Background: Recent concerns regarding the association between macrotextured breast implants and anaplastic large cell lymphoma (ALCL) have led to renewed interest in the use of devices with less texturing. Smooth implants appear to have a decreased risk of ALCL; however, low implant adherence has led to questions about implant stabilization and bottoming-out. The senior author has used a split muscle support (SMS) technique to help support the implant infero-laterally in over 380 breast augmentations and augmentation-mastopexy using smooth implants, with a low complication and reoperation rate.
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