Over a third of the surgeries I perform utilize breast implants. This includes breast augmentation, breast lifts with augmentation, and breast reconstruction after mastectomy for breast cancer. I most frequently recommend round implants over anatomically shaped breast implants and this will be discussed in the blog.
What I like about a round, smooth wall silicone breast implant is its fluidity … the ability to change shape depending upon gravity. Therefore these implants more closely resemble natural breast tissue. When a woman is upright, more breast tissue is below the level of the nipple. When a woman is lying down, the breast tissue drifts to the outside of the breast. The smooth, round implant mimics this changing breast volume location. Round implants also tend to be softer and since the implant is round, it may spin or turn around under the breast without distorting breast appearance.
Most anatomic breast implants are shaped like a teardrop. To maintain their teardrop form, they are denser than anything other than an adolescent breast. In a mature breast these implants tend to be easily felt because they are firmer than the surrounding breast tissue. They are called form stable implants because they do not change shape. However, the tear drop shape tends to be a problem. This form stable shape may be fine and dandy when the lady is seated or standing. But if they are lying on their back or side, the formed implant fails to adjust and it still looks like a “standing” breast. This is not a very natural or attractive appearance. Also with a tear drop shape, if the implant rotates at all, the fullness intended for the bottom of the breast is now in the armpit or at the top of the breast. Again this is an un-natural, fake, “boob job” appearance. Initially these implants were promoted to increase fullness in the top part of the breast. After surgeons and patients began to realize these implants did not increase upper fullness, the shaped implants are now promoted as expanding the lower part of the breast in direct opposite to what they were designed to do initially.
To hold these anatomically shaped implants in the “standing” position and decrease rotation of the implant, an aggressive texturing of the implant surface is required. The surface of these implants is not smooth but they have a surface resembling very rough sandpaper. This aggressive texturing has been associated with cancer (T-Cell Lymphoma) developing in the scar tissue which forms around the breast implant (see my previous blog November 2014).
These are some of the disadvantages of a tear drop form stable breast implant. Are there any advantages to the textured anatomic shaped breast implants? Because they are firmer, they are less likely to show “implant folds” in a thin patient who has less breast tissue to cover the implant. Plastic surgeons who use them claim they “appear more natural.” But a recent article published in Plastic and Reconstructive Surgery (January 2017) disputes that argument. After 1800 observations, the observers were unable to recognize the type of implant in each patient. Also there was no agreement between the first and second determination made by the same observer on the same patient reviewed at a different time. Their conclusions are that “the results obtained…using anatomically shaped and round prostheses are indistinguishable and do not justify the…use of anatomically shaped implants in the patient.” Also the added cost of the anatomically shaped implant doesn’t seem to be justified.
Our office can answer any additional questions you may have choosing your new implants or any concerns you may have with your present implants.
Thomas J. Francel, M.D.