Smooth or textured implants for over the muscle BA? How likely is it for smaller implants (300-350cc) to slip out of the pocket?

Hello!  Thank you for your question!  The prepectoral or subfascial approach is certainly a viable one. In terms of the implant type, consideration for a textured implant would be wise as it would significantly reduce the capsular contracture rate vs a smooth a smooth implant in the same position.   Creation of a pocket to fit the implant would minimize rotation and displacement, especially if an anatomically-shaped implant is used. Hope that this helps. Best wishes!

In general I prefer to use a textured implant which seems to
get a grip on the surrounding tissue and is less likely to slip in the pocket.
Additionally going over the muscle prevents problems with a muscle pushing
the implant up or down.

This is a good question for your surgeon. Textured implants have been shown to decrease the risk of capsular contracture when placed above the muscle. However, in my practice I typically use smooth round implants placed below the muscle in a dual plane position. Placing the implant under the muscle provides another layer of camouflage for the implant, and decreases the risk of capsular contracture.

In general I prefer smooth implant placed behind the muscle unless there is a specific reason to choose textured implants or a subglandular pocket.  Different surgeons have different approaches and I don't think there is one right answer, but in my experience for most patients this approach can produce a very nice result.

Hello and thank you for your question.  The best advice you can
receive is from an in-person consultation.  I prefer smooth silicone implants over textured.  However, I also prefer under the muscle.  There are several advantages and disadvantages to over vs under the
muscle.  Under the muscle has the advantage of lower capsular contracture
rates, less risk of rippling, and better visualization with future mammograms. 
Most patients say that under the muscle also has a more natural look and
feel.  The size, shape, and profile of the implant is based on your
desired breast size/shape, your chest wall measurements, and soft tissue
quality.  This decision should be based on a
detailed discussion with equal input from both you and your
surgeon.  This entire surgery can be
performed with a small incision technique.  Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their results.   The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Dear Kate,For over the muscle breast augmentation, textured breast implants are the preferred choice because of lower capsular contracture rates.  The option of round versus anatomic (tear drop) shaped textured breast implants should be discussed with your plastic surgeon so that you know the advantages and disadvantages of each.  Good luck!

I prefer in  most cases to use smooth walled implants.  Each doctor may have a bit of a different preference. Best to be seen in person.

You should consult with a board certified plastic surgeon first. Most of us prefer smooth, round implants beneath the muscle. There are numerous benefits from this approach, which can be detailed during your consult. Best of luck.

The majority of people will get the best results with smooth implants under the muscle. This has the lowest chance capsular contracture and rippling. The implants will not slip out from under the muscle if done properly. You can consider implants over the muscle if you have greater than 2 cm soft-tissue pinch in the upper pole of the breast. In this instance, there is some data that textured implants may have a slightly lower risk of capsular contracture. This needs to be balanced with the new data that textured implants are associated with the ALCL lymphoma. I would schedule a couple of consultations with plastic surgeons who are certified by the American Board of Plastic Surgery who specializes in cosmetic plastic surgery, as evidenced by membership in The American Society for Aesthetic Plastic Surgery. Ask to see many pre and post opphotos and speak with previous patients. 

You will find the majority of surgeons choose the smooth silicone implant and place it under the muscle for the best results. Implants cannot slip out of a pocket but the pocket can be dissected to the wrong size or shape or the pocket can stretch out.