Aesthetic Plastic Surgery

, Volume 43, Issue 6, pp 1454–1466 | Cite as

Smooth Prosthesis: Our Experience and Current State of Art in the Use of Smooth Sub-muscular Silicone Gel Breast Implants

  • Nicola ZingarettiEmail author
  • Francesca Galvano
  • Paolo Vittorini
  • Francesco De Francesco
  • Daria Almesberger
  • Michele Riccio
  • Luca Vaienti
  • Pier Camillo Parodi
Original Article Breast Surgery



The objective of this clinical review is to provide an overview of the use of silicone gel-filled breast implants placed in the sub-muscular position, with a focus on complication rates reported for both smooth and textured implants. Furthermore, our experience in this field is also reviewed.


MEDLINE, EMBASE, Web of Science, Scopus, the Cochrane Central and Google Scholar databases were reviewed to identify the literature related to smooth breast implants. Each article was reviewed by two independent reviewers to ensure all relevant publications were identified. The literature search identified 98 applicable articles. Of these, just a few articles were found to have a therapeutic level of evidence. The reference lists in each relevant paper were screened manually to include relevant papers not found through the initial search.


Eight articles report the risk of capsular contracture when the breast implants were placed in the sub-muscular position. Six of these articles report a similar rate of capsular contracture in smooth and textured implants. Local complications such as wrinkling, late seroma and double capsules were found to be associated with the use of textured breast implants (4 articles). All articles concerning BIA-ALCL reported a total absence occurring in smooth breast implants. All cases have been associated with textured mammary prostheses.


With our expertise in the field and the results of this up-to-date literature review, it can be concluded that there are no significant advantages of using one type of implant surface over the other when placed in the sub-pectoral position.

Level of Evidence V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors


Smooth sub-muscular silicone gel breast implants Breast augmentation Prosthetic breast reconstruction Capsular contracture BIA-ALCL 


Compliance with Ethical Standards

Conflict of interest

All authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationship, allilations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The authors declare that they have no conflicts of interest to disclose.

Ethical Approval

Our institutional ethics committee approved the study design.

Informed Consent

Written informed consent was obtained from each patient prior to the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2019

Authors and Affiliations

  1. 1.Clinic of Plastic and Reconstructive Surgery, Department of Medical Area (DAME), Academic Hospital of UdineUniversity of UdineUdineItaly
  2. 2.School of Medicine and Psychology, Sant’Andrea Hospital“Sapienza” University of RomeRomeItaly
  3. 3.Clinic of Plastic and Reconstructive SurgeryPresidio Ospedaliero Villa LetiziaL’AquilaItaly
  4. 4.SODC Chirurgia Ricostruttiva e Chirurgia Della ManoAOU Ospedali RiunitiAnconaItaly
  5. 5.Research and Training Center in Regenerative SurgeryAccademia del LipofillingAnconaItaly
  6. 6.Department of Plastic Surgery, IRCCS Policlinico San DonatoUniversity of MilanMilanItaly
  7. 7.Department of Plastic Reconstructive Surgeryc/o Ospedale “S. Maria Della Misericordia”UdineItaly

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