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 canreceive 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 themuscle. Under the muscle has the advantage of lower capsular contracturerates, less risk of rippling, and better visualization with future mammograms. Most patients say that under the muscle also has a more natural look andfeel. The size, shape, and profile of the implant is based on yourdesired breast size/shape, your chest wall measurements, and soft tissuequality. This decision should be based on adetailed discussion with equal input from both you and yoursurgeon. This entire surgery can beperformed with a small incision technique. Make sure youspecifically look at before and after pictures of real patients who havehad this surgery performed by your surgeon and evaluate their results. The most important aspect is to find asurgeon you are comfortable with. I recommend that you seek consultation with aqualified board-certified plastic surgeon who can evaluate you in person.Best wishes and good luck.Richard G. Reish, M.D.Harvard-trained plastic surgeon