (November 2014), about half of my patients are selecting round silicone gel implants, and the other half selecting "Gummy Bear" implants. It noteworthy to remember that the silicone teardrop "Gummy Bear" implants are filled with a firmer type of silicone gel which is one of the reasons these implants do a much better job of retaining their shape. This is the reason why they are also referred to as “form stable implants”.
It is my opinion, based upon critical review of my own cases, that in the case of both SALINE and SILICONE implants, that teardrop shaped implants give a more natural shape than round implants in the vast majority of cases. If one looks critically at the breast augmentation cases in my photo gallery, I believe that they will come to the same conclusion. It is important to note that in some women, particularly those with an adequate amount of good quality breast tissue to drape over the implant, that the shape of the implant may be less important to the overall aesthetic result.
Smooth vs. Textured
All implants consist of a silicone shell which can either have a smooth surface or a "fuzzy" or textured surface. The textured surface was developed many years ago in an attempt to reduce the rate of capsule contracture.
An implant with a smooth surface can freely move and turn within the breast pocket, but an implant with a textured surface "sticks" to the underside of the breast and muscle and on top of the chest wall (ribs) in a fashion not to dissimilar to Velcro. A textured surface will keep the implant anchored in position so that it cannot rotate. This is of no concern with a round implant. When using a teardrop shaped implant, rotation of the implant will result in an alteration in breast shape.
The two different surfaces give the surgeon some additional choices in optimizing the breast augmentation results. In the case of a patient with better quality breast tissue, with good thickness, a textured implant will attach to the chest wall and the underside of the breast tissue or muscle, and may result in less stress on the lower portion of the breast because all the weight of the implant isn’t sitting on the bottom of the breast. This is somewhat theoretical. In the case of a patient with very thin tissue, a textured surface will attach to the underside of that tissue, and may be more likely to demonstrate visible rippling as when the implant ripples; it pulls the breast tissue in with it, causing a visible ripple in the breast surface.
In the case of teardrop implants, there really is no choice. One needs attachment to the surrounding tissues, or else the implant will rotate within the pocket and the breast shape will constantly change as the implant rotates. This is not an issue with round implants because if they rotate, the shape remains the same. The advantage in choosing a teardrop implant, be it saline or silicone, is a more natural shape and, in especially the case of the silicone teardrop "Gummy Bear" implant, with better preservation of that shape over time as compared to a round implant.
In the photos above, the implant on the left is round and has a smooth surface, the implant on the right is a shaped or teardrop (anatomical implant) and therefore has a textured surface. Shown below are a comparison of four augmentations performed using round smooth saline, anatomic textured saline, round smooth silicone gel implants and anatomic textured silicone gel implants ("Gummy Bear" implants) -all placed under the muscle:
In the case of silicone implants, I think that the coherent nature of silicone gel changes things. Silicone gel implants are less firm than saline implants, so the breast tends to retain its natural shape tendency, rather than have it influenced by the firmness of a saline implant. There are anatomical silicone gel implants called form stable implants, the “Allergan 410″ implants which received FDA approval in February, 2013. The Allergan 410 implants have been in use in other countries for about 15 years prior to their obtaining FDA approval in the United States. The main advantage of these devices is the superior preservation of the shape of the breast over time as compared with all the other types of implants. There is an entire section of this website dedicated to the Allergan 410 implants.
Round implants come in four different variations of shape: low, medium, high and extra-high profile. The higher the profile, the narrower the base width for a given implant volume. A higher profile can enhance the forward projection of the breasts, which would otherwise require larger breast implants with wider bases. However, such devices are associated with greater thinning of the breast tissue, chest wall deformities and creation of uncorrectable deformities. I find that the medium profile implants seem to give the most consistent, natural results.
Round silicone gel filled implants come in four “profiles” as demonstrated below: low, medium, high and extra-high profile. For a given volume of implant, a low profile has a wider base width but less forward projection, a high profile has a narrower base width but a greater forward projection, and a medium profile lies in between the two. Restated another way, “the higher the profile, the narrower the base width for a given implant “volume”. A higher profile can enhance the forward projection of the breasts, which would otherwise require larger breast implants with wider bases. However, such devices are associated with greater thinning of the breast tissue, chest wall deformities and creation of uncorrectable deformities. I find that the medium profile implants seem to give the most consistent, natural results in the majority of women, and the low profile implants work well in women with little breast tissue and very tight soft tissue envelopes.
Natrelle is Allergan’s brand of silicone gel filled implants. The top row is the style number for ordering purposes, the middle row is Allergan’s name for the profile shape, the bottom is my assessment of the profile, probably the easiest way to remember them.
The teardrop 410 “Gummy bear” implants are shown below. As of this writing, November 2014, the implants are available in “full” or “moderate” height and “full” or “moderate projection” yielding a combination of only four “shapes”, shown below:
When selecting an implant profile, one must take into account the tissue envelope. Trying to achieve more forward projection with a high profile implant in a tight tissue envelope will not work because a tight envelope will simply limit the amount of forward projection that you can have and will furthermore probably result in atrophy of breast tissue and possibly even a chest wall deformity (depression in contour). An important point to remember is that probably all breast implants will result in some atrophy of the breast tissue, so it is paramount to choose an implant size and profile to minimize this deleterious effect upon the breast tissue. The solution is to go with a lower profile implant. My personal opinion and recommendation, for the vast majority of cases, use either low or medium profile to avoid damage to the breast tissue in terms of atrophy.