How Do I Choose a Breast Implant Shape?

Episode summary

Does the shape of a breast implant determine the final breast shape? It is one factor among several. Darren M. Smith, MD, a board-certified plastic surgeon in New York City, explains how implant shape, size relative to the body and placement interact with a patient's preferred appearance.

Originally published September 4, 2020. Implant availability, practice preferences and safety statements in this recording reflect that time; current context appears below.

Key takeaways

🎯 Breast shape preferences

The episode distinguishes a gently sloping upper breast from a fuller upper pole. These are aesthetic preferences to discuss, not a single ideal everyone should share.

🔎 Implant shape options

Round and anatomically shaped implants distribute volume differently. Rotation of an anatomical implant can change its appearance.

📏 Implant size and coverage

Implant size and tissue coverage affect how prominent an implant looks; the implant's label alone does not predict the result.

📅 Historical implant preference

Dr. Smith describes his preference in 2020 for smooth, round implants and explains how he approached different aesthetic goals with them.

🔄 Healing and implant changes

Breasts can change during healing, but rupture, capsular contracture or implant movement can also change appearance and require evaluation.

Questions this episode answers

Can round implants produce a sloping upper breast?

Dr. Smith explains that they can in an appropriately planned augmentation. The discussion centers on selecting dimensions and placement in relation to the patient's body and goals rather than assuming that only a teardrop implant can create that look.

Do implants change position after surgery?

The episode describes gradual settling during healing and notes that its timing varies. It also distinguishes settling from complications that can change shape. New or concerning changes should be assessed rather than automatically attributed to normal settling.

ℹ️ Current implant safety context

The FDA states that BIA-ALCL risk is higher with textured than smooth implants. The recording's absolute statement about smooth implants should not be taken as a current zero-risk assurance. Implant-specific risks and alternatives belong in an informed consultation.

For silicone implants, current FDA guidance on rupture recognizes ultrasound as an alternative to MRI for screening patients without symptoms. Confirm a follow-up plan for your implant; the original MRI discussion is not a complete current monitoring plan.

🔗 Related information

Read current information about breast implant options, breast augmentation, and augmentation recovery, or schedule a consultation.

Educational information, not individualized medical advice. Implants are not lifetime devices, and results and risks vary. Show notes updated September 30, 2026.

Original show notes

Having a breast augmentation is a very personal process, and it's important to understand your options to ensure you get the look you want. Board certified NYC plastic surgeon Dr. Darren Smith explains.

[00:08] I'm board certified New York City plastic surgeon, Dr. Darren Smith, and this is plastic surgery before and after. Your source for the real deal about plastic surgery procedures, news about trends in aesthetic medicine, and candid sessions with industry insiders. We hope you enjoy today's episode. How do I choose a breast implant shape? The good news here is that there aren't that many options. Essentially, when we... talk about the shape of breast implants. Most people are deciding between a more natural teardrop shaped breast and a less natural appearing rounder breast shape. And this is really a matter of personal preference. Some people want to look naturally busty and other people want to look like they had surgery. So here we're going to go through some of the factors that can impact the ultimate shape of your breast augmentation. So first we'll talk about the more natural appearing teardropped shaped breast. And this breast shape is characterized by a nicely gently sloping upper pole with a round proportionate lower pole. And when I say upper pole of the breast, I'm simply referring to the portion of the breast that is above the nipple and areolar complex. And the lower pole of the breast is the portion of the breast that is below the nipple areolar complex.

[01:42] The other general shape of breast implant or breast augmentation is the round breast, and this is characterized by a more even distribution in volume between the upper and lower pole of the breast, or what we might call a breast with a great deal of upper pole fullness. There really are three factors that will determine the shape of your breasts after a breast augmentation procedure. The first is the shape of the breast implants themselves. The second is the size of the breast implants. And finally, the third factor is the position of the breast implants, specifically whether it's placed above or below the pectoralis major muscle. In terms of the options with regards to the shape of a breast implant itself, there are two choices. The first is a round breast implant. And a round breast implant essentially has an even distribution of its volume such that it looks like an oval when viewed from the side.

[02:53] that is, there is an equal amount of volume that goes into the upper pole of the breast and that goes into the lower pole of the breast. The other option for the shape of a breast implant is what's called an anatomic breast implant, also called a shaped breast implant. And when we look at a shaped or anatomic breast implant from the side, we'll notice that there is a relative fullness of the lower pole of the implant and a relative lack of volume at the upper pole of the breast implant. Round breast implants were the original type of breast implant and the teardrop or anatomic shaped breast implant came along a bit later to help surgeons achieve a more natural or teardrop shaped breast. Now, one thing that's important to know about teardrop shaped breast implants is that once they are placed in the implant pocket, it's possible for them to change positions over time.

[03:57] Whereas this is not an issue with round breast implants because while a round breast implant might in fact rotate over time, it just doesn't matter because it has an even volume distribution. On the other hand, if a teardrop or shaped breast implant rotates over time, that can lead to an unnatural and irregular breast shape because the implant has an uneven volume distribution. So... to minimize the chances of a shaped breast implant rotating after it's placed, one of the things that the breast implant manufacturers did was introduce a texture to the shell of the breast implant. So this is just a very rough surface and the idea is that it adheres to surrounding tissue and minimizes the motion of the breast implant after it is placed. Now...

[04:50] with recent discussions of ALCL or anaplastic large cell lymphoma which is an extremely rare form of malignancy associated with textured breast implants. We're really not using textured breast implants at this point and therefore we aren't using these teardrop shaped breast implants. So we're just sticking to round smooth breast implants. at this point as there have not been any cases of ALCL reported in association with smooth or non textured breast implants. So at least at the time of this recording the choice of shape of breast implant is dramatically simplified because there really only is one that most people are using which at least in the United States which is the smooth round breast implant.

[05:47] The next factor that we mentioned that contributes to the shape of your breast augmentation is actually the size of the breast implant. And this comes into play because you can imagine that if you put a very large breast implant into someone with a relatively small frame, it's just going to be more visible and it will have more visible upper pole fullness. So the breast augmentation will look less natural. On the other hand, if you use a smaller volume breast implant, you are going to have less visible upper pole fullness and you'll tend to have a more natural appearing result. So the size of your breast implant is something that you'll decide with your board certified plastic surgeon at the time of your consultation to really find a breast implant size that fits your body size and shape.

[06:42] and such that it can deliver the look that you're going for. The next thing that we consider with regards to the appearance of your breast augmentation or the shape of your breast augmentation is where your implant is placed in relation to the pectoralis major muscle. So the pectoralis major muscle is one of the muscles of the chest and it is positioned underneath the breast tissue or the breast gland and we can either put a breast implant over the muscle or under the muscle. In cases where we're looking to achieve a more natural appearance, we are going to tend to put the breast implant under the pectoralis major muscle because that simply camouflages the implant more effectively as there is more tissue between the implant and the outside world. Specifically, if you put an implant under the pectoralis major muscle, the layers going from inside to outside are breast implant, pectoralis major muscle, breast gland, fat, and then skin. On the other hand, if you put a breast implant over the pectoralis major muscle, you're more likely to see that implant, and you're more likely to see a more pronounced upper pole. So in that case, you are putting the implant over the pectoralis major muscle, so the layers moving from inside to outside in this case are breast implant, breast tissue, fat, and skin. So since there's less stuff between the breast implant and the outside world, it's going to have a less natural appearance with more pronounced upper pole fullness. So putting this all together in terms of deciding about your breast implant shape and how you're going to get the shape of the breast augmentation that you want. If you're going for a teardrop shaped breast augmentation since we really aren't using the teardrop breast implants or the anatomic or shaped breast implants at this point. The way to maximize a natural appearance, which we can do very effectively even without using teardrop breast implants, is to choose an implant that is of moderate size, not oversized with comparison to your size and shape, and placing that implant under the pectoralis major muscle. And the key to all of this is to speak with your surgeon and make your preferences known so that you and your surgeon can come up with a plan together. A related question that we get a lot of the time is do breast implants change shape? And the answer is Yes. Now, there is one kind of shape change that all breast implants undergo, and it's a natural and expected part of a breast augmentation procedure, and this is the breast implant drop. And what does this mean? It means that when we place your breast implant right after the procedure, it's going to look like it's relatively high up on the chest wall, and there is going to be exaggerated upper pole fullness.

[09:48] over time your chest tissue is going to relax and the breast implant is going to gently settle into its final position and that exaggerated upper polefulness will tend to fade away unless you made an effort to really preserve that upper polefulness by either choosing a very large breast implant or putting the implant over the pectoralis major muscle. So the Breast implant drop refers to the normal process of a breast implant settling into its natural shape and position over time and this is something that usually occurs within a few weeks to a few months after the procedure and it's very variable from person to person and it's pretty difficult to predict the timing of the breast implant drop.

[10:34] The other thing that can cause a breast implant to change shape is breast implant rupture. So if you have a saline breast implant and it pops or ruptures due to either trauma or fatigue over time, the whole thing will just deflate like a water balloon and the affected breast will lose volume and essentially flatten out too close to its original volume. And there won't be any question about what happened. You'll be able to tell just by looking yourself in the mirror that your breast implant ruptured. On the other hand, a silicone breast implant may not deflate if it ruptures and often the modern silicone gel breast implants won't simply because they're made out of a highly cohesive silicone gel such that a lot of these implants, especially what we refer to as gummy bear implants because of their consistency, can literally be cut in half and the gel more or less stays put. So it's for this reason that when you have a silicone the FDA recommends that you have periodic MRIs after the procedure to ensure that your breast implant has remained intact. And this is where the term silent rupture comes from. Since with the silicone breast implant, your implant can rupture and you may never know because the shape may not change. Whereas on the other hand, with a saline breast implant, if that ruptures, you're going to know right away because the saline will just leak out.

[12:00] The other way that a breast implant can change shape is with capsular contracture. And capsular contracture is an uncommon complication of breast augmentation. And what happens in capsular contracture is that the scar that forms around the breast implant and every implant will form a scar and that's how the body kind of walls off the implant and keeps it safe. But the abnormal thing that occurs in capsular contracture is that the scar around the breast implant, which we call a capsule, actually shrinks. So if you can imagine a scar, a spherical scar, uh shrinking around essentially a ball in this case a breast implant that has a fixed volume that can first of all be painful and second of all this can actually change the size and shape of the breast implant so with a capsular contracture the implant often needs to be removed and replaced and there are several ways to deal with this that we'll cover in another episode but capsular contracture is another way that a breast implant can change shape.

[13:04] Finally, another way a breast implant can change shape is what we alluded to earlier. And this is when an anatomical or teardrop breast implant rotates. This can also lead to an abnormal or asymmetric breast shape. So that's a rundown on breast implant shape. And I just want to call out a... cool little quiz that we just put on our website you can reach it at www.breastquiz.com that if you're thinking about a breast augmentation it will ask you a few questions and it will give you an idea of the kinds of results you can expect with different kinds of breast implants and the inspiration for this was we often have a lot of people coming into the office showing us pictures of their ideal result after breast augmentation, which we absolutely love. And we created this tool so that people could have ready access to pictures that they could bring in and show us based on their preferences as they enter them into the quiz. So check that out. It's at www.breastquiz.com and let us know what you think.

[14:15] Thanks for listening, and don't forget to subscribe, share the show, and head over to DarrenSmithMD.com for more real-world plastic surgery talk.

Original Captivate episode. Original release date: 2020-09-04. The recording is the source for the transcript and episode discussion. Later context in the written summary is identified separately.

• breast implant options
• breast augmentation
• augmentation recovery
• schedule a consultation
• Related episode: How Do I Choose My Breast Implants?
• Related episode: Can I Breastfeed After a Breast Augmentation?
• Dr. Smith’s background and training