There are several different manufacturers of implants that provide different types of gel implant. All implants are smooth now. The firmness will depend on patient factors that provide the most natural softness while avoiding wrinkling. A tissue expander may be the initial approach to implant surgery if there is loss of tissue or upcoming radiation.
This illustrates a typical immediate reconstruction using a tissue expander. A second surgery replaces the expanded implant to a permanent implant. Sub-pectoral or superficial options may be discussed with your plastic surgeon. There is often a role for fat transfer to improve the natural appearance.