Under muscle round Mentor implant, smooth or textured? (photos)

Question

I am skinny with very small boob. I want to breast augmentation in this year then try to visited 2 doctor to get discussion. Both of them suggestion is under muscle Mentor round implant. However 1 was smooth and 1 was texture Siltex. From my own study for this selective ,smooth is more natural while texture is more keep in position. If I decide smooth ,how much mal-position occurrence and long-term position compare to texture? Thank in advance.

Eric Pugash, MD · Answer

Patients can find it confusing when different surgeons propose different options. Aesthetic surgery is a craft, and not necessarily based on hard science. Textured implants have been proposed to demonstrate lower rates of capsular contracture, which is the commonest complication with breast augmentation. While there is evidence that this may be the case when the implants sit over the muscle, there is none (as far as I am aware) that this is the case for submuscular placement. Moreover, textured implants show more rippling (which could be a concern in a very slender person like you), require longer incisisions, have higher infection rates, come with a risk of fluid accumulations months and years later, and have a risk of a very rare condition called ALCL. For these reasons I nearly always use smooth implants. All the best.

Ted Eisenberg, DO, FACOS, FAACS · Answer

In my experience with over 6600 breast augmentation patients, all have had round smooth implants with good long term positioning.  I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I do this with my patients, we then look at pictures of women with similar measurements with different size breast implants. My patients tell me that this process is very helpful in determining what size breast implant is right for them.
Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author

Stacey Folk, MD · Answer

There once was a day when we had very few options for breast augmentation. It’s actually wonderful that we have so many options now but it certainly can make it difficult when making choices for what is best for you. Smooth round silicone implants under the muscle is always a very reasonable way to go. There are downsides of implant mobility which can result in the implant dropping more than ideal, or falling a bit to the outside when patients lay down. These may not sound like big problems but spending some time on real self you will find that it is not an uncommon complaint. In 22 years of practice I had a tremendous amount of experience with  smooth round implants And this change in position over many many months postoperatively is my biggest complaint. When it comes to texturing each company has their own proprietary design and each has its own unique characteristics. With mentor the texturing is more of a bumpy surface or when I described as a cobblestone road. There is no tissue in growth into this textured implant so based on what others who use this brand commonly have taught me is that they still have the ability to move over time post-operatively. Allergan implants are very highly textured and create almost a Velcro type surface of tissue in growth so they tend to have the least mobility. This aggressive texturing has a higher association with anaplastic large cell lymphoma so this is another brand that I have rarely used in my practice.  I was reluctant to use anatomic or teardrop shaped implants when they first became available in the United States because I did not see any reason to change from smooth which I had used for years. I was very pleasantly surprised with my early and late results when using the Sientra anatomic implants. This texturing is different than the Mentor because there is less implant Mobility and less tissue in growth than Allergan. To date there have only been four cases world wide of ALCL with this brand. I have been extremely pleased with the Sientra anatomic implants with breast augmentation, and will use round textured if patients are really going for more fullness superiorly, but this is not as common a choice for me. As plastic surgeons we all have our own nuanced choices and I think this is a good thing. Our choices are based on our own personal experiences and we all do tend to create some pretty strong opinions even though they may not be backed up with a lot of data. It is just important that you feel very comfortable with your surgeon and your decisions. If there was truly one best way to do things we would all be doing the same thing. Best of luck with your upcoming surgery!  You appear to be an excellent candidate based on your photos regardless of what type of implants you select.

Lawrence N. Gray, MD (retired) · Answer

I agree with a sub-muscular augmentation. I strongly suggest smooth implants. There are no studies suggesting any advantage to textured implants under the muscle. Textured implants add another risk not found with smooth implants, ALCL, a rare cancer. Textured implants may need a longer incision and may feel too firm. There is no advantage to mal-position. It is a risk if the surgeon does not make a correct pocket, having nothing to do with the implant surface.

Brooke R. Seckel, MD, FACS (retired) · Answer

I agree with your choice.  When smooth round implants are placed under the muscle using a dual plane technique and the surgeon properly leaves a small internal bra composed of the serratus anterior muscle there should be no problem with malposition or bottoming out of the implant.  In 1 survey 83% of board certified plastic surgeons you smooth round cohesive silicon gel breast implants.  Recent concerns about textured breast implant associated anaplastic large cell lymphoma is another reason to use smooth-walled implants.

John Squires, MD (retired) · Answer

I have been doing plastic surgery in Denver for the past 27 years. During that time I have had a chance to use a number of different types of implants and different surgical techniques. When I first started out, I would occasionally have problems with smooth implants falling out to the side too far or dropping down too low. For a while I used textured implants to try to eliminate this problem. I found the textured implants to be much firmer than the smooth implants. The data about textured breast implants causing lymphoma, ALCL has convinced me that textured implants are not worth the risk. With modifying my surgical technique and limiting lateral dissection of the pocket I have almost eliminated implant malposition with smooth implants. Some surgeons believe textured implants have a lower rate of capsular contracture. While this may be true about the muscle. There is no difference below the muscle. For these reasons, I recommend smooth implants under the muscle and have been very happy with that choice.

Under muscle round Mentor implant, smooth or textured? (photos)

Answers (6)

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