Is my opinion
the implants placed under the muscle tend to have a softer and more natural
look because the muscle drapes gently over the top of the implant. When
implants are placed above the muscle, particularly in the very thin patient the
result can look like a coconut stuck to the chest. There is also
clear evidence that capsular contracture rates and infection are lower
when implants are placed under the muscle and that mammography is better.
For my athletic patients, which is about 99% of my practice, when they go to
the gym and bench press or weight lift the implants will look less natural for
that moment in time because the pectoral muscle pushes on the implants.
But for the 97% of their lives, not bench pressing or weight lifting a
submuscular implant I believe he is a much more natural appearance. While
a woman with a fuller breast can sometimes hide a subglandular implant pretty
well, a subglandular implant can burn bridges for patients who might want a
breast lift in the future. A subglandular implant separates the breast
tissue from the muscle. If the patient wants a lift in the future the blood
supply to the nipple and the areola is more in jeopardy. Best wishes.
experience textured implants, because of the manufacturing process, create a
slightly thicker shell which has the potential to cause more rippling and
visible, palpable problems with the implant. This is especially true with
saline implants. Shaped implants generally require a textured surface to
promote "sticking" or adherence of the implant to your own tissue to
prevent rotation of the device. If a shaped device rotates inside your body the
result is unpredictable. The studies indicate there is little difference in
capsular contracture between smooth and textured implants as long as they are
under the muscle. Hope this answers your question. Most plastic surgeons in the
US use smooth round silicone gel filled implants placed under the muscle. Dean Vistnes.
A: Sub muscular vs Sub Glandular placement
Submuscular placement may be more uncomfortable the first few days following surgery. The possible benefits of submuscular placement are that it may result in less palpable implants, less capsular contracture, and it will make it easier to image the breast with mammography. The appearance may be more “natural” for patients who are very thin. Subglandular placement may make your surgery andrecovery shorter and you may have less discomfort. This placement may provide a slight “lift”. Subglandular placement may result in more palpable implants, more capsular contracture and more difficult imaging of the breast with mammography. This placement is often recommended for those patients with sagging, but do not want a breast lift (mastopexy) and for tubular breast deformity
Thank you for your question. Smooth breast implants are used far more commonly in the United States than are textured breast implants. There is no reason for you not to have smooth breast implants placed beneath your chest muscle, they should work fine. You're correct that textured implants can be firmer, and are more difficult to place during surgery. Always respect your own feelings and have what you want.
In general, textured implants can be more palpable and visible. Smooth implants under the muscle are a more common choice.
Kenneth Hughes, MD
Los Angeles, CA
I would recommend choosing a surgeon you trust and go with their guidance. There are a lot of opinions about the differences between smooth and textured implants. I can present data from the literature to argue for any opinion.
Many of the problems that are seen I believe are due to many different choices made in the placement of the implants such as pocket, size, type of implant, etc. As one surgeon has mentioned most US surgeons place smooth implants under the muscle yet we still see the problems that this technique is supposed to minimize. I realize my answer may not help guide you at all but I would recommend that you interview different surgeons and express your expectation for your result. Then let the surgeons guide you in what they feel will give you the best result in their hands. Then choose the one you have the most faith and trust in.
I prefer smooth implants over textured. Smooth implants have a thinner shell, are softer in feeling, and are less likely to rupture. Overall, there is a lower complication rate with smooth implants compared to textured implants
This depends on the saline or silicone and which manufacturer of the implants. Some textured saline implants have a thicker shell that may make the implant more palpable. One silicone implant company warranties their textured silicone implants against capsular contracture for two years when the implants are placed under the muscle. This decision is best made in consultation with your American Board of Plastic Surgery certified surgeon.