What is the difference between a round implant and an anatomical implant?

A round implant has the same volume at the top and bottom, which enhances the cleavage and creates a more 'projected' result. An anatomical implant (teardrop shape) replicates the natural shape of the breast with more volume in the lower half. It is generally recommended for patients seeking a very natural result or with little existing breast tissue.

Should the implant be placed in front of or behind the muscle?

Submuscular placement (behind the pectoralis major muscle) is generally recommended when the patient has little existing breast tissue: it better conceals the implant edges and reduces the risk of capsular contracture. Pre-muscular placement (in front of the muscle) is more often chosen in patients with sufficient natural tissue. The decision depends on the clinical examination.

Is it better to choose a smooth or textured implant?

Since the ANSM recommendations (2019) on the association between macro-textured implants and lymphoma (BIA-ALCL), the clear trend is towards smooth or micro-textured implants for round prostheses. Anatomical implants require texturing to prevent rotation, but macro-textured implants have been withdrawn from the market. The choice is discussed during the consultation.

Can you freely choose the size of your implants?

The size is chosen together during the consultation, taking into account morphology (breast base width, chest, height), available tissue, and the desired result. "Sizers" (templates) may be used to visualise the result. Excessive volume relative to morphology increases the risk of complications and an unnatural result.

Do breast implants last a lifetime?

No. Breast implants are not lifetime devices. Their average lifespan is 10 to 20 years, but they may require replacement sooner in the event of a complication (capsular contracture, rupture, deflated implant). There is no fixed duration beyond which they must be systematically replaced in the absence of symptoms.

Breast Surgery — Complete Guide

Choosing Your Breast Implants

Round or anatomical, smooth or textured, in front of or behind the muscle

Choosing breast implants is one of the most important decisions in a breast augmentation. Shape, surface, volume, placement — each parameter influences the final result and the risk of complications. This guide explains the differences so you can approach your consultation fully informed.

1. Shape: round or anatomical?

This is often patients' first question. Both shapes deliver excellent results — in the right indications.

Round implant

Projected result, enhanced cleavage

Symmetrical in all directions. Produces a more pronounced result in the upper half of the breast. Less sensitive to potential rotation (always symmetrical). Available in smooth or micro-textured finish.

Indicated for:

More glamorous result
Visible upper-pole volume
Wider base morphologies
Patients with sufficient natural tissue

Anatomical (teardrop) implant

Very natural result

More volume in the lower half, like a natural breast. Recommended for underdeveloped or aplastic breasts. Requires texturing to prevent rotation — this point should be discussed in consultation in light of ANSM recommendations.

Indicated for:

Ultra-natural result
Little existing breast tissue
Narrow-base morphologies
Reconstruction after mastectomy

Key takeaway: Shape alone does not determine the result. Base width, volume, placement, and tissue quality matter just as much — if not more — than implant shape.

2. Surface: smooth, micro-textured, or textured?

Implant surface has been at the centre of a major debate in recent years, due to the association between macro-textured implants and BIA-ALCL lymphoma.

Smooth

Recommended (round)

Perfectly smooth surface. Slightly higher risk of capsular contracture according to some studies, but no link with BIA-ALCL. Natural mobility within the pocket. Current standard for round implants.

Micro-textured

Recommended

Very fine, intermediate texturing. Adheres slightly to tissues without creating particles. Best compromise between stability and safety. Increasingly used.

Macro-textured

⚠ Withdrawn from FR market (2019)

Surface with pronounced texture (Biocell, Siltex…). Withdrawn from the French market by the ANSM in 2019 due to the increased risk of BIA-ALCL. No longer available in France.

3. Placement: in front of or behind the muscle?

The position of the implant relative to the pectoralis major muscle influences the result, recovery, and long-term complications.

Submuscular (retromuscular)

The implant is placed behind the pectoralis major muscle. The muscle forms an additional cover over the upper portion of the implant.

Advantages

+Better concealment of implant edges
+More natural result with little tissue
+Reduced risk of capsular contracture
+Better mammography visibility

Disadvantages

−Longer and more uncomfortable recovery
−Possible implant animation during muscle contraction
−More complex technique

Pre-muscular (subglandular)

The implant is placed directly behind the mammary gland, in front of the muscle. A simpler technique.

Advantages

+Faster recovery
+No muscle animation
+More immediately projected result
+Shorter procedure

Disadvantages

−Implant edges more visible with little tissue
−Slightly higher risk of capsular contracture
−Less suitable for slender patients

Dual plane:An intermediate technique called "dual plane" places the upper portion of the implant under the muscle and the lower portion under the gland. It offers a good compromise between muscle coverage and a natural result, and is widely used today.

Frequently asked questions

Who decides which implants to use?+

The surgeon and patient decide together during the consultation. The surgeon proposes options suited to the morphology and expressed wishes. The final decision belongs to the patient, after receiving all necessary information (including the risks specific to each option).

Can you try on implants before surgery?+

Yes, "sizers" (simulation templates) can be used during the consultation. They allow you to visualise the effect of different volumes inside a bra. Some surgeons also use photographic simulation software. These tools give an idea of the result but cannot guarantee an identical outcome.

Are silicone gel implants safe?+

Yes. Modern cohesive-gel silicone implants are safe and subject to rigorous oversight by health authorities. In the event of rupture, the cohesive gel remains localised. They are widely used in Europe and are the most natural-feeling implants available.