Subglandular Placement Smooth or Textured Implants on a B-cup? (photo)

My surgion is going to place the implant over the muscle (my choise), he says that a smooth implant above the muscle will give me CC without a doubt. But I am afraid the textured implant will give me rippling and "traction rippling". My own tissue is about 250-275cc so I have a large b, small c-cup now and want a fuller bust without being to busty. We decided 250cc in my bigger breast and 275cc in the smaller breast, mentor moderate + implant. What implant surface would you recommend me?

Doctor Answers 15

Subglandular or submuscular?

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I agree with your surgeon. The data suggests that the only time textured implants really reduce capsular contracture is when silicone gel implants are placed in the subglandular position. I think that you have enough breast tissue to cover over the implants, which are relatively small, without having to worry about visible rippling.

Implant texture

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I am not a big fan of textured implants for the reasons you illustrated. I prefer smoth in most cases. You  may want to ask your surgeon about the choice or even get a second opinion.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews


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In our practice we tell our patients that 225 CC equal about 1 cup size.. Weather you do textured or smooth its up too the patient. You didn't mention whether you were doing saline or silicone. If you're doing saline you're going to have a high probability of having rippling later in life.

Stuart B. Kincaid, MD, FACS (in memoriam)
Beverly Hills Plastic Surgeon

Smooth implants for suglandular placement

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We are talking about a subglandular gel implant we hope. The siltex texture is meant to reduce capsular contracture, though we still prefer a smooth implant as the implant might wear better. The moderate profile gel should not show through and though submuscular is better for some, you still can have a very nice result in a suglandular pocket.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Subglandular Placement

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Having seen so many patients with bad ripples back when textured implants were in common use I am reluctant to use them any more. 

But rather than debating smooth vs texture implants, I would suggest thinking more about submuscular placement. You don't tell us how you made your choice. Capsular contracture and rippling are both more common with subglandular placement of implants. Subfacial placement is also an option you can discuss with your surgeon.

Thanks and best wishes.

Jourdan Gottlieb, MD
Seattle Plastic Surgeon

Subglandularly placed implants, why?

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Why do you want your implants placed subglandularly.  The discomfort and recovery time of submuscularly placed implants is not that much more.  In my experience with patients, Submuscular implants are most uncomfortable for about 2-4 days and by about a week, you can resume your activities of daily living, but not reaching overhead or excercising for at least three weeks.  Implants place submuscularly have several advantages (less palpable rippling, less risk of capsular contracture-hardening of the implants, and easier to obtain mammograms when the time comes).  

Todd C. Case, MD
Tucson Plastic Surgeon

Breast Implant Position

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You should rethink your choice. Going subglandular or 'subfacial' will make you prone to cc and rippling with smooth implants, and rippling with textured.  Evidence based medicine points to appropriately sized, smooth and round implants placed under the pectoralis muscle to minimize these complications.

Best of luck.

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 100 reviews

Avoid subglandular! Subfascial will provide the most natural appearing breast augmentation

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Subglandular results tend to age very poorly.  I would recommend subfascial placement with low profile implants for the best results.  I use a technique called "Cold-Subfascial Placement" to preserve all of the fascia and retain support for a long lasting augmentation.  the decision of size should be based on your chest wall dimensions and the base width of your breasts.  I hope this helps!



All the best,


Rian A. Maercks M.D.

Textured vs Smooth Covering - Which Is Best Above The Muscle?

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Dear Suzisue, Wow - so many opinions.  Who are you to believe?  I did my first breast augmentation before 1980.  I have seen trends come and go.  I used smooth and textured implants, both above and below the muscle.  I believe you are making a mistake going above the muscle as a location.  I believe you are making even a greater mistake by considering textured implants.
Textured implants were the manufacturer's attempt to have a silicone covering mimic the polyurethane implant (the best implant we ever had).  Unfortunately, the texturing of both manufacturers failed to gain the success of the polyurethane.  In my experience, textured implants go hard and cause traction rippling, especially in the superpectoral space.  
I would recommend, as many others have, placing smooth silicone implants in the partially subpectoral space.  I believe this is a much more natural look, they stay softer, and you get a better mammogram.
As a sidebar note, you have large, fatty deposits at the front of your armpit.  These are known as axillary breasts.  This tissue is breast tissue when you went through puberty, known as the Tail of Spence.  This is easily suctioned out through a small incision in your armpit, and you can use this incision to place the drain mandatory in every breast augmentation.  The #1 cause of hard breasts is neither smooth or textured covering of implants, but is blood around an implant from capillary oozing.  A drain placed for as little as the first 24 hours improves your chance of soft breasts tremendously. 

Sub glandular implants give the most natural looking and feeling breasts

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While it is often necessary to place breast implants under the muscle because the woman does not have enough breast tissue to cover the implants with out being able to see and or feel ripples, you will get the most natural looking and feeling breasts by putting them under the breast. I also feel that silicone gel  textured implants are the best. With these the breast tissue will almost always will attach to the implant with out capsular contraction and keep the implant from moving around the pocket and avoid bottoming our or sliding out into the arm pit area. My preference for the incision is a peri areolar incision which is around the bottom have of the colored portion of the areola. This scar is almost alway great and imperceptible. Not only are the results better but the pain and discomfort is dramatically less. 

Carl W. "Rick" Lentz III, MD
Orlando Plastic Surgeon
5.0 out of 5 stars 17 reviews

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