Capsular Contracture Rates in Subfascial and Subglandular Breast Augmentation With Smooth vs Textured Implants

Subfascial placement has been reported to reduce capsular contracture (CC) in primary breast augmentation. Given the shift toward smooth implants, it is unclear whether the perceived advantage reflects the surgical plane or historical implant selection. This study compares CC rates between subfascial and subglandular breast augmentation stratified by implant surface. A systematic review and meta-analysis were conducted. PubMed (National Institutes of Health, Bethesda, MD), Embase (Elsevier, Amsterdam, the Netherlands), Scopus (Elsevier), Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane Library, London, UK), and Google Scholar (Alphabet, Inc., Mountain View, CA) were searched through April 2025. Studies reporting CC in primary augmentation with specified implant surface and plane were included. Random-effects models generated pooled incidences and odds ratios. Subgroup analyses evaluated studies published in the last decade with a mean follow-up duration of >24 months. Thirty-three studies met inclusion criteria. Across all years, studies comparing subfascial vs subglandular placement for smooth implants demonstrated no statistically significant difference in CC rates (7.2% vs 17.1%, P = .13). Studies evaluating textured implants similarly showed no significant difference between planes (0.9% vs 3.7%, P = .08). In studies published since 2015, smooth implants demonstrated comparable CC rates between subglandular and subfascial placement (8.2% vs 10.3%, P = .54). In studies with a mean follow-up of >24 months, no significant differences were observed for smooth implants, whereas textured implants demonstrated lower rates with subfascial placement. Microtextured implants demonstrated the lowest CC rates. When controlling for implant surface, CC rates do not differ significantly between subfascial and subglandular placement. Previously reported reductions in CC with subfascial augmentation appear driven by textured-implant cohorts. In contemporary smooth-implant practice, CC rates are similar across prepectoral planes. Level of Evidence: 3 (Therapeutic) For image description, please refer to the figure legend and surrounding text.