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Background: When women consider breast augmentation, they understandably spent an enormous amount of time focusing on the size of the implanted result. Along with that assessment comes the consideration of the breast shape which they assume comes from the effect of the implant. While this is somewhat true, there is also a strong influence of what one’s breasts initially looked like.

Generally speaking, breast augmentation can result in two basic shapes regardless of the implant’s size. One can either develop a rounder looking breast or one with a more tear-drop shape. The rounder look is for those women who want a lot of upper pole fullness and will have the ‘augmented’ look. For those women who want a more natural look, breasts that have a tear-drop shape are preferred. These types of implanted breast shape looks are highly personal and there is no right or wrong type of breast shape.

To help with creating different implanted breast shapes, there are now two types of preformed implant shapes…round and shaped. Round breasts implants are so named because they look round when sitting on a flat surface. (they become less round when the implant is vertically oriented)  Shaped breast implants have a sloped look when laying on a flat surface (2/3s bottom pole and 1/3 upper pole) and keep the identical shape when vertically oriented. Because of this performed shell geometry, shaped breast implants have also been called ‘tear-drop’ and ‘anatomical’ breast implants.

The use of a shaped breast implant is very useful for the women who definitely want to avoid a round full upper pole after surgery. It is also beneficial for those women that have pseudoptosis or type 1 ptosis and want to try and avoid the need for a breast lift. Having more volume on the lower pole of the implant allows it to provide a mild lift or filling out effect as opposed to pushing the sagging breast tissue down further when the more of the implant volume is higher up on the breast.

Case Study: This 38 year-old female had lost much of her breast volume after pregnancies and chemotherapy for lymphoma. (now disease free) She originally was a very full D cup and now just had a lot of loose breast skin. The nipple was just above the inframammary fold but substantial breast skin hung over it. (the definition of pseudoptosis)

Under general anesthesia, inframammary incisions (4.5 cms) were made to insert 650cc shaped breast implants with an oval base shape. The implants were inserted with a no-touch implant technique using a funnel device delivery method. The implants did have to be touched to rotate them and ensure they were completely vertically oriented in alignment with the nipple inside the pocket.

Unlike many immediate breast augmentation patients, she never experienced the significant high upper pole fullness that is often seen before the implant settles as the breast tissue relax and soften. Because of the textured surface, great care must be taken in their placement so that they are exactly where the surgeon wants them. Textured implants do not have the ability to drop as much as smooth round implants, if they will settle at all.

Case Highlights:

1) The shape of the breast after augmentation is influenced by the shape of the underlying implant. While it is not always a one to one relationship, round implants tend to make rounder looking breasts.

2) Shaped breast implants have the ability to prevent too much postoperative breast ‘roundness’ of the upper pole.

3) To prevent shifting of a shaped breast implant after surgery, it has a textured surface which makes it necessary to place the implant through an inframammary fold approach.

Dr. Barry Eppley

Indianapolis, Indiana

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