Breast augmentation involves advanced medical devices. In this guide, we break down how breast implants are made, the types available, and the features that ensure long-term quality and safety.
What Is a Breast Implant Made Of?
Silicone breast implants are Class III medical devices, meaning they are designed for long-term implantation. To be approved for use in France, they must carry the CE mark, be listed with the French National Agency for Medicines and Health Products (ANSM), and follow strict regulations for traceability and safety monitoring.
Most implants consist of:
- A 3-layer silicone shell
- Filled with silicone gel or saline
The Different Types of Breast Implants
Breast implants are classified based on the filling material, shell characteristics, and shape.
Types of Filling Materials
Saline-Filled Breast Implants
Saline implants are known for their high safety profile and were exclusively used in France between 1997 and 2001. Today, they account for less than 1 % of breast augmentations in France. Nevertheless we still use them in more than 10% of cases because we do think they are the safest implants available. The only saline implants available in France are manufactured by Mentor, with production in Texas, USA, for over 30 years.
- These implants are always round in shape and come with a smooth shell.
- The saline solution is filled through a valve during surgery, which allows the empty implant to be inserted through a small incision of less than 2 cm.
Advantages:
- The saline solution is harmless to the body
- Implant wear or rupture is immediately noticeable, as the implant will visibly deflate.
- Saline implants are perfect for new minimal invasive breast augmentation surgery as they can be inserted through a 2 cm scar.
Disadvantages:
- The feel may be slightly less natural compared to silicone gel
- Risk of sudden deflation, possibly occurring while traveling
- An estimated risk of early rupture of 4% the first 2 years that might be related to the fragility around the filling valve
Silicone Gel Filled Breast Implants
Silicone gel implants are the most widely used implants worldwide.
- The shell is composed of three layers of medical-grade silicone elastomer, molded using a specific shape and layering process.
- An anti-diffusion barrier is inserted between the inner and outer layers to prevent gel perspiration.
- After manufacturing, the shell undergoes strict quality control, especially to ensure uniform thickness.
- The filling hole is sealed with a patch, and then liquid silicone gel is injected.
The medical-grade silicone gel comes from one of two FDA-approved manufacturers: Nusil or Applied Silicone.
- After injection, a catalyst is added, and the implant is heat-cured to polymerize the gel, making it cohesive.
- We specifically prefer the responsive gel by Applied Silicone, which creates a memory-shape effect, minimizes folds in the upper breast area, and offers high tensile strength, reducing the risk of gel fracturing during implant placement.
Importantly, this is a cohesive gel, not liquid silicone, meaning if the implant ruptures, the gel will not leak into the body—it stays intact.
Benefits of Silicone Gel Implants
- A more natural feel with fewer visible folds
- Longer lifespan compared to saline implants due to the absence of a filling valve
Drawbacks to Consider
- Requires a slightly larger incision (between 3–5 cm, depending on the implant size)
- Harder to detect rupture through a clinical exam alone, since the implant doesn’t deflate
- In rare cases, silicone gel migration may occur if the rupture goes unnoticed
We use silicone gel implants in over 90% of our procedures due to their durability and natural look and feel. While they tend to last longer, we recommend:
- A clinical exam and ultrasound every year
- An MRI every two years starting from the fifth year after surgery, to detect any silent ruptures.
Types of Breast Implant Shell Textures
The outer shell of a breast implant acts as the interface between the implant and your body. Your body’s reaction to the implant depends largely on the type of shell, which plays a key role in the risk of developing capsular contracture (hardening around the implant).
There are two types of capsular contracture:
- Early-onset contracture (within 6 months): Often linked to bacterial colonization on the skin or mammary gland around the implant (a phenomenon known as biofilm). This risk increases when bacteria enter in large quantities, blood accumulates around the implant, and the inflammatory response is weak.
- Late-onset contracture (5 to 25 years post-surgery): Caused by wear and tear of the silicone shell and/or implant rupture. Degraded silicone can trigger localized inflammation, hardening the breast over time.
Smooth Shell Implants
Smooth implants were the first to be introduced on the market. Saline-filled implants are only available with smooth shells and only come in round shapes.
Advantages:
- Can be inserted through a small incision
- Thinner shell, making them less palpable
- Low post-op inflammation, resulting in fewer immediate side effects
Main drawback:
Because of the minimal inflammatory response, white blood cells are less likely to eliminate bacterial biofilm around the implant. This can lead to a higher rate of early capsular contracture, as high as 10%.
This is particularly common with periareolar incisions, which involve cutting through the mammary gland and can release bacteria from milk ducts.
To reduce this risk, we recommend an inframammary incision (under the breast) and a post-op medical protocol designed to minimize biofilm and inflammation.
Micro- and Macro-Textured Shells
Developed in the 1980s, textured shells were designed to reduce the risk of capsular contracture. The rough surface induces an inflammatory response that disrupts collagen fibers, lowering the contracture rate from 10% (smooth) to approximately 3% (textured).
However, textured implants have been linked to anaplastic large cell lymphoma (ALCL) — a rare cancer of the immune system.
For this reason, we no longer use textured implants and strongly recommend smooth shell implants.
Types of Implant Shapes
Round Implants
Round implants remain the most commonly used worldwide. Their shape stays consistent even if the implant rotates after surgery. However, high-profile round implants with a flat base can sometimes rotate in an anterior-posterior direction.
Round implants provide significant upper pole projection, which enhances cleavage and creates a full, “apple-like” breast shape — although some patients may find this less “natural.”
Visibility of the upper edge can be a concern with prepectoral (above-the-muscle) placement, especially if the implant size exceeds 300 cc. In such cases, submuscular placement may be necessary, which can be more uncomfortable post-op.
We use round implants in about 20% of cases, especially when the patient already has natural breast volume and wants a more enhanced cleavage.
Ergonomic Implants (Motiva ERGONOMIX)
Motiva’s ergonomic implants are filled with a responsive silicone gel designed to mimic the natural movement of the breast. These implants adapt to body position and avoid the stiff look of older anatomical implants.
Although their base is round, they behave like anatomical implants once inside the body, creating a natural, teardrop shape.
They also have a smooth shell, which reduces the risk of ALCL.
These implants come in a wide variety of sizes and profiles, allowing for customized fitting based on individual anatomy.
We use ergonomic implants in more than 80% of our cases.
Final Advice
Following the PIP implant scandal, many women have become understandably more invested in researching their options. While this is positive, it’s also important to trust a board-certified plastic surgeon. Based on personal experience and scientific literature, your surgeon can recommend the safest and most appropriate implant for your body.
Our Recommended Approach
- If you already have natural volume and want a moderate increase with more cleavage:
→ We recommend round saline or round silicone-gel implants, low to medium projection, 200–300 cc
→ Inserted via a 2-3 cm incision under the breast or through the armpit in a retro glandular space.
This surgery can be performed under local anesthesia plus sedation through a minimal invasive fashion with early recovery
- If your natural breast volume is limited or the fold is poorly defined:
→ We suggest ergonomic silicone gel implants, 275–420 cc
→ Inserted through an inframammary incision under the muscle
In most cases, we work with Motiva implants, but the treatment plan is always tailored to your anatomy and aesthetic goals. We might use Mentor round saline, Polytech round gel or Perle round Gel