I am planning on getting breast augmentation however I have pectus excavatum. Which silicone would be better texture or smooth ?

I already saw two doctors. The first one told me he was going to use textured silicone under the muscle so they won't move in together. And the other one told me he was going to use smooth silicone under the muscle. That I don't need texture silicone and that texture silicone can't be placed under the muscle.

Doctor Answers 8

Smooth versus textured implants

Silicone or Saline

Both silicone filled and saline filled breast implants are approved for use in the US by the FDA. Both are safe. Breast implants in general have had multiple studies looking at the incidence of collagen vascular disease in patients both with and without implants. There is now definitive evidence that silicone gel implants do not increase a woman's risk for any rheumatologic condition or any set of symptoms that may represent a new disease. Interestingly, the shell of both implants is made of a rubberized silicone. Therefore, what's actually touching the patient inside the pocket is silicone in both a saline and silicone breast implant. There are a few differences in saline and silicone implants that one should consider before choosing each. Saline implants, because they are filled with water, if properly filled, will collapse in the upper portion of the implant is the water reaches a meniscus and lays flat. Saline implants also have a more palpable edge that looks like a wave that you can feel and sometimes see as a wrinkle. When saline implants are grossly overfilled beyond the manufacturers stated range, these wrinkles can be alleviated by the implant, however, may feel very firm. Because saline implants are two convex discs essentially glued together, as they are filled the transition from the back of the implant to its front can be very abrupt leading to a much more visible edge. This will make the breast seem very round in patients with very little overlying tissue. In my mind, there are a few advantages of saline implants. Saline implants cost less and because they come with no fluid in them, can be placed through remote access ports like the bellybutton or underarm. Silicone gel implants do not wrinkle as much, feel more breast- like, look better under the breast with less harsh of an edge and therefore less visible. Because the gel is connected all the way through to the top of the implant, even in the upright position the upper pole of the breast does not completely collapse. I believe this is better in situations where after pregnancy or weight loss, the patient needs some fullness added to the upper pole of her breast. There's also a difference in how long these implants may last. In my experience, saline implants have a 10 year break rate that somewhere in the low teens and silicone gel implants are somewhere below 5%. In today's modern cosmetic breast practice, where Vectra 3-D imaging is commonly done, I don't think it's an advantage of saline implants that you can add some saline to them intraoperatively to make better symmetry. Using the Vectra 3-D imaging platform, different sizes and shapes and volumes of implants can be placed on a 3-D image of the patient to decide which implants make for the best symmetry and therefore nothing needs to be changed in the operating room. One of the criticisms of silicone gel implants in the past was that the gel with a broken implant could escape into the breast tissue and end up causing systemic illnesses or get into the lymph nodes. Modern silicone gel implants are made with a gel diffusion barrier on the inside such that the small particles of silicone cannot leech through the shell. Also, the shell itself is highly cohesive or sticky taking on more of the consistency of a gummy bear candy than of a liquid. In fact, if the implant is cut in half the gel will only extrude from the remaining implant if squeezed and then return to the shell when the pressure is let go. Therefore, in the event of a broken silicone gel implant the gel will be contained mostly inside of the shell of the implant. In my cosmetic breast practice, for the last 10 years or so, I have used mostly silicone gel implants. Hope this information is helpful.

Louisville Plastic Surgeon
4.7 out of 5 stars 54 reviews


I usually use round smooth silicone implants in most patients. I often put them under the muscle as well.  Each surgeon may have different preferences and plans based upon a given patient's anatomy. Good luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

BA Surgery and Pectus Excavatum

Hello and thank you for your question. Either a textured or smooth silicone implant can be used. I wish you the best in finding the right answers and there are a lot of great answers and information on the forum as well as on my website. Remember, it is best to see a Board Certified Plastic Surgeon who can in person examine you, take key measurements and go over with you your specific aesthetic goals. Bringing several photos of your "ideal" look can be helpful as well. My consultation is done at no charge, and with the consultation is a review and discussion about several things including incision location, implant placement, implant size, shape, type as well as the expected recovery period. I take personal care of all my patients to ensure optimum results. There are several key differences and some similarities in the types and shapes of breast implants. It is best to see and feel in person the different sizes, shapes and textures of the various implants during a consultation with a Board Certified Plastic Surgeon. Best of luck.

Benjamin J. Cousins M.D.
Board Certified Plastic Surgeon

Benjamin J. Cousins, MD
Miami Beach Plastic Surgeon
5.0 out of 5 stars 10 reviews

Pectus excavatum

You could have the surgery performed either in a subglandular or subpectoral fashion with textured or smooth devices respectively.  In general the subpectoral way is performed to limit risks of capsular contracture.  Your pectus deformity depending on severity will affect the way the pocket is dissected, but either technique should be adequate.  You may also consider fixing the pectus excavatum deformity at the same time as the augmentation. 

John Michael Thomassen, MD
Fort Lauderdale Plastic Surgeon
4.9 out of 5 stars 49 reviews

Bias of Surgeons

Breast implants used for breast augmentation is partially a bias of the surgeon based on their experience.  You can use either smooth or textured and get indistinguishable results in a hands of good surgeons.  What is more important is the pocket control (surgical procedure performed).
You most certainly can use textured under the muscle.
Best Wishes,
Nana Mizuguchi, MD

Nana N. Mizuguchi, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 50 reviews

Textured implants are increasinly used less

Textured implants were developed to reduce the incidence of capsular contracture ( a poorly understood process with development of scar tissue around the implant most commonly seen in the first six months after surgery).  They, however, have a higher rupture rate and when implants are placed behind the pectoralis major muscle the advantage of lower rates of contracture are negated. 
The one exception with textured implants involves shaped implants and if your surgeon has advised a "tear drop implant" that would negate the above.
In my experience smooth round high or ultrahigh profile patients with a smooth surface placed behind the pectoralis major muscle in a biplaner technique give the best results.

Tom Tracey Gallaher, MD
Knoxville Plastic Surgeon
5.0 out of 5 stars 13 reviews

Breast augmentation and pectus excavatum?

Thank you for the question.  In my practice, I usually use smooth round silicone gel breast implants for most patients who present with pectus excavatum. In my experience, breast implants tend to help “camouflage” the concavity, making the cleavage area look deeper. Often times postoperatively is hard to know that the patient initially presented with pectus excavatum.
Often, patients with pectus excavatum have medially sloped chest walls ( sloped towards the cleavage area); care must be taken during the breast implant pocket dissection to avoid the implants coming together too close in the sternal area.
Also, patients with pectus excavatum may have their nipple/areola complexes relatively medially positioned on their breasts; without intervention this inward leaning appearance of the nipple/areola does not improve with breast augmentation surgery.
Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I would suggest that you meet with well experienced board-certified plastic surgeons; asked to see lots of examples of his/her work. You may find the attached link, dedicated to breast surgery for patients with pectus excavatum, helpful to you as you learn more.
Best wishes.  

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,488 reviews

Breast augmentation with pectus excavatum

Without pictures or an exam it is difficult to determine which is the best choice implant in your case. Textured or smooth implants differ in their covering. A texture implant has less chance for moving or rotating after being placed. They both can be placed above or below the muscle. It depends on how thin the overlying skin is when choosing where the implant is placed.
Finally although a significant surgery, sometimes correction of the excavatum is needed to help the appearance of the chest.
Make sure your doctors are board certified plastic surgeons and good luck!

Ryan Hoffman, MD
Philadelphia Plastic Surgeon
5.0 out of 5 stars 39 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.