A ^Retired Plastic Surgeon's Notebook

Can’t tell which side is anatomic and which side is round? Neither can I!

I think the anatomic implants vs. round implants smack down may finally be over.  As those who read my blog know, I am not a huge fan of anatomic implants although I have tried really, really hard to learn to love them over many, many years.  Anatomic implants are presented as the best thing since microwave nachos and those of us who keep going back to round implants are sometimes dismissed as Luddites.  Anatomic implants are pushed by industry paid “experts” who make the rounds at meetings and extol the wonder of these more-expensive-and-more-complicated-than-round implants.  And patients ask for these anatomic implants being lead to believe that they will look more natural.  

A few years ago, evidence started trickling in that anatomic implants actually did not have  advantages over round implants in standard breast augmentation in anatomically normal women. There were studies where before and after photos were shown to expert plastic surgeons and they could not tell which patients had which implants.  I was present at one of these sessions where a panel of experts did no better than a coin toss.  But the study that nobody thought could be done – put an anatomic in one side and a round in the other side on the same patient – has been done!  No patient would sign up for having two differently shaped implants used for her augmentation and no institutional review board would approve such a study.  But some very clever surgeons did this study in 75 volunteers.   Their average age was 39 and their average BMI was 20 (this, by the way, is quite thin).  The surgeons took the patients to the OR and put a round implant in one side and a comparably sized anatomic implant in the other side and then took standardized photographs.  They then removed the anatomic implant and replaced it with a round implant to match the other side.  The standardized photographs were shown to a panel of experts.  Even the panel of experts could not tell the round vs. the anatomic when presented with these side by side breast implants!

I really take my hat off to the Drs. Hidalgo and Weinstein for doing this study.  It is this sort of research that helps us make decisions based on reality rather than the latest hype from an industry hired gun.  

Intraoperative Comparison of Anatomical versus Round Implants in Breast Augmentation:  A Randomized Controlled Trial.  Hidalgo, David A. M.D.: Weinstein, Andrew L. M.S., Plastic & Reconstructive Surgery:  March 2017, Pages 587-596.

Thanks for reading!  Dr. Lisa Lynn Sowder

Shaped vs. Round Breast Implants

Shaped or Round Breast Implant? Toss a coin!

Shaped breast implants are all the rage these days.  A lot of this is driven by the manufacturers who love to promote these implants and a lot is driven by patients who sometimes insist on the latest and greatest be it a cell phone, blender or breast implants.  And I use shaped implants from time to time but in many cases, a shaped implant is of no advantage over a round implant.

About a year ago, I attended the annual meeting of The American Society for Aesthetic Plastic Surgery (ASAPS).  One of the best presentations involved a panel of five well seasoned (a.k.a. over 50) plastic surgeons.  They were shown multiple before and after photos of breast implant patients and asked to comment on the cases, in particular whether the patient had shaped or round implants.  The panel of experts was right less than 50% of the time!  In other words, they could have had a panel of five year olds toss a coin and come up with better results!

Years ago I was quite enamored with shaped implants and actually came to rather despise them!  I had issues with malposition and particularly rotation which can lead to some funky shaped breasts and which requires re-operation.  I have gotten a whole lot better with these implants with improved implant design and modifying my technique, but honestly, in 90% of cases a round implant will work just fine as long as it’s NOT TOO BIG (that’s another blog).

So in most cases a patient can save themselves some money and me some aggravation by going with round implants.  Yet another win win.  I just love win win, don’t you?

Thanks for reading!  Dr. Lisa Lynn Sowder