In April of 2012, the FDA approved the use of shaped implants in theU.S.This marks the first time that plastic surgeons have been allowed to use non round implants in the U.S. Up until this point, only round shaped saline and silicone implants could be used. Now we have tear-dropped shaped implants available.

The shaped implants are different in several ways. First, they have a specific front-back and left-to-right orientation. That means that they have to be put in perfectly oriented. If they rotate or shift, the two breasts will look different. This is not a concern with round implants. Second, in order to keep their shape, the silicone is much firmer. This results in a firmer implant than the traditional silicone implant. Third, the incision has to be a little larger since the implants can’t be readily forced through a tiny incision. This means that for most patients, an incision made underneath the breast fold (inframammary) is required for inserting these shaped implants.

These new implants are made by Sientra, and have been used world-wide for many years and sold under the brand name Silimed. They are manufactured inBrazil and packaged inSanta Barbara. The Sientra implants are just as safe as other breast implants. The FDA made the company follow thousands of patients for many years in order to make sure that there were no problems-either short term or long term. In fact, these new implants have the lowest rate of capsular contracture of any implant on the market.

What are the main advantages of the shaped implants? The biggest benefit is that the implant doesn’t ripple and holds its shape in all positions. This makes it an ideal implant for patients who are undergoing post-mastectomy reconstruction, and extremely thin patients with very little breast tissue. This type of implant is also well suited for a woman with some minimal breast droopiness that doesn’t want a breast lift. The shape of the implant helps “lift†the nipple to a small degree, but more effectively than a round implant. Furthermore, the very low rate of capsular contracture makes it a good option for a woman who has had capsular contracture with other types of silicone implants. Finally, only board-certified plastic surgeons are allowed to use these new implants. This will give you the reassurance that your surgeon is adequately trained to use these breast implants.

What are the main disadvantages of the shaped implants? The main issue I have with these implants is that they are quite a bit firmer than the round silicone implant. This is because the gel in the implant is denser, the shell of the implant is harder, and most importantly, the pocket in which the implant sits is very snug, and so the implant isn’t very compressible since there is no room for it to flatten out. All of this results in a firmer breast. Some patients complain of this when they hug other people. A second issue is the risk of the implant rotating. It is especially of concern in someone who already has implants and is getting them replaced. If it happens, it can only be fixed with an operation. Finally, over many years, these implants tend to thin out the overlying breast tissue, especially in the upper pole of the breast. This can lead to the upper edge of the implant becoming visible over time in women with very little tissue. Of course, with the round implants the same women would develop visible rippling in the upper breast area, so no implant is perfect for this type of patient.

So what conclusions can we draw about the new shaped implants? Well, there is no doubt that these breast implants are a fantastic addition to the field of breast augmentation and breast reconstruction. For the right patient, they are a great option. They are not suited for all women, however. The first step in figuring out if you are a good candidate is to set up a consultation with your board-certified plastic surgeon. After discussing your goals and concerns, as well as your unique anatomical features, your plastic surgeon will be able to recommend the implant that is best suited for you.