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Round or Shaped Breast Implants?

During a typical consultation with a patient interested in breast augmentation, I discuss options including incision placement, pocket placement, and, of course, implant options.  Implant options include silicone versus saline, low, moderate versus high profile,  smooth versus textured surface, and round versus anatomic shape.  Women frequently are under the assumption that an anatomic shaped implant is better than a round implant, but is this actually true?  It has always been my experience and thus, my opinion, that if a prospective augmentation patient has at least some shape to her own breasts, that she merely needs enhancement of that shape, and therefore she can get a good result with a round implant.  And now I have a study that corroborates my experience. The following is hot off the press from my Plastic Surgery  specialty society’s recognized journal:

Round or ‘Shaped’ Breast Implants? Even Plastic Surgeons Can’t Tell the Difference

Looking at before-and-after photos, plastic surgeons and plastic surgical nurses can’t tell whether breast augmentation surgery was done using conventional round implants or newer anatomically shaped implants, reports a study in the January issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

At least in the specific group of patients studied, the results of breast augmentation using round versus shaped implants are indistinguishable, according to the new research, led by Dr. Carlos Rubi of The IMED Hospital Department of Plastic Surgery, Valencia, Spain. The results suggest that routine use of increasingly popular “teardrop-shaped” implants is not justified.

No Visible Difference in Results between Implant Types in Before-and-After Photos

In the study, 30 plastic surgeons and plastic surgery nurses reviewed preoperative and postoperative photos of 30 women who had undergone breast augmentation with round or anatomically shaped implants—15 patients in each group. The two groups were otherwise similar: all procedures were done using silicone implants, placed under the muscle (subpectoral), with an average implant size of about 300 cc.

For each set of photos, the surgeons and nurses judged whether the procedure was done using round or shaped implants. The goal was to determine if the aesthetic results of round versus shaped implants could be differentiated from each other.

For all observations, there was about a 50-50 chance that the surgeons and nurses could correctly identify the type of implant used. There was a lack of agreement not only between different raters, but also for individual raters comparing the same images several weeks later.

Plastic surgeons performed slightly better than nurses in identifying the type of implant—possibly because they could deduce which type would likely be recommended, based on the “before” photos.

Introduced recently, teardrop-shaped implants have become increasingly popular for breast augmentation surgery. “A widespread idea is that the anatomically shaped implants give more natural results than the round implants,” Dr. Rubi and coauthors write.

But the new study shows that even plastic surgeons and plastic surgery nurses cannot tell the difference between the final outcomes of breast augmentation with round versus shaped implants, in a group of patients with otherwise similar characteristics. The results add to a previous study that showed similar outcomes with the two implant types used for breast reconstruction.

The inability to tell the difference between implant types for breast augmentation questions the preference for shaped implants—especially since they cost more and carry a risk of complications related to implant rotation, compared to round implants. “The systematic use of anatomically shaped implants is not justified,” Dr. Rubi comments. “Natural results are achieved with both types of implants.”