Tag Archives: tuberous breasts



If we’re taking bets on a woman who is at least partially clothed, without X-ray vision even a plastic surgeon has to admit, “No.” But that doesn’t mean there’s not some help going on. There’s all kinds of smoke and mirrors out there. The bionic push-up bras aside, I’ve had patients go down two cup sizes in the exam room once they remove the Victoria’s Secret water bags. And even though they’re just meant to try on in the office, I swear that my supply of sample “try-on” breast implants has definitely dwindled down over the past few years.

Don’t even try to decipher the ones you see in magazines. Even the implants are photo-shopped—-here’s a lovely video about that from one of my old posts that I highly recommend 🙂

Of course, there are the obvious ones, like the ninety-five pound woman sporting a DD cup, or the one who looks like she has melons pushing up to her chin.

But those are obvious to everyone. So maybe a better question to ask is:

“Why do some breast jobs look fake and others don’t?”

Even here in Beverly Hills, most women seeking breast augmentation—whether it’s a college graduation present or part of their mommy makeover–want to look “natural,”  “in proportion to their body,” and often have it done so “nobody can tell.”

In my experience, the most important variables involved in achieving a natural-appearing breast augmentation with an implant are:

1)    The size of your breasts to begin with.

Especially the width. As a breast implant size increases, so does the base diameter. Your goal may be a D cup, but if your chest wall is too narrow, the implants will not only stick out on the sides and disrupt your natural anatomy, but this is a set-up for unnatural shape, rippling and implant malposition down the road. When I help a patient choose a breast implant, I recommend keeping the base diameter of the implant at about one centimeter narrower than the base of her breast.

2)     Your skin envelope.

Is there room in there for the size implant that you want, or is it going to be so tight that the implant will never drop? Chances are, if you’ve had children and breast fed there will be plenty of room, but not always. Also, skin in darker and Asian women is usually thicker and has more elasticity, so it doesn’t stretch as much for a big implant.

3)     How much breast tissue do you have now?

Can you pinch at least two centimeters of thickness? If so, if you go with a size-appropriate implant, you probably have enough tissue to camouflage the upper border so there won’t be that obvious ledge. Having your implants placed “under the muscle” or sub-pectoral also helps avoid this problem.

4)     What is the distance from your nipple to your inframammary crease (the fold underneath your breast)? This usually depends on whether you have tuberous breasts or not. If the distance is closer to ten than five centimeters, you are more likely to get a natural, tear-drop shape result with a breast implant, as opposed to a round one.

So–again, keeping it G-rated—with all of the above information, can you tell which of the women below has had breast implants?

The answer is, of course, ALL OF THEM (I mean, come on, this is L.A.)

I grew up in New York where everyone got nose jobs, but I’d never even heard of anyone having a “boob job.” You just started every high school summer promising yourself that this was going to be the year, you were just a late bloomer and somehow you were going to show up at school in September with a C cup. And if it didn’t happen, well…the only option was to learn to live with it and develop your personality. Even in Northern California where I went to college, I remember hearing about one girl on campus who was rumored to have had breast implants and it just seemed so unfathomable to me. I mean, how could her parents let her do that, and where would you go to even do such a thing?

Well, I soon found out. And what I also found out was that unless you’re talking about a twenty-one year old girl with perfect natural C-cup breasts, breast implants actually usually look do better than the real thing.

I remember when my plastic surgery chairman at UCSD took his daughter to a Britney Spears concert (yes, this was a long time ago, before she’d even been married the first time or had any kids). They had really bad seats, and although they’d had to watch the show through binoculars,  he did get a good close-up look at Britney in her risqué costume, and he said that she had breast implants. This was when she was a teenager, long before such an accusation was even hinted at in the media, so I asked him how he could know such a thing without seeing her naked and he said, “Because they look too good.”


So since then whenever someone asks me, “Do you think those are fake?” my expert plastic surgeon’s answer is always:

“If they look too good to be real, then they’re probably not.”



Call it collateral damage. She may not have been wearing a plunging neckline, but after her gorgeous debut on the World War Z London Premiere red carpet—like nothing happened!–the Google phrase “What kind of breast implants does Angelina Jolie have?” has got to be trending.

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And once the word is out, the demand across the world for whatever brand and style they are will probably put them on back order for a year. And the implant companies that weren’t used may even see their stock plummet. For a month or so, until the frenzy subsides.

I’m convinced that the “Angelina Effect” will change breast implant terminology forever. Which is great, because I think we were all getting bored with the same old-same old: the “round implant,” the “gummy bear implant” and the “teardrop-shaped implant.” Now there will be the “Angelina Jolie implant” (which, to clarify, must be one of the former three.)

Why is this so incredibly timely?

There has recently been an exceptionally intense knock-down drag-out war going on between the breast implant companies, as they are more aggressively than ever vying for plastic surgeons’ business.

Up until last year, for decades all we’ve had available in the U.S. were third-generation round silicone gel implants. Remember, these implants that we’ve been using are made of cohesive gel—the silicone is solid enough that it won’t leak out into the breast if the shell is ruptured, but it is still soft and moves (think “Jello®,” not “Gummy Bear”). And we’ve had two breast implant companies to choose from, Allergan and Mentor.

Meanwhile, Allergan has been tantalizing us over the past five years at our plastic surgery meetings with dinner presentations about their 410 implant, the miraculous shaped, form-stable anatomic cohesive-gel (translation: “Gummy Bear Teardrop-Shaped implants”) that was going to change breast augmentation forever. Apparently, it has already changed the rest of the world, but our FDA still wasn’t approving its use in the U.S.

Then last year, out of nowhere, Sientra–the little Brazilian “breast implant company that could”–got their Gummy Bear Teardrop-shaped implant through the FDA first.  (See last year’s post First New Brand of Breast Implants In Over Ten Years FDA-Approved and why this is such a big deal).

…and Allergan’s 410 just became available a few months ago…

And the war is on!

I have to say, the fallout has been tremendous for the plastic surgeons, especially for those of us who attended the annual week-long American Society of Aesthetic Plastic Surgery (ASAPS) meeting in NYC this past April, where the first round of competition took place.

We were wooed with extravagant Manhattan dinner events that could have been straight out of Gossip Girl. Allergan hosted an evening soiree at the glamorous midtown Cipriani’s:


Not to be outdone, Sientra took a few hundred of us out for a dinner cruise up the Hudson River on a luxurious private yacht from the  Chelsea Piers, complete with an open bar and our own personal après dinner fireworks show along the Manhattan skyline, timed perfectly to the music of Katy Perry onboard.

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The Statue of Liberty was a main focal point of the cruise—I’m pretty sure it was supposed to be a symbol of our liberty to use a new implant, and I’m not kidding.


To be fair, Allergan also had an open bar. 🙂 And they do have  their own fleet of especially attractive male reps and guys in corporate.

Okay, so now I’m going to get serious. This lengthy post is really meant for those of you who are actually thinking about getting breast implants, and are getting very confused by your research out in Cyberspace: “Allergan 410’s” “teardrop” “gummy bear” “Sientra.” Women are coming into my office asking for implants by names they don’t even understand the meaning of. And it’s going to get even more confusing when you see the new Allergan “Keep Them Guessing campaign popping up in your beauty magazines.

Yes, there’s suddenly so much new stuff out there that it’s even becoming hard for the plastic surgeons to keep track.

So which breast implant is the “best” implant?

Just because something is new and different doesn’t necessarily mean it’s better, or right for you.

I’m going to break down the whole new breast implant mystery as clearly as I can, with answers to the following questions:

1)   Are the new “Gummy Bear” implants less likely to leak than the ones we have been using?

NO. They are all cohesive gel. Again, think “Jello®”:

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Vs. “Gummy Bear”:

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2)  Why was a Gummy Bear  Teardrop-Shaped/anatomic implant invented?  I have friends who have round implants and their breasts look totally natural.

The third generation cohesive gel round implant will conform to and take the shape of your existing breast. The Teardrop-shaped (anatomical) implants were designed for breast reconstruction and breasts with deformities, and when they are used, the breast will take the shape of the implant.

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Ironically, what I have found in my practice is that most of my breast cancer/ reconstruction patients don’t even want a “Teardrop-shaped” implant. Once they see that big round tissue expander blowing up, they get so excited about having Victoria’s Secret-looking breasts that they always pick the high profile implant.

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3) Why are the new teardrop shaped implants made of this new, stiffer “Gummy Bear” stuff?

Because if something is shaped, it has to stay stiff and keep the shape, otherwise it will turn into a weird shape when it moves. If a round implant changes shape, it just stays round. But if a “teardrop-shaped” breast changed shape, who knows what oblong-looking thing it could turn into.

This is also why all shaped implants need to be textured. Think of the textured shell as a sort of “Velcro®” that sticks to the surrounding tissues, keeping it from moving around.

4)   What is the difference between the Sientra teardrop-shaped implant and the Allergan 410?

Besides the fact that each company feels that their product comes in “more optimal” shapes and sizes and that their texturing is better than the other’s, the main difference is that the Allergan 410 is firmer. The advantage of this is that it probably is more effective in shaping a tuberous or tight breast. The disadvantage is that it definitely feels firmer. However, keep in mind that even the Sientra implant feels firmer than the regular round ones we’ve been using.

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Can you really tell that one is firmer than the other when they are inside, under the muscle?

I think it’s different in everyone.

5)   What is the softest implant available and why wouldn’t everyone just want that one?

In my opinion, the round Mentor cohesive gel implant is the softest third generation silicone gel implant out there right now. However, with softness comes increased chances of rippling on the sides, so if you have very little breast tissue or body fat to cover the implant, you may have to make a tradeoff between softness and rippling.

6)   Exactly how hard are these Gummy Bear implants, and how do they compare to the regular round silicone ones?

You should make a consultation with a plastic surgeon who has samples in their office so you can feel for yourself.

7)   My doctor doesn’t want to use the teardrop shaped implants because he said they can “turn.” How often does that happen?

I think that if the teardrop-shaped implants are used in the appropriate circumstance by a plastic surgeon who understands the principles of using them, the incidence of them “turning” is very low.

8)   Who is a good candidate for a teardrop shaped implant?

Someone who is an A or small B cup, with tight skin, who wants a breast augmentation and wants absolutely NO fullness of the upper pole (upper slope) of the breasts

9)   Who is not a good candidate for a teardrop shaped implant, and should stick with a round one?

If you have any sagging of your breasts to start with, or you are getting a redo like a removal and replacement, you are most likely better off with a round implant. To work well, the Gummy Bear Teardrop-Shaped implant has to be placed in a tight skin pocket.

If you don’t want the incision to be underneath at the breast crease (inframammary incision) The Allergan 410 implant is too stiff to place through a periareolar (around the nipple incision) and requires a little bit of a larger incision than the other implant options. Since the Sientra implant is a little less stiff, if you have a big areola, you can sometimes have it placed through a periareolar incision.

But what if I want them to look natural? 

Define natural. 🙂  True “natural” is flat and saggy. Usually when women say “natural” they mean “not big and fake.” If you have breast implants placed that are not too big for your chest wall, they will look natural. The “naturalness” of a breast augmentation has to do with the size of the implant used relative to the amount of space there is to place it. (see post from last year Can you always tell if someone’s breasts are fake?)

10)   Should I get textured or smooth implants?

One message I did get out of our big ASAPS meeting in NYC was that textured implants, once big in the eighties, are now becoming in Vogue again as the studies are showing that they have a decreased rate of capsular contracture (scar tissue around the implant). However, since the textured capsule sticks more to the surrounding tissue, they can have an increased rate of rippling, especially in a very thin woman. Again, another trade-off.

Remember, if you are getting teardrop-shaped implants, the decision is made for you—they are all textured (see #2). So you don’t have to even think about this one.

11) What is the point of a “Gummy Bear” round implant, like the one Sientra makes?

At first I was very gung-ho about this one—it seemed like the solution to almost everyone’s problems. The texturing would decrease the rate of contracture, and the increased stiffness would keep it from rippling, without having to make a commitment to a teardrop-shaped implant if the patient wasn’t a good candidate for one. However, I have learned myself that this one is not the be-all and end-all answer for everyone. I’ve seen some great results and just recently one not-so-great. Again, with these Gummy-Bear implants, no matter what shape they are, the breast skin around them has to be tight. If there is any looseness at all you can get a weird “sandbag” effect when it moves.

I hope that the above FAQ’s were helpful for those of you trying to sort out some honest, unbiased answers.

So back to Angelina…do I know which implants she has? There are rumors filtering down through the Beverly Hills plastic surgery grapevine…But just remember that, no matter how amazing she looks (let’s be honest, she looked pretty amazing to begin with, and she had amazing surgeons at the Pink Lotus Breast Center) don’t automatically assume that whatever amazing implants she has are the right ones for you.

Everyone is different. Angelina Jolie is a thin woman who had bilateral prophylactic nipple-sparing mastectomies. You may be undergoing a procedure for breast cancer, a removal and replacement for previously ruptured implants or capsular contracture, or you may be just be considering a breast augmentation to kick off the summer in a bikini… Regardless, your situation is unique, and your plastic surgeon should be able to discuss the pro’s and con’s of each type of implant, so that you understand the choice that you are making.

Still, having said all that, there’s no denying that from a financial standpoint, when it happens, the identification of the “Angelina Jolie breast implant” brand will unquestionably give that company a “leg up.”

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(sorry couldn’t resist :))




Answer to the question “Which breast implant does Angelina Jolie have?

If you saw some of the press releases about her experience, you may have noticed that somewhere in there it says she had a “shaped implant.” Well, at the time of her procedures, Sientra was the only company who’s teardrop-shaped implants were available for general use. So, there you go.