What does Sientra mean when they say "Silimed’s proprietary texturing method is designed to promote tissue in-growth?"

Yes, they are referring to the implant shell.   There are three implant manufacturers in the US and they either have different methods of texturing the shells for their textured implants.  Allergan uses a process where salts are spread on the shell and later washed off (salt-loss technique), leaving the implant shell with an irregular, textured surface.  Mentor uses a process where the implant shell is stamped with a sponge, leaving a more regular, textured surface.  Sientra does not disclose the specifics of their texturing process but the result is somewhere in between Allergan's and Mentor's.Tissue in-growth refers to a Velcro-like connection that growths between your bodies tissues and the implant.  If you open the capsule around a smooth breast implant, there is no bond between the implant and the capsule.  When you open a capsule that forms around a textured implant, there is a Velcro-like bond between the capsule and the implant.  This bond can be easily broken, if needed in surgery, by simply running a finger or instrument between the capsule and implant.  That tissue in-growth with textured implants is what helps keep the implant in place over time.

Every implant manufacturer uses a separate proprietary technique for creating the shell texturing.  Texturing promotes tissue ingrowth, think of it as velcro, so that the implant does not move/settle the way smooth implants move.

Sientra breast implants are made by the Brazilian company Silimed, which started in Rio de Janiero in 1978 to import French breast implants into Brazil for growing plastic surgery use in that country. In 1981 Silimed began to manufacture its products in Brazil, in a small
laboratory compatible with the technical requirements of the time. One
year later, it already exported to other countries in Latin America and,
in the following years, expanded to foreign markets, with products
geared towards various specialties.

Silimed began construction of a new factory in 1985, which started
to operate in early 1989. In 2000, a second factory was built,
starting its activities in 2003. After 35 years in the market, Silimed
operates with two factories in Brazil and exports to all five
continents.In 1990, Silimed began manufacturing textured mammary implants. In 1999, Silimed received 510K approval from the FDA (Food and Drug Administration) in the USA for its textured and smooth silicone elastomer implants. [this information from Silimed's own website history of the company]On March 9, 2012, Silimed's Sientra silicone gel mammary implants received FDA approval for sale in the USA. Silimed is the first manufacturer
outside the USA whose silicone mammary implants, smooth and textured,
are approved in the USA. Furthermore, Silimed became the first
manufacturer in the world whose form-stable (teardrop shaped) textured silicone gel implants were approved in the US market. (Allergan--formerly Inamed--subsequently received FDA approval for its style 410 textured-surface shaped highly cohesive silicone gel implants, the popularly-named "gummy bear" implants).But because Sientra's high-strength, cohesive, form-stable (teardrop-shaped), textured-surface implants were actually first to be FDA-approved in this country (and because they have used that terminology in their website information about their implants), many now call these "gummy bear" implants as well. The terminology is therefore confusing, like calling every facial tissue "Kleenex" when it might actually be a Puffs, or every copy machine a Xerox, when it could be a Minolta. But you know what I mean.Each of the 3 USA breast implant manufacturers has shaped, textured-surface cohesive (or ultra-cohesive) implants, and each manufacturer has their own patented or "trade secret" way of creating the textured surface--the  "proprietary" texturing method. McGhan (now Allergan) implants use a lost-salt technique where salt crystals create the high and low spots of the texture, designed to promote tissue adherence and ingrowth. The salt is then washed away before implant sterilization. This tissue adherence is not unlike Velcro, but is not the "hook and fabric loop" structure that Velcro uses. This texture mimicked the structural properties of polyurethane-covered implants from 2 1/2 decades ago, where tissue ingrowth was shown to reduce (or prevent) capsular contracture (CC). CC was much more common at that time, since breast implants were usually placed ABOVE the muscle and just below the breast tissue, where there was significant bacterial contamination from the normal bacteria within the breast ducts. The texturing was also thought to "break up" the unidirectional collagen scar fibers that aligned themselves along a smooth-surface implant, contracted, and formed CC. And it worked! CC rates diminished.Mentor developed their own textured-surface implants (Siltex), and their method of creating the surface texture was also proprietary (and different). It was a stamping process that created a much more finely-grained or almost "fuzzy" surface. My own experience with these implants showed that tissue ingrowth and adherence did not happen with this type or method of texturing, and years of experience with saline textured-surface implants showed a higher leak rate.Sientra's method of texturing implants leads to a texture much more similar to the Allergan texture, but their technique is, again, proprietary, meaning they have their own way of creating what they feel is a better texture designed to promote adherence, ingrowth, CC reduction, and implant rotation avoidance (since an upside-down teardrop-shaped implant or sideways-positioned implant that was "stuck" there looks really wonky!We know from other areas of bioengineering (such as rough-surface titanium hip or other orthopedic implants) that human tissues do not adhere equally to all man-made textured surfaces or materials. But we do know that textured breast implants DO reduce CC, particularly when used above the muscle. But since most plastic surgeons now place their breast implants BELOW the muscles, and have learned that even without texture this reduces CC significantly, the place for texture below the muscle is less for prevention of CC than for prevention of rotation to an abnormal position! We also know from X-ray studies of women with smooth round breast implants and women with textured teardrop-shaped implants, the round implants are actually teardrop-shaped when the woman is standing, and indistinguishable from textured teardrop-shaped implants. They looked identical! But when reclining, the smooth round implants assumed a flatter round shape and dropped slightly to the side of the chest, just like naturally large(r) breasts do, whereas the teardrop-shaped implants did not move and poked straight up in an unnatural still-teardrop shape, making these so-called "anatomic" implants LESS anatomic than the smooth round ones.Silimed is the first implant company that has decided to sell its products only to American Board of Plastic Surgery-certified "real" plastic surgeons, not to physicians of various specialties who wish to perform breast augmentation. Sientra implants also come with a 2 year capsular contracture warranty that replaces the implants in the event of baker 3 or 4 CC (but does not cover operating room, anesthesia, or surgeons fees). Sientra textured surface high strength cohesive silicone gel teardrop-shaped implants typically cost more than the smooth round cohesive silicone gel implants by Sientra AND the other two implant manufacturers. As mentioned above, textured implants may not be appropriate for below-the-muscle placement, and may have a somewhat unnatural look when reclining, so the extra cost may not provide an advantage over smooth round cohesive implants by Sientra or the other two breast implant manufacturers. Discuss this carefully with your ABPS-certified plastic surgeon. We ALL have the availability to utilize these implants if you want them, but there may be other reasons some surgeons promote one brand over another, including listing on the implant website.Consider all of these facts before choosing one "brand" over another, both implants AND plastic surgeons! Best wishes! Dr. Tholen