Gel implants can be separated into round shaped implants and teardrop shaped implants. Round implants can be covered with a smooth sheet of solid silicone shell, or a rough-surfaced “textured” solid silicone shell. Initially, textured implants were developed to reduce the tendency towards scar tissue tightening around breast implants. The rough-surfaced texturing, however, has only been shown to help reduce this risk when the implants are placed above the muscle. In patients who have implants placed below the muscle, there is no known significant benefit to texture surfaced round implants. Round implants have the distinct advantage that they are symmetrical and, therefore, if they turn or rotate, your breast will remain normal in appearance. In most cases, I recommend that routine breast augmentation be performed with smooth, round implants placed below the muscle. This is what I recommend whether the implants are silicone gel-filled or saline-filled.
There are teardrop or “anatomically” shaped implants available now. These implants are filled with a particular type of silicone gel that holds its shape and, therefore, by its nature, is somewhat stiffer than round implants. This highly cohesive gel is thicker in quality than the slightly less cohesive gel in round implants. Because it is stiffer, it holds its shape, but it does provide a somewhat firmer-resulting breast when used for breast augmentation. Teardrop/anatomically-shaped implants do provide the fullness that is desired in breast augmentation, but do not provide as much fullness in the upper part of the breast since they are, after all, by definition “teardrop-shaped”. This teardrop shape provides most of the fullness towards the bottom of the breast and less towards the top. Some women are concerned with having too much fullness in the upper portion of the breast following breast augmentation. They might think, therefore, that teardrop implants are worth the trouble. In my experience, a certain fullness to the upper breast is desirable. Excess, unnatural fullness certainly is not. I have not found (during over 20 years in practice) that excessive fullness occurs when careful, competent use of round implants positioned below the muscle is done.
Teardrop/anatomically-shaped breast implants are, by definition, asymmetrical. For that reason, it is important that they not rotate once in position. Obviously, if an implant rotates and is asymmetrical, it will change the appearance of the breast in an undesirable way. Instead of the breast having attractive fullness below and the appropriate contour above, the opposite will occur which would give the breast, obviously, an unusual appearance. To reduce the tendency toward implant rotation, all teardrop-shaped implants must be textured on their surface. This rough texture, as well as very careful attention to surgical technique, can reduce the risk of rotation to as low as three to five percent of patients. These are pretty good odds. In addition, drains are necessary when teardrop-shaped implants are used. These are a minor inconvenience for the first week after surgery and are easily removed in the office during your first follow-up visit. In addition, you will be required to wear a bra twenty-four hours a day for the first two weeks postop. This is not necessary with round, symmetrical implants.
Are teardrop-shaped implants the “gummy bear” implants you might have heard about? Yes they are, but I prefer to avoid the term “gummy bear”. The reason I don’t like it is that while they are firmer than traditional implants they are certainly not nearly as firm as “gummy bear” candy is.
One last difference between round implants and teardrop-shaped implants is that teardrop implants are the most expensive implants available. They are nearly four times as expensive as saline implants and almost twice as expensive as round gel implants. For the many reasons mentioned, I prefer, in the vast majority of patients, to use smooth round implants placed below the muscle.