Round textured vs smooth? Which is better under the muscle and why?

I have had 3 consults. The doctor I like the best wants to use round textured implants in a dual plane position. I have been doing a lot of research and textured implants don't seem to be used as often. Is there really a big difference?

Doctor Answers 12

Ask Your Surgeon For The Pros and Cons of Textured versus Smooth

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I have my preferences, and I explain them to my prospective patients.  There are cases where the textured, anatomic implants may be my choice despite the increased cost.  These particular implants are useful in cases of borderline, mild drooping when the dual plane is used.  Each implant has pros and cons, and your surgeon can go into detail about which may be best for your situation.   I hope your experience goes very well.

Bismarck Plastic Surgeon
4.7 out of 5 stars 24 reviews

Breast Implants/Breast Augmentation/Anatomic Gummy Bear Implants/ Silicone Implants/Breast Implant Revision Surgery

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I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body.  Once we determine that we can choose the profile based on what you want or need to achieve.  

Implants under the muscle, there is less risk of capsular contracture.  Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon



Round Textured vs. Smooth?

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It is my strong preference to use a textured implant weather going over the muscle or under the muscle. In fact it is my preference to place an implant over the muscle whenever possible to avoid animation deformity from the pectoralis muscle as well as to achieve better tighter cleavage options than when we place an implant under the muscle.

Smooth vs. Textured implants

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There are many variables which come into play when considering implant choice. The choice of textured vs. smooth is one of these points. While the majority of plastic surgeons prefer smooth implants (with a recent survey putting the number at upwards of 80%), there are differences.

The advantage of textured implants is the purported lower risk of capsular contracture. This is generally mitigated by placement of the implant in the submuscular position. Additionally, when using anatomic shaped implants a textured coating is important to counter potential malrotation of the implant (with the textured surface acting as velcro). Smooth round implants on the other hand will demonstrate greater movement within the pocket.

Both options are safe and can be employed to obtain an aesthetically pleasing result. As always, discuss your concerns with a board certified plastic surgeon.

Donovan Rosas, MD
Kissimmee Plastic Surgeon
5.0 out of 5 stars 13 reviews

Round textured vs smooth? Which is better under the muscle and why?

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Research studies show that there is very little difference in outcomes or complications between smooth and textured implants when placed under the muscle. There is a slight increased risk of fluid collection around the implant when using a textured implant and if it is an anatomic shaped textured implant, there is a risk of rotation if the pocket dissection is not done precisely.


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My preference is for smooth round silicone gel implants but some surgeons like textured implants. Either one gives a good result in the right patient.  You can ask your surgeon why he prefers textured over smooth as well 

David R. Alfonso, MD, FACS
Grand Rapids Plastic Surgeon
5.0 out of 5 stars 66 reviews

Round textured vs smooth? Which is better under the muscle and why?

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The surface of the outer shell of breast implants can be smooth or textured and either can produce good cosmetic results.. There are pros and cons of each and the best implant for any particular patient depends on many factors including individual anatomy and desired outcome. Smooth implants usually have thinner shells and move more freely in their pocket than their textured counterparts. Many plastic surgeons believe that the thinner shell allows smooth implants to feel more natural. Implants with smooth surfaces are less likely to ripple. Textured implants were designed to lower the risk of capsular contracture, but whether it achieves that is open to debate. The textured implants may have a greater chance of leakage or deflation. One type of implant, known as the anatomical or teardrop-shaped implant ("gummy-bear" or form-stable), is only available with a textured surface, because this surface helps keep these contour shaped implants in position and diminishes the risk of rotation and distortion. Some of the differences of the implant surface characteristics depend on whether the fill material is saline or silicone gel.

Currently, most plastic surgeons in the U.S. prefer smooth implants. You should discuss your concerns with your plastic surgeon, who should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAP).

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Round textured vs smooth? Which is better under the muscle and why?

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Thank you for your question.  Your most important decision is her choice of surgeon and it sounds as though you have confidence in the surgeon you have chosen thus I would recommend he follow your surgeon's advice.

Placing the implant under the muscle as the preferred technique because it provides better coverage of the implant and reduces the risk of capsular contracture.

For what it is worth, at a recent national meeting of board-certified plastic surgeons a survey was done which revealed that 83% of the plastic surgeons present use smooth round silicone gel implants.

Round textured vs smooth? Which is better under the muscle and why?

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Thank you for the question.

The difference between these types of implants is the feel and surface characteristics of the outer surface of the implants. I do not think that there are any advantages of using textured implants and use the smooth round implants almost exclusively. Personally, I think that the surface coating of the breast implants are probably the least important factor when it comes to a successful outcome achieved with breast augmentation surgery. 

****Much more important, will be careful selection of your plastic surgeon and careful communication of your goals.  Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 


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 hope this (and the attached link, dedicated to breast augmentation surgery concerns) helps. Best wishes for an outcome that you will be very pleased with. 


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Smooth and textured implants are both good. There are a few additional potential problems with textured implants compared to the smooth. Since we have a wide variety of shapes and sizes of breasts, it is very helpful to have a nice selection of implants to find the perfect fit.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.8 out of 5 stars 18 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.