What kind of breast implant has the least amount of risk? After some research, it seems like textured form stable round is best?

-Textured has less chance of capsular contracture. But putting ANY kind of implant under the muscle also reduces capsular contracture. So would using a textured implant under muscle reduce contracture even further, or no? -Are there any benefits to using form stable vs gel or saline? The only benefit I can think of is no leakage, but I'm not even sure if that matters or not. -I would choose round over shaped because there would be no worry about rotation. What are surgeons' opinions about this?

Doctor Answers 11

Breast Implant Choices

Every breast implant has pros and cons and there is no implant that is without risks. There are some implants that I feel have some advantages over others although each implant needs to be tailored to each specific patient, their goals and their particular anatomy. In general, I select silicone over saline implants as silicone is a softer, more natural, and better feeling material. With current technology silicone implants are very cohesive and the leaky silicone of the “old days” is no longer an issue.

With regards to smooth and textured, each has its pros and cons. Textured devices have a lower risk of capsular contracture, they are less likely to shift out of position over time, and they do not require breast massage after surgery. These implants do have a slightly higher chance of being palpated through the skin, as the shells are minimally thicker than their smooth counterparts. Textured round implants with more form stable gel tend to have a rounder look, similar to a high profile smooth round in many cases, so for patients who want a very natural appearance a textured anatomical implant is often the best option. These implants create a more natural upper breast slope. There is a chance of rotation with these implants, but when placed properly this risk is extremely low.

Placing implants under the muscle absolutely reduces the risk of capsular contracture. However, a recent study that I was involved in which was published in Plastic Reconstructive Surgery journal showed that adding the textured implants further decreased the risk of capsular contracture.
All silicone gel implants are form stable to a certain degree. However, anatomical implants and certain manufacturers’ textured and smooth implants are more form stable than the average 4th generation smooth silicone implant. Form stability is a good thing as long as the implants do not feel excessively firm.

Each surgeon will have their own preferences as far as which implant they feel works best for their patients. In many cases, there is no right answer, but a wide variety of implants that can be selected to achieve the best results for each given patient.

Santa Monica Plastic Surgeon
5.0 out of 5 stars 53 reviews

Under vs Over the muscle

Under the Muscle (sub-muscular) – When you hear the words “under the muscle” this actually means the breast implant is placed partially under the pectorals major muscle. Submuscular placement may be more uncomfortable the first few days following surgery due to the disruption of the muscle. The possible benefits of submuscular placement are that it may result in less palpable implants, decreased risk of capsular contracture, and easier to image the breast with a mammogram. Under the muscle placement is recommend for women are are very thin with very little breast tissue. The partial muscle coverage will hide the implant better and help avoid visibility of any implant imperfections such as rippling. The appearance will also look more natural.
Over the Muscle (sub-glandular) – Over the muscle means above the muscle and under the breast tissue. This placement may make your surgery and recovery shorter and you will likely have less discomfort. This placement can provide a slight “lift.” Sub-glandular placement can result in more palpable implants, increased risk of capsular contracture and more difficult imaging of the breast with mammogram. This placement is often recommended for those patients with mild breast sag, but do not want a breast lift (mastopexy) and for tubular breast deformity.

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

What kind of breast implant has the least amount of risk? After some research, it seems like textured form stable round is best?

Hello adviceforme,
Thanks for your question.
For the most part, breast implant risk is similar by implant type.  When you break it down by risk category, some pearls do come out.
A round texturized gel implant, placed in an exact subpectoral pocket, should have the least theoretical risk. This being said, texturized implants need to be placed perfectly for best outcome.
If this is your choice, I recommend that you find a surgeon who uses this type of implant predominantly for your best chance at a great outcome.
Good luck,
Dr. Shah

Manish H. Shah, MD, FACS
Denver Plastic Surgeon
4.8 out of 5 stars 56 reviews

What kind of breast implant has the least amount of risk?

True risk is pretty much the same within a small range of percent with all implants, however results may be significantly different. You would need an exam by an experienced surgeon who will then give you recommendations to suit your needs. 

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 27 reviews

Which is lowest risk?

Recent studies in the US and Europe suggest textured implants, under the muscle, and placed through a fold incision do better over time with less CC and revision surgery. The MemoryShape FDA numbers are the lowest reported so far. The risk of rotation was 1.8% while the reduction in CC of shape vs round is much more significant than the risk of rotation. Best wishes, Dr. Aldo

Aldo Guerra, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 202 reviews

Best Breast Implant?

This is a good question without a good answer.  There are now hundreds of different breast implants available to plastic surgeons for use in breast enhancement surgery.  They are all FDA approved and years of research have proven these devices to be safe and non toxic to the body.  There are advantages and disadvantages to each style and type of implant.  It is very important to match the right implant to the right patient, this requires an in depth consultation with detailed photographs, measurements, sizing systems, before and after photographs and talking with other breast implant patients.  It is only after this thorough evaluation that the "best implant" can be determined for YOU and only YOU!

Please see a Board Certified Plastic Surgeon who specializes in breast enhancement surgery to maximize the best result.

Good Luck!

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 75 reviews

Implant choices

There is no one easy answer.  There are slight advantages to textured over smooth, but disadvantages as well.   A small improvement in capsular contracture rate may be offset by a greater risk of rippling.  The biggest trade off with a shaped implant is the more natural shape vs. the risk of rotation.  

David A. Lickstein, MD
Palm Beach Gardens Plastic Surgeon
5.0 out of 5 stars 6 reviews

What type of breast implant is best for me?

A breast augmentation procedure with implants placed via an incision in the inframammary fold, placed in the sub-pectoral pocket, utilizing the "no touch technique" with a Keller funnel, utilizing nipple shields, using preoperative Intravenous antibiotics, intra operative antibiotic irrigation, and post operative oral antibiotics will carry a fairly low risk of a capsular contracture regardless of the type of implant used.  As to which type of implants are "best" really depends on your breasts pre-existing appearance, shape, thickness of the breast envelope, as well as many other factors such as constriction of the lower pole of the breasts, droopiness, etc. I suggest you choose your surgeon wisely, be certain of his/her certification by the ABPS, be certain that this surgeon has a vast experience with breast augmentation over many years, look at photos of his/her typical results, and ask a lot of questions. Please don't think I'm avoiding your specific questions, there are just too many variables based on your own unique breast anatomy to answer which type of implant would be ideal for you as an individual. This would require a detailed examination. Best of luck!

Jeffrey K. Scott, MD
Sarasota Plastic Surgeon
5.0 out of 5 stars 54 reviews

Choosing your breast implant

There are many issues which can be discussed when choosing your breast implant. This includes capsule contracture, shape, size, failure rates, side effects after rupture ..... You should get all of these explained to you when you go for a consult. You can also find good info on this site.

Ronald Schuster, MD
Baltimore Plastic Surgeon
4.9 out of 5 stars 78 reviews


The least risky implant of all is still the smooth round saline implant since it is a bag filled with salt water. However, I would suggest meeting with a board certified plastic surgeon, being examined and measured, and see what size, style and shape would work best for you.

Connie Hiers, MD
San Antonio Plastic Surgeon
4.6 out of 5 stars 13 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.