Breast augmentation with implants was long the most commonly performed plastic surgery procedure in France. Although it has now been narrowly overtaken by liposuction, the ANSM nonetheless recorded 82,600 breast implant placements in 2024. For women considering it, however, certain questions arise — chief among them the goals of the procedure, namely whether they are seeking a natural, understated result or, conversely, a more pronounced contour. Beyond the other factors (volume, frame, texture, etc.), the choice between round or anatomical breast implants then takes on its full importance when it comes to reshaping the breasts.

The two main families of breast implants

Breast implants differ according to several elements such as volume, material, texture, projection and, of course, the shape of the breast. There are mainly 2 broad families of implant, namely:

round implants (hemispherical in shape): smooth and made of silicone gel, they account for the vast majority of procedures. They are in fact the only implants used by Dr Hunsinger and Dr Henri Derhy at the Rive Droite Paris Étoile clinic in the 17th arrondissement;
anatomical implants (pear- or teardrop-shaped): once very popular for their shape mimicking the natural appearance of the breast, their use was banned in 2019 because of the rare cancer risk (anaplastic large-cell lymphoma) associated with the macro-structured surface needed to prevent rotation. This was notably the case for Allergan’s Natrelle 410 models using Biocell technology. New anatomical implants with a micro-structured shell have since been developed without being banned. The long-term track record for this technique nonetheless remains limited for the time being.

Round implants: for whom, for what result?

Round implants are particularly recommended for an apple-shaped breast when the areola is well centred relative to the mammary gland. They can also be chosen when the upper part of the breasts lacks projection (breast ptosis). They can also meet the wishes of patients seeking a significant increase in volume with a pronounced contour (a « pigeon-chest » effect).

Round implants have the advantage of being insertable through a variety of techniques:

via the inframammary approach (under the breast);
via the axillary approach (under the armpit);
via the periareolar approach (through incisions around the areola).

Contrary to popular belief, round implants are perfectly capable of achieving a natural result, just like anatomical implants. It in fact all depends on the chosen volume, the desired projection and the amount of pre-existing mammary gland. In this respect, round implants are very versatile and can produce anything from an understated breast to a pronounced cleavage, depending on the patient’s wishes.

Even in the event of rotation (which is extremely rare), the shape of the breast implant remains spherical and therefore symmetrical between the upper and lower parts. Rotation thus has no impact on the appearance of the breast and in no way requires a further procedure, as can be the case with anatomical implants.

Anatomical (teardrop) implants: for whom, for what result?

Anatomical implants produce a somewhat more understated result, with less projection in the upper part of the breast and concentrated in the lower part, hence the « teardrop » appearance. They are therefore better suited to slim women with a limited amount of breast tissue or to those who have undergone a mastectomy following breast cancer (breast reconstruction procedure). Anatomical implants allow a very natural result with a soft, gradual slope towards the base of the breast, which holds most of the volume.

Anatomical implants do, however, carry the major drawback of rotation. In the event of rotation, the breast can then become asymmetrical, which requires a further surgical procedure.

Smooth, nano-textured or macro-textured surface: what it changes

The choice of implant type is not limited to the shape of the implant. The implant’s surface also has a significant impact on how well it holds in place, and therefore on patient safety. There are broadly 3 types of surface for breast implants:

smooth implants: they allow the implant to move freely within the pocket created by the surgeon. The smooth surface is therefore risk-free, since it does not come into contact with the surrounding tissue, which also limits potential inflammation. This smoothness does, on the other hand, result in poorer stability and therefore a higher risk of rotation. It can also lead to the development of a capsule due to capsular hypertrophy of the membrane surrounding the breast implant;
macro-textured implants: they have a rough surface acting like Velcro that grips the surrounding tissue. This textured surface fully stabilises the implant, particularly for anatomical implants. This system does, however, have the major drawback of friction risks between the membrane and the implant, which can sometimes lead to an intracapsular rupture. Some macro-textured implants have even been withdrawn from the market following documented risks of a link with a particular form of lymphoma (ALCL);
micro-textured (or nano-textured) implants: this is the latest generation of implant, whose promise is to combine stability and safety thanks to micro-roughness, imperceptible to the naked eye, that grips the tissue without damaging it. The implant can thus follow the body’s movements freely without rotating. These very fine anchors also reduce the risks of capsular contracture and irritation.

Ergonomix implants: round implants that behave like anatomical ones

Ergonomix implants developed by the Motiva brand are made of a softer gel than traditional round implants. This gel, which follows the movement of gravity, mechanically gives the breast a less convex appearance at the top of the chest when standing. The Ergonomix implant then approaches the teardrop shape of anatomical implants when standing while redistributing when lying down. It therefore remains technically round in shape (and thus carries no risk of rotation) but with full adaptability to the body’s movements, in the manner of an anatomical implant.

How your body shape guides the choice

Various factors come into play when choosing the type of breast implant, in particular:

the amount of existing mammary gland: for slim patients with little breast tissue, the anatomical implant will be preferable to avoid an overly visible demarcation in the upper part. Patients with a certain glandular volume, on the other hand, can opt for round implants, with the breast tissue harmoniously covering the top of the implant;
skin elasticity: the round implant is preferable when the skin is still firm, since it allows the implant to be contained, giving a convex appearance. A patient whose skin has lost collagen and elasticity should, conversely, turn to anatomical implants to avoid a sagging effect and the worsening of breast ptosis;
the type of placement: round implants are generally placed behind the pectoral muscle (submuscular placement), whereas anatomical implants are placed in front of the pectoral muscle (retroglandular position). The dual plane position is compatible with both implant shapes;
the patient’s expectations in terms of volume and projection.

The choice of implant also cannot do without an analysis of the patient’s body shape. For a natural result, the surgeon will then take into account various characteristics of the breast, such as:

the shape and width of the chest: a wide chest makes it easier to use round implants to « fill » the width of the chest. Conversely, for a narrow chest, thinner and taller anatomical implants will be better suited. Custom anatomical implants in particular make it possible to better manage the height-to-width ratio of the chest;
the diameter of the breasts: the size of the implant must be matched to the diameter of the base of the breasts (the implant should be about 0.5 cm to 1 cm smaller). Here again, a narrow base will generally rule out round implants, which increase the risk of overflowing at the sides and/or a « uniboob » effect if the breasts come together too much in the middle of the chest. Anatomical implants will therefore be better suited to narrow diameters, even if the implant must sufficiently fill the space to avoid a « peaked » effect;
the spacing between the breasts: placing round implants on a wide sternum can be an opportunity to visually bring widely spaced breasts closer together to create a more pronounced, plunging cleavage effect. Conversely, anatomical implants will be better suited to narrow spacing to avoid overflowing;
the height of the chest: an anatomical implant fills the vertical space of a long chest more fully, whereas a round implant is better suited to a short chest so as not to appear too low;
the position of the nipples: for low nipples (often due to breast ptosis), anatomical implants can help rebalance things by accentuating the lower part. Nipples at a medium height, on the other hand, allow round implants to be placed in order to accentuate the upper part and obtain the often sought-after « push-up » effect.

The major implant brands: Allergan, Mentor, Motiva, Sebbin

Here are the main brands of breast implants on the market:

Allergan, long the world leader, whose position was weakened by its Biocell macro-textured implant range, withdrawn from the market in 2019 over its alleged responsibility in cases of BIA-ALCL lymphoma. The brand, bought in 2019 by AbbVie, now focuses on smooth implants (in particular the Natrelle Inspira range), whose quality is recognised for submuscular placement;
Motiva, behind the recent revolution in micro-textured implants. Their flagship product is the Ergonomix implant (already mentioned above), which is characterised by an ideal compromise between adaptability and safety thanks to its nano-textured SmoothSilk shell. The brand also offers a major innovation with electronic identification microchips (Qid) that make it possible to check the condition of the implant from the outside;
Mentor, a historic American brand (part of the Johnson & Johnson group), particularly renowned for the reliability and robustness of its implants. The brand developed MemoryGel technology (shape-memory CPG gel), which has obtained FDA approval and allows the implant to naturally return to its shape after movement. The brand also offers a vast catalogue of implants with a wide variety of diameters, profiles and gels used, making it possible to adjust the desired level of firmness;
Sebbin: a French manufacturer of high-end artisanal implants that met bespoke needs, in particular for cases of breast reconstruction or chest malformations. The group was, however, placed in court-ordered liquidation and ceased operations on 3 March 2025;
Arian: of entirely French design, this brand based in Mougins developed the Monobloc manufacturing concept — that is, seamless — which avoids any risk of implant rupture for extreme safety. We are, moreover, strong advocates of these implants, which we regularly use at the CERDPE clinic in Paris 17;
Polytech: the largest European manufacturer, this German brand is renowned for the high safety of its implants as well as for its polyurethane foam coating (« Microthane ») that prevents capsular hypertrophy. This coating literally locks the implant in place and forms a kind of « biological Velcro » that holds the implant in position and minimises the risk of capsular contracture;
Serian: an American brand in the high-end segment that patented HSC gel technology, a very dense, stable silicone gel. It markets the promise of a very safe implant that does not run even if cut.

3D simulation and sizers: how the choice is made during the consultation

Beyond the type of implant (round or anatomical), the choice of implant for a patient is also made in consultation with the surgeon. During the various consultations scheduled at the Rive Droite Paris Étoile practice in the 17th arrondissement, Dr Hunsinger or Dr Henri Derhy use, in particular, 2 main tools to help the patient refine her choice:

sizers: these are trial implants to be placed inside a specialised sports bra. The sizer helps the patient not only to visualise the shape and projection of the future implants but also to appreciate the extra volume and weight represented by the new breasts. This assessment nonetheless remains incomplete, since the implant may appear more inflated than it will actually be, given that it is only placed on the breast and not inside it. It must therefore be supplemented by simulation tools;
the 3D simulator: this takes the form of software that allows the patient to virtually visualise the presence of the future implant on a 3D avatar from photos of her chest. She can thus obtain a projection from different angles to decide whether she wishes to opt for a round or anatomical implant, for a larger or smaller size (for example 250 cc or 320 cc), for a precise diameter or for a particular profile height. 3D simulation makes it possible to aggregate these various pieces of data to find the best possible balance in relation to the body shape.

Thanks to these tools as well as to the attentiveness and clear guidance of our experienced surgeons, you will be able to choose your implants with full knowledge of the facts in order to obtain harmonious, natural results without excess.

Monitoring implants: what the regulations say

Medical monitoring of breast implants has been considerably strengthened in recent years, particularly following the safety issues that arose with macro-textured implants (BIA-ALCL). It is carried out, in particular, by the ANSM at the French level and is governed by the 2021 MDR regulation at the European level. The following measures have, among others, been put in place:

Implants placed on the market must compulsorily carry a CE marking;
An implantation certificate must be issued to the patient at the end of the procedure. It must in particular state the brand of the implants, their volume (in centilitres) and their batch and serial number. It must be renewed every 5 years following a new assessment;
Older implants marketed before the European regulation must undergo recertification to ensure they meet the new standards;
A national implant registry has been set up in France to ensure product traceability. The unique device identifier (UDI) must make it possible to immediately alert all patients carrying an implant in the event of an identified safety problem;
Finally, a care follow-up protocol has been drawn up with recommendations on the frequency of consultations (close together at first, then every 1 to 2 years) as well as a detection protocol to follow if a capsular contracture or intracapsular rupture is suspected (ultrasound, breast MRI, detection of changes in shape and volume, types of breast pain, etc.).

FAQ

What is the lifespan of breast implants?
While it was once considered that breast implants should be replaced every 10 years as a precaution, this is no longer the case today. No expiry date is set for an implant, and replacement should only be carried out in the event of mechanical wear identified during an examination (risk of capsular contracture or intracapsular rupture).

Is breast implant placement compatible with breastfeeding?
In the vast majority of cases, yes, it is possible to breastfeed with breast implants, particularly when the scar is located under the breast fold (inframammary approach) or in the armpit area (axillary approach). A scar around the nipple (periareolar approach) can sometimes limit the volume of milk produced.

What is capsular contracture?
Also known as a capsule, capsular contracture occurs following an immune reaction that causes a hardening of the membrane surrounding the implant. An implant replacement is then often necessary to ensure the patient’s safety.

Who legally oversees breast implant procedures?
The legal oversight of breast surgery is provided at several levels:

on the quality and compliance of the products: the ANSM (formerly AFSSAPS) in France, in conjunction with the MDR regulation; the FDA in the United States;
at the level of practitioners: the CNOM (French National Medical Council) and the HAS (French National Authority for Health);
more broadly on plastic surgery: the SoFCPRE (learned society) in France and ISAPS internationally.

What is the best season for breast implant placement?
Winter and autumn are generally the ideal periods for practical reasons (easier concealment of recovery, less waiting, less swelling in the cold, etc.).

Is there a price difference between round and anatomical implants?

Yes, anatomical implants are generally a little more expensive (by at least 20% or so) due to slightly more complex manufacturing and a generally longer placement (in particular the creation of a very precise pocket).

Round or anatomical breast implants: how to choose?

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