Smooth or Textured Implants for Someone with Muscle Flex Deformity? (photo)

I have problems with double bubble and muscle flex deformity that have not improved despite corrective surgery. After a second opinion from another doctor, the new surgeon suggests smaller implants above the muscle. Today I Mentor 500cc plusprofile coh2 textured. I have rippling in the cleavage area on one breast. The new implant would be Mentor plusprofile approximately 300-375cc. Should I choose smooth or textured implants? What are the pros and cons of smooth implants?

Doctor Answers 5

Addressing Breast Deformity & Bottoming Out

"Bottoming Out" is the term given to implant #displacement, where the implant drops down below the existing inframammary fold; the natural crease beneath your breast. This may occur when the fold has been released excessively during surgery or may be due to factors of the patient’s collagen and tissue integrity. The implants then sit very low on the chest with a lack of internal support for the implant itself.

Correction usually involves #restoring the crease beneath your breast to it's normal position with internal reconstruction of the capsule around the implant (#capsulorrhaphy). Sometimes a biologic fabric (Acellular Dermal Matrix or #ADM) can be used to attach to the breast tissue internally while supporting the implant.
This corrects the placement of the implant, redefines the breast shape, and also refines the internal fold. Stretch #Deformity occurs when the breast fold is in the correct position, however, the length of the tissue between the nipple and the fold stretches. This may be due to the patient’s soft tissue inelasticity and/or the size or shape of the implant that is used. Skin laxity can change with age, pregnancy, weight changes, or heredity. 
Correction of this problem usually includes skin excision as part of a mastopexy (breast lift/reshaping).
It may be necessary to use ADM to further support the breast tissue if too thin. Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery.

Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Double bubble deformity

Thanks for your question.  It would appear that your double bubble deformity is related to animation with muscle contracture, and this could be modified by placing implants submam marry,  I would also consider using textured implants to help reduce the contracture rate.  I am less concerned as to the brand of the implants used.  Smaller sized implants always help as well when trying to deal with  capsular contracture and bottoming out.  Let your Plastic Surgeon continue to give guidance about this

Good luck to you.

Frank Rieger M.D.  Tampa Plastic Surgeon

You have a good plan

If you place the implants above the muscle the contraction deformity will be corrected.  I would also go with a smooth silicone implant. The double bubble can be corrected at the sam time.

Miguel Delgado, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 75 reviews

Over or under the muscle when you have contraction deformities

is a difficult decision.  Before proceeding, I would want to know what kind of "corrective" surgery you had and because if you haven't had the dual plane technique and capsule work to improve the level of your implants, that seems like a reasonable alternative to changing implants and the pocket.  The dual plane technique divides the muscle completely and elevates the tissue off of the muscle as well.  If you believe you are too large and wish to downsize and cannot tolerate any movement of your implant, then your plan sounds reasonable.  In my experience, I find textured implants to fail more than smooth implants and I do not believe it will make a difference in your situation.  In my hands, smooth implants are revised much less and are much more forgiving when trying to massage your implants to better symmetry.  Best wishes in achieving your goals... your surgeon should be able to help guide you through this and understand what the revision policy is, if there is one.


Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Conversion to Sub glandular Breast Implant Position?

Thank you for the question and pictures.

Based on your description, I would advise you not to trade one problem (pectoralis muscle flexion deformity) for another (breast implant rippling). This is what may happen if you remove your breast implants and place them in the subregional position.  This is especially true given that you already described rippling in the cleavage area on one breast. Instead, I would suggest maintaining the breast implants in the sub muscular position, but releasing the scar tissue/ muscle inferiorly.  This must be done very carefully to avoid postoperative implant malposition. In my opinion, there are many advantages of maintaining the implants in the dual plane (sub muscular position),  even if some ( less severe) muscle distortion remains.

I hope this helps.


Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,487 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.