A recent article in Medscape discusses how ultrasound is a great alternative to MRI for a check up on how your breast implant is doing.  The surprise finding, is that 1 out of 4 anatomic, silicone breast implants is malrotated, and what’s more, the patients didn’t notice this!  What’s going on?

I warn you in advance, the article is detailed, geeky, and scientific.  I am actually typing this on a speaker’s podium now.  So, I’m neck deep in the inside baseball of breast implants.  But if you listen up, you’ll learn all about it, and I would definitely welcome any questions you may have: is the email address.

Round Versus Anatomic Breast Implants

Smooth Breast Implants

Textured Shell Anatomic Breast Implants

Ultrasound Versus MRI for Long Term Follow-up

Surprise! 1 out of 4 Breast Implants are Mal-Rotated

Why I Still Prefer Round Breast Implants

Round Versus Anatomic Breast Implants

In the past, the world of breast augmentation and reconstruction has used round breast implants.  If they happened to rotate inside of the breast implant pocket, no biggie.  They are symmetrically round, so they look the same no matter how they rotate.

Along came the anatomically shaped (tear drop) implants.  Breast reconstruction was the main instigator in this development.  After a mastectomy, patients simply don’t have any breast tissue.   They’re often looking for the most natural breast shape possible.

A round implant may not provide the desired result, and may not be as compatible with the remaining tissue or skin.  This type of thinking and a desire for natural appearance, has filtered into cosmetic breast augmentation, and the exact same tear drop breast implants can be used in both types of breast surgery.

Smooth Breast Implants

The holy grail of breast implants has always been to try to make them more anatomic and natural looking.  Breast implant manufacturers have produced tear drop breast implants in the past with a smooth shell, but since the human body can’t grip or “latch” onto a smooth surface in the breast implant pocket, these breast implants occasionally rotated upside down.  Not very anatomic; not a good look; and back to the drawing board!

Textured Shell Anatomic Breast Implants

Today, anatomic shaped breast implants are filled with silicone for a more natural feel, AND they have a textured shell/ textured outer envelope.  The human body will “latch” onto the textured surface, so your breast implant is less likely to move and rotate.  The implant will retain the thinner portion at the top of the breast, and the thicker portion at the bottom of the breast.

Ultrasound Versus MRI for Long Term Follow-up

All silicone breast implants are supposed to be visualized every 3 years with MRI.  This is a very strong recommendation, but not a requirement, put forth by the FDA.  Since health insurance often does not cover a follow up MRI, and they are expensive, it’s no shocker that most patients don’t get them.

The new research shows that ultrasound, a much cheaper and faster technology, is just as good as MRI to detect defects with breast implants in breast reconstructive and cosmetic breast augmentation patients.  Great news.

Surprise!  1 out of 4 Breast Implants are Mal-Rotated

The big surprise, which the researchers were not looking for but noticed, was that 1 out of 4 breast implants were mal-rotated.  The thicker portion of the anatomic breast implant was not at the bottom of the breast implant-  it was to the side, or even at the top of the breast.

Even more interesting, the patients seemed not to have noticed that their breast implant was out of place!

Why I Still Prefer Round Breast Implants

I have placed both anatomic and round breast implants.   In fact, I was in the original research surgical study to use silicone breast implants in patients before the FDA re-approved silicone breast implants in the USA, back in November, 2006.  You see, being old. …er, I mean… having surgical experience, does have it’s advantages.  I’m extremely familiar with these breast implants.

When placing the anatomic implants, plastic surgeons should surgically create a smaller, more precise pocket for the implant.  More measuring.  Very careful dissection.  That way there is less opportunity for rotation.

So why do I still prefer round implants?  The rotation concerns highlighted by this study only confirm my observations.  Just because there’s a belief that anatomic shaped breast implants “should” look more natural, doesn’t mean they do.

Do your own experiment!  Come into the office and you can try this.  Hold a round breast implant vertically.  You can see that the breast implant actually gets thinner at the top, and thicker at the bottom, which is what a natural breast looks like.  This is a phenomenon we like to call “gravity.”


Here, you can see a round breast implant and an anatomic/ tear drop shaped breast implant, both of which I am holding up.  Both take the form of a natural breast shape – thinner at the top, thicker at the bottom –  when in position on a body.


Now factor in that women usually prefer to have cleavage”, or fullness, at the top of the breast.  They don’t want stretched cartoon orbs placed above their collar bones, so they explain by describing their ideal look as “natural.”

But in truth, without a bra or support, fullness at the top of the breast, while attractive, is actually a little unnatural.  Virtually all breasts will “drop” slightly without an underwire or bra holding them up.  Round implants + gravity achieve the natural contour and the fullness that most of my patients are looking for.  Round produces the desired result.

Now that we know anatomic breast implants have about a 25% chance of mal-rotating, I prefer to use round breast implants in most patients and situations.  Even if a round breast implant rotates, the look and feel remain the same, based on it’s shape.

The bottom line–  I still use anatomic breast implants, but I tend to use them in my breast reconstructive patients, including breast cancer, tuberous breast deformity, and other reconstructive cases.  I usually use round breast implants in my aesthetic and cosmetic plastic surgery patients, for the reasons listed above.

That’s as clear as I can make this topic for you, friends.  I am, after all, a doctor geek, despite my charm and love of exotic travel.  Should you have any questions, please let me know.  You can also schedule a consultation in my office, and I can be reached at or 415 362 1846.

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