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There are conflicting recommendations in the literature regarding the use of textured implants to reduce capsular contracture in subglandular breast augmentation. The authors reviewed the literature to evaluate the effectiveness of surface texturization in reducing capsular contracture.The electronic databases MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched for randomized controlled trials comparing textured with smooth implants for subglandular breast augmentation. Study quality was evaluated, and data were extracted from the relevant studies by two reviewers. Outcome measures were reduction in capsular contracture as defined by Baker grade, applanation tonometry, and patient self-assessment. Overall, the treatment effects were expressed as relative risk for dichotomous data and as weighted mean differences for continuous data.Six randomized controlled trials were identified with a total of 235 patients (470 breasts). Textured implants were associated with less capsular contracture as evaluated by Baker grade at 1 year (relative risk, 4.16; 95% CI, 1.58 to 10.96), 3 years (relative risk, 7.25; 95% CI, 2.42 to 21.69), and 7 years (relative risk, 2.98; 95% CI, 0.86 to 10.37) of follow-up. Applanation tonometry used as an objective measure of firmness, however, was not sensitive enough to detect any significant difference in contractures in the two groups (weighted mean differences, −1.54; 95% CI, −6.83 to −3.75). Interestingly, the self-assessment questionnaire revealed that capsular contracture or firmness is one (albeit a very important factor) of many facets in patient overall satisfaction.This systematic review suggests that implant texturization reduces the incidence of early capsular contracture in subglandular breast augmentation. However, further studies are needed to evaluate the long-term effect of texturization and confirm the long-term benefits noted in this study.