A technical decision with aesthetic implications

When a patient comes in for a breast augmentation consultation, one of the most frequently asked technical questions is about the shape of the implant: anatomical (teardrop) or round? The answer is not straightforward, and the choice has a direct impact on the final appearance, the naturalness of the result, and potential specific complications such as rotation.

This article discusses the technical differences between the two types of prostheses, the objective indications for each, and practical considerations. The final choice is made by the surgeon during the consultation, based on each patient’s anatomy and individual goals—but understanding the differences helps the patient play a more active role in that decision.

What Are Anatomical (Teardrop-Shaped) Implants?

Anatomical implants, also known as “teardrop” or “tear-shaped” implants, have an asymmetrical shape: less volume at the upper pole and more volume at the lower pole. The design concept is to mimic the natural shape of a young breast when the patient is standing. Visually, in a standing patient, the result is a gentle slope from the cleavage toward the nipple, with greater projection in the lower portion.

All anatomical implants have a textured surface (the implant surface is rough, not smooth): this is necessary because the texture allows for adhesion to the surrounding tissue and prevents—or reduces—rotation within the surgical pocket. If an anatomical implant were to rotate, the larger pole would end up at the top instead of the bottom—a highly unfavorable aesthetic outcome.

What Are Round Prostheses?

Round implants have a symmetrical shape: the volume is distributed in a circular pattern, with the same volume at the upper pole as at the lower pole. When the patient is standing, gravity partially redistributes the volume downward, but the upper pole remains fuller than in an anatomical implant.

Round implants can be textured or smooth. Smooth implants have a completely smooth surface and reduce certain complications, although they are associated with slightly higher rates of capsular contracture in some studies. Because they are symmetrical, rotation is not a cosmetic issue (there is no “top” or “bottom”).

Key Differences in the Results

Appearance of the upper pole

This is probably the most significant aesthetic difference:

• Anatomical: less voluminous upper pole, gentle slope, natural “upright” appearance. The cleavage is more discreet.
• Round: a fuller, more prominent upper pole; a more visible cleavage; a more “spherical” appearance. Some patients are looking for exactly this effect.

Appearance when lying down

This is a less-discussed but important difference:

• Anatomical: When the patient is lying on her back, they retain their teardrop shape to a certain extent, which gives the breast a somewhat “stiff” appearance when lying down.
• Round: When the patient is lying down, the contents redistribute due to gravity, giving the breast a more natural, “drooping” appearance when lying down (mimicking the behavior of the natural breast in that position).

Turnover Risk

The specific risk associated with anatomical implants is rotation: the implant may rotate within the surgical pocket, especially during the first few months. If it rotates more than 20–30 degrees, the aesthetic result is compromised and may require reoperation to reposition it. Rotation of round implants is aesthetically irrelevant.

Visual Comparison

When to Choose One or the Other

In Favor of Anatomical Shoes

• Very thin patients with thin skin, where a full upper pole would look unnatural
• Tuberous Breast: A Procedure to Lengthen the Breast and Give It a Teardrop Shape
• Explicitly seek the most natural-looking result possible, without an artificially prominent cleavage
• Active female gym-goers whose toned upper body must complement their figure

In Favor of Round Ones

• Explicit search for a high-neck top with a visible neckline
• Patients with good natural breast tissue that already has a natural teardrop shape; the implant simply adds volume
• Revision surgeries for previous breast augmentation procedures involving implants that have rotated
• Preference for a more natural-looking breast when lying down
• Highly active patients who would require frequent rotation

Market Trends Over the Past 10 Years

Until around 2015, anatomical implants accounted for a significant share of the European market, especially among surgeons who valued a natural look above all else. In recent years, however, the pendulum has swung toward round implants due to several factors:

• No risk of rotation: simplifies monitoring and eliminates a cause for reoperation
• A more natural appearance when lying down: in patients who spend a lot of time lying down (mothers, athletes), round implants perform better
• Current beauty trends: Social media has popularized breasts with visible upper poles, which align with the round ones
• Advances in textures: Modern round prostheses with a polyurethane coating combine a low risk of rotation (due to adhesion) with the symmetry of round prostheses

This does not mean that anatomical implants have disappeared: they remain the best choice in specific cases (tuberous breasts, very thin patients, reconstructions), and for surgeons with extensive experience using them. The decision is still made on a case-by-case basis.

The Other Key Issue: Silicone vs. Polyurethane

In addition to their shape (anatomical or round), implants differ in the material used for their outer layer. Polyurethane implants—which can be round or anatomical—have a special outer layer that significantly reduces capsular contracture, the most feared long-term complication of breast augmentation. At Mallorca Medical Group, we offer all three options (textured silicone, smooth silicone, polyurethane), and the choice is made on a case-by-case basis depending on the patient.