In recent months, plastic surgery has turned its attention to the effort to create more objective standards for breast augmentation results. One earlier effort established “standards” for the shape of the ideal breast. A more recent effort looks at the impact of the type of breast implant on breast shape after breast augmentation. The study looked at relatively small sample sizes of women receiving round breast implants and anatomic breast implants (17 women, 34 breasts and 10 women, 20 breasts, respectively), performed with either transaxillary or inframammary incisions. The breast augmentations were evaluated six months postoperatively using 3D surface imaging. The variables they considered were 3D linear distance (measuring breast projection), breast volume, and surface measurement. The study found that breast volume changes were closely correlated with the size of the breast implant, with only 2.4% difference. It also found that for every 100 cc of breast implant volume inserted, the distance between the nipple and the inframammary fold increased by about 0.8 cm (0.3 in). However, the study also found that the inframammary fold tended to drop by an average of 1.3 cm (0.5 in) for round breast implants or 1.1 cm (0.43 in) for anatomic breast implants, not significantly impacted by the incision site. The study also showed that breast projection was significantly greater for anatomic breast implants than with round breast implants. Women achieved about 2.4 cm (0.9 in) more projection with anatomic breast implants, compared to only about 1.7 cm (0.7 in) with round breast implants. However, in both cases the actual projection achieved was less than was expected based on breast implant manufacturers’ parameters–25% less for anatomic breast implants and 22% less for round breast implants. The difference between expected and achieved projection may potentially account for why up to half of all revision breast augmentations are because women request a size/style change of breast implants. If women are not achieving the projection they desired, the projection that their plastic surgeon thought would be achieved, they may be moving to larger breast implants to get those results (other studies have shown that almost all women requesting a different size breast implant request larger ones). For many years, shaped breast implants have not been approved for breast augmentation, but recently Sientra, Inc. breast implants became the third manufacturer to have breast implants approved, including their anatomic implants. However, it is unlikely that surgeons will rush to use them, because of their risk of rotation. If you are considering breast augmentation and want to talk about the results you could achieve, please contact Philadelphia plastic surgeon Dr. David A. Bottger for a consultation.