Choosing the Right Breast Implant Shape: Michael Bain MD’s Expert Advice 96812

Picking an implant shape seems straightforward until you start trying to visualize how it will look on your body, both in motion and at rest. In consultation rooms, I hear the same questions on repeat: Will round implants look fake on me? Are teardrop implants worth the extra cost? How do I keep cleavage without heaviness at the sides? These are the right questions to ask, because shape, combined with size and projection, drives the final look just as much as surgical technique.

Implant shape is not a popularity contest. It is a tool to solve a specific set of anatomical variables: your ribcage width, breast footprint, nipple position, skin elasticity, muscle tone, and tissue thickness in the upper pole. Shape also affects the way light hits the chest and how breasts behave when you lie down, raise your arms, or run. A thoughtful plan starts with how your tissue drapes today and where you want volume tomorrow.

Below, I explain how round and anatomic implants differ in real life, who tends to do well with each, why projection sometimes matters more than shape, and what to expect during recovery when shape choices meet surgical technique. I also include practical considerations for patients who are pairing breast augmentation with a breast lift, liposuction, or a tummy tuck as part of a more comprehensive plan.

The two major shapes and what they really do

Most implants come in two shapes: round and anatomic. Anatomic is often called “teardrop,” though that term oversimplifies the effect. Both shapes can be filled with either silicone gel or saline, and both come in a range of base widths and projections.

Round implants are symmetric in every orientation. When standing, they produce a balanced distribution of volume that often fills the upper pole more than anatomic options. When you lie down, round implants tend to settle naturally, which many people perceive as soft and mobile. Round implants come in different cohesivities, from soft gels that shift with gravity to firmer gels that hold their dome-like shape.

Anatomic, or teardrop implants, are shaped to mimic a natural slope: thinner at the top, fuller at the bottom. They can create a gentle transition in the upper pole, which can be helpful in patients with very little tissue. They typically require a textured surface to reduce the risk of rotation, since a rotated anatomic implant will distort the breast shape. Some newer designs use form-stable gel to retain their contour.

Patients are often surprised when they learn that a soft round implant placed correctly beneath the muscle can look natural and sloping, especially in individuals with enough tissue coverage. Conversely, a firm anatomic implant with high projection can look structured, almost sculpted. Shape is only one lever among several that affect aesthetics.

What shape means for your goals

If your priority is upper-pole fullness that reads more “augmented,” a round implant offers a predictable result. If your goal is a subtle, athletic contour with lower-pole fullness and a restrained upper pole, an anatomic design may be worth considering, especially if you are starting from an A cup with very slim soft tissue. For most patients who want a natural look without fussy maintenance, a smooth round implant with the right projection and base width checks the box.

The nuance shows up in edge cases: wide ribcage with narrow breast footprint, mild asymmetry, or a constricted lower pole. In those situations, I often favor a round implant combined with pocket work that releases tight tissue, or a short series of expansion maneuvers during surgery. The implant’s freedom to settle can be as important as its inherent shape.

Projection, not just shape, controls the silhouette

Projection refers to how far the implant projects from your chest wall at a given base width. High projection increases forward fullness and cleavage potential. Moderate or low projection spreads volume more laterally, which can look beautifully proportionate on broader torsos.

Projection choice can amplify or soften the impact of shape. A moderate projection round implant may yield a gentle slope that looks similar to an anatomic device in someone with average tissue. A high projection anatomic implant can produce crisp lower-pole definition even in a very flat chest. This is why trying to decide shape before discussing projection almost always leads to confusion.

In the office, I measure your base width, nipple position, and sternal notch to nipple distance, then assess how your tissue responds to compression. The point is not to hit a specific cup size, but to land a base width that fits your chest, then select a projection that meets your aesthetic target without stressing your skin envelope.

The role of the muscle and pocket placement

Placement above or below the pectoralis major muscle changes the game. Subglandular placement keeps the implant directly behind breast tissue. It can showcase shape more obviously, which sometimes benefits an anatomic device. It can also highlight rippling, especially in thin patients. Submuscular or dual-plane placement tucks the top of the implant under the muscle while the lower part sits under tissue. This buffer softens upper-pole edges and often allows a round implant to behave more “teardrop” when standing, then round out when reclined.

In women with very little tissue, submuscular cosmetic procedures Newport Beach placement reduces visible edges and rippling. In athletes with low body fat who use their chest muscles heavily, we discuss animation changes and whether a more stable subfascial or modified dual-plane pocket might serve them better. Pocket strategy needs to be decided alongside shape, not after.

How anatomy dictates the better choice

Every plan starts with what your current breast gives us. A few scenarios illustrate common patterns I see:

A narrow chest with tight lower pole and high nipple position. Chasing a teardrop shape here sometimes exaggerates the upper-to-lower ratio. I lean toward a narrow-base, moderate-to-high projection round implant, combined with release of the lower pole. This approach helps expand the bottom of the breast and avoids a torpedo look.

A wider chest with dispersed breast tissue and mild laxity. A moderate projection round implant can look very natural and fill the central breast well. If the patient wants maximum subtlety, an anatomic implant with a similar base width can compress the upper pole slightly and make the lower pole more dominant.

A very petite patient with minimal tissue thickness. An anatomic implant can create a believable slope and hide upper edges under the muscle. A soft, low-cohesivity round implant can achieve a similar look if the pocket and projection are chosen carefully. The decision often comes down to a patient’s tolerance for the small but real risk of anatomic implant rotation.

A deflated breast after pregnancy or weight loss with a low nipple position. Shape alone will not fix this. A breast lift with augmentation addresses both position and volume. In many lift-augmentation cases, a round implant fits more predictably inside the reshaped skin envelope, because the lift controls the slope, and the implant adds internal affordable plastic surgeon Newport Beach support and projection.

Texture, rotation, and modern safety considerations

Anatomic implants generally use some form of texture to reduce movement and rotation. Rotation is uncommon but not trivial. If a teardrop implant rotates 90 degrees, the breast will look distorted until it is corrected. Round implants can rotate freely without visible change.

Texturing raises a separate topic patients read about online: the association between certain textured implants and a rare condition called BIA-ALCL. Risk depends on specific textures and device histories. Current practice emphasizes informed selection and careful follow-up. Many surgeons now favor smooth round implants for most patients, both for aesthetics and peace of mind. That does not mean anatomic implants are off the table, only that the trade-offs should be clear, and the choice should be guided by individual anatomy and goals.

Feel and movement in daily life

The tactile experience matters. Softer gels feel more like natural tissue but can ripple more if coverage is thin. Form-stable gels hold shape more but feel firmer. Under the muscle, even a firmer gel softens in feel over months as the tissue settles and the muscle relaxes. When you lie down, round implants tend to spread laterally and upward like natural breast tissue. Anatomic implants keep their biased lower fullness, which some patients prefer and others notice feels less mobile.

If you are a side sleeper, lateral drift is a real consideration. Broader-based implants resist shifting better, and good pocket control prevents the implant from sneaking toward the armpit. Wearing a supportive bra at night during the first few months helps the pocket mature in the right position, regardless of shape.

Scars, incisions, and how shape influences approach

Most implants go in through an inframammary fold incision, which gives precise control of pocket dimensions. A periareolar approach is possible in selected cases but can limit access and raise the risk of bacterial contamination, especially with larger, more cohesive implants. Transaxillary or transumbilical routes are less common with today’s devices, especially for anatomic implants, which need meticulous orientation.

If you choose a teardrop device, expect your surgeon to protect the implant’s orientation during insertion and to verify position before closure. For round implants, insertion can be faster, with fewer technical steps, though attention to symmetry and fold position is equally critical.

Combining augmentation with a breast lift

When a breast lift is planned with augmentation, shape does not sit on the top of the decision tree. The lift sets the envelope and nipple position, and the implant fills that architecture. In many mastopexies, a round implant is favored for its predictability and for the freedom it gives the surgeon to fine-tune upper-pole support. Some patients still benefit from an anatomic implant, particularly when the goal is a conservative upper pole with strong lower fullness. The key is to avoid over-projecting a tight lift, which can stress incisions and widen scars.

Scars from a lift vary based on how much repositioning is required. A small periareolar lift can correct minor areola position changes. Moderate to significant ptosis usually calls for a vertical or anchor pattern. When patients want minimal scarring but need a lot of lift, expectations need to be aligned. Implant shape will not compensate for inadequate nipple elevation.

Sizing sessions that tell the truth

Sizers help. Trying on different volumes and projections inside a soft bra can show how your base width interacts with projection and shape. It is not perfect. Sizers sit outside the body and do not account for muscle coverage or tissue release. But they do teach you how a 300 cc moderate projection feels compared with a 275 cc high projection. I sometimes show patients before-and-after photos with identical volumes and different shapes, then ask which look they would choose if they did not know the shape. Most of the time, expert plastic surgery Newport Beach they point to pocket quality, fold control, and projection over the shape label.

Recovery and how shape choices show up in the first months

The first four weeks are noisy. Swelling, high-riding implants, and muscle tightness create a temporarily boxy look, especially under the muscle. Round implants often soften faster in the upper pole as the muscle relaxes. Anatomic implants can look a bit lower-pole dominant early, then refine by three months. Light activity starts within days, desk work in a week, and unrestricted upper body exercise around 6 to 8 weeks, depending on your case and your surgeon’s protocol.

Massage and implant motion exercises are not universal anymore. With cohesive gels and controlled pockets, many surgeons avoid aggressive manipulation. If you are given exercises, follow the exact instructions. Do not apply a generic regimen you found online that could stretch a carefully crafted pocket.

Longevity, revisions, and what shape means over time

Implants are not lifetime devices. Most remain problem-free for many years. Common reasons for revision include size change, scar tissue tightening around the implant (capsular contracture), implant malposition, and natural breast changes with age or weight fluctuation. Shape can influence how noticeable some of these issues become.

With anatomic implants, rotation is the obvious shape-specific risk. With round implants, malposition such as lateral drift or double-bubble can occur if pocket control loosens, but rotation is invisible. Capsular contracture can make any implant feel firmer and sit higher. Round implants can mask contracture better visually because they do not have a preferred orientation. Anatomic implants in a contracted pocket can look more distorted. This does not mean anatomic implants are fragile, only that their benefits come with maintenance considerations.

When liposuction or a tummy tuck enters the plan

A comprehensive body plan often pairs breast augmentation with liposuction of the flanks or a tummy tuck. When scheduling combined procedures, surgical time, positioning, and postoperative garment use all must be coordinated. A tummy tuck increases core pressure and can temporarily limit upright posture, which subtly changes how augmented breasts appear during the first weeks. I advise patients to judge symmetry and shape after the abdominal swelling subsides. If you are using a compression garment or binder after a tummy tuck, make sure it does not ride up and press the lower breast or inframammary folds. Correct bra selection during the first month makes everything easier.

Liposuction of the axillary roll or lateral chest can refine breast borders. If you plan it, your surgeon can narrow the visual footprint of the breast, which sometimes allows a slightly wider-base implant without looking heavy on the sides.

The honest pros and cons, distilled

Here is a compact comparison that reflects what I see day-to-day, not catalog copy.

Round implants

Flexible look that can read natural or augmented based on projection and pocket
No visible consequence of rotation and simpler to place
Often softer upper pole feel over time under the muscle
Can look round or overly full in the upper pole if projection is too high for your tissue
Smoother surface widely used, with broad safety familiarity

Anatomic implants

Built-in slope helpful in very thin patients seeking a subtle upper pole
Strong lower-pole shaping in select anatomies
Rotation risk, especially in very active patients or with loose pockets
Textured surfaces and form-stable gels require careful counseling and follow-up
Can feel more structured and less mobile depending on cohesivity

This is one of two lists allowed, and it exists to make a quick side-by-side point that would be unwieldy in paragraphs.

A note on cup size, bra fit, and photography

Bra sizing varies wildly across brands. A 34C in one store can fit like a 32D in another. During planning, focus on base width and projection instead of a letter. Postoperatively, wait at least six weeks before shopping for expensive bras, and expect your size to stabilize around 3 to 6 months. For photos, judge more than the front view. Look at quarter-turn angles and arms-up positions. Good surgical results respect symmetry across multiple postures, not just one flattering pose.

What to bring to your consultation

Responsible planning relies on a clear target and realistic constraints. Bring reference photos that show the upper-pole slope you like, not just cup size. Wear or bring a soft, non-padded bra for sizing. If you have a history of keloids, weight fluctuations, breastfeeding challenges, or chest workouts that matter to you, say so upfront. If you are considering future pregnancy, that matters too. Breast changes from pregnancy and breastfeeding can alter shape regardless of implant type.

As a board-certified plastic surgeon, I place a premium on education and collaborative decision-making. The best outcomes happen when shape, size, projection, and pocket are chosen as a set, matched to the way your tissues behave. That is why two patients with the same sizer volume can leave with different implants, and both look right.

Real-world case sketches

A distance runner with an A cup, 11 cm base width, and pinch thickness under 1 cm. She wants a small, natural boost that does not broadcast augmentation. We choose a smooth, round, moderate projection implant around 240 to 270 cc, dual-plane placement to soften edges, and careful inferior pole release. Her result slopes gently up top and looks unoperated in sports bras.

A mother of two with deflation, mild ptosis, and stretch marks. She brings photos favoring a rounder, classic augmented look. With a planned vertical lift, we select a smooth round high projection implant in the 300 to 330 cc range to recreate upper fullness while the lift resets the nipple position. The lift controls the slope; the implant provides structure and cleavage.

A slim, 40-year-old patient after significant weight loss with a very flat chest and tight skin envelope. She wants a barely-there change. An anatomic, form-stable implant with narrow base and moderate projection creates a clean lower-pole highlight with a conservative upper pole. We discuss rotation risk and the tactile difference. She accepts the trade-off for the specific aesthetic.

These are archetypes, not prescriptions. Your plan will vary based on measurements taken in person.

Cost, availability, and long-term thinking

Anatomic devices and highly cohesive gels can cost more than standard smooth round implants. If your anatomy does not require the added features, paying extra for shape alone rarely changes the outcome. If you plan for potential revisions over a 10 to 20 year horizon, factor in ease of replacement. Round implants are widely stocked and straightforward to swap if you decide to adjust size after children or weight changes. Anatomic replacements require precision with orientation and texture matching.

Warranties exist for many implants, but they cover device issues, not aesthetic preferences or natural changes. Ask for details so you know what is and is not included.

When the subtle details matter most

The line between a “just right” result and a “not quite” outcome often comes down to fold position. The inframammary fold anchors the base of the breast. If it is not set at the correct height and in symmetry, shape debates become secondary. A slightly lowered fold can lengthen the lower pole and make even a round implant read as teardrop. A fold that is too high crowds the lower pole, pushing fullness upward. Skilled control of these landmarks is the quiet success factor that does not show up in marketing names.

The bottom-line guidance

Choose the implant that matches your tissue, your tolerance for maintenance, and your aesthetic goal. Most patients who seek a natural look achieve it with a smooth round implant placed under the muscle with the right projection. Patients who are extremely lean or want the subtlest upper pole sometimes benefit from an anatomic, form-stable device, understanding the orientation and texture considerations. The conversation should also include how a breast lift, liposuction around the bra line, or a tummy tuck might interact with implant behavior during healing.

Make sure you see a surgeon who measures carefully, shows a range of before-and-after photos that match your body type, and explains trade-offs without pushing a one-size-fits-all solution. If you feel rushed past the details of pocket placement, fold control, and projection, keep asking until you are satisfied. The right shape serves your anatomy; it does not fight it.

Michael Bain MD is a board-certified plastic surgeon in Newport Beach offering plastic surgery procedures including breast augmentation, liposuction, tummy tucks, breast lift surgery and more. Top Plastic Surgeon - Best Plastic Surgeon - Newport Beach Plastic Surgeon - Michael Bain MD