A teardrop breast implant favors fullness at the lower part of the breast. Most of my breast implant patients are equally concerned with the filling the upper portion of the breast to create some fullness up top.  A round breast implant tends to create fullness throughout the breast.

There may also prove to be a higher rate of fold failure in anatomical breast implants or teardrop breast implants that may lead to deflation.

When you hold a round breast implant up on it's side, hanging it from the top, which is the position it is in when you stand,  it becomes a teardrop shape anyway! The filler, whether saline or silicone, has weight and therefore stretches the bottom somewhat. The top then collapses somewhat. If you start with a smaller top, and the bottom stretches slightly over time, the top can end up empty when you stand. This would allow the empty area to rub, front against back, and theoretically increase the possibility of fold failure. (This deflation theory is theoretical at present and has not been proven statistically to my knowledge!)

Does a round implant make a round breast?....No!

I do not think that there is a very big difference in the shape of the breast when standing after the implant settles into it's optimal position! This is because a breast implant is easily molded into whatever shape it is pushed into. A soft breast implant cannot overcome the pressure of the overlying muscle and skin very much, if at all.

Therefore, in my opinion, the ultimate shape of the breast will mostly depend upon the size and position of the pocket we make, the shape, elasticity and thickness of the muscles and skin, and the size of the implant we use. An artificially round breast, in my experience, usually occurs due to placing the implant outside the muscle in a situation where there isn't good skin and fat coverage.

The  possibility of less fullness across the upper portion of the breast after settling is something that should be considered in making this choice.   As with the smooth/textured discussion, I do not think teardrop breast implants are medically unwise and do not force the choice. I  will allow the patient to choose whichever implants they prefer. Considering these issues, however, I  recommend staying with round breast implants for most patients.