Do textured implants settle the same way as smooth ones?

Question

I'm 31yo 5'3 113lbs and I'm having my ba on 01/20/15. My ps suggested me sientra 410cc -440cc hp textured under the muscle but now I'm a little worried that they don't settle or acommodate appropriately. How long do textured implants take to settle in place?

Richard Baxter, MD · Answer

Part of what we call settling is just swelling going down, but smooth implants may settle a bit as the scar capsule forms and matures. Textured implants should not settle very much. Although the original purpose for texturing was to reduce capsular contracture, this is no longer considered the most important factor. Sientra's textured silicone gel implants have a higher percentage fill, which may mean slightly less tendency for rippling. This can be especially important for high profile implants in a thin patient.

Ira H. Rex III, MD · Answer

Textured implants are made to adhere to the surrounding tissues and therefore no settling would be expected. The appearance may change as the surrounding tissues change and the swelling subsides. With smooth implants, there may be some movement as tissues stretch, but this should only be minimal. Basically, even smooth implants are meant to stay where the surgeon places them.

Gary Lawton, MD, FACS · Answer

Textured implants do not settle the same way that smooth implants settle.  You need to define your goals and communicate them to the plastic surgeon.

John LoMonaco, MD, FACS · Answer

The upside is textured implants tend to stay in place in patients who may tend to have skin or tissue laxity. I find them useful on certain breast lift patients. The down side is they cause visible rippling and wrinkling at a rate much higher than smooth implants, especially in thin individuals.  They also have a higher rupture rate and are probably only marginally helpful at preventing capsular contracture.

Raffy Karamanoukian, MD, FACS · Answer

Textured implants take some time to settle, just as smooth implants do.  Textured implants are mainly used to reduce the risk of skin contracture. Best, Dr. Karamanoukian

Richard H. Tholen, MD, FACS · Answer

Textured implants are designed to adhere to the tissues, whether they are teardrop-shaped or round. Adherence is particularly important for teardrop-shaped implants, since teardrop-shaped implants would look really weird if they rotated upside down, for example! That means they must be placed in exactly the proper orientation, symmetrically, and cannot be expected to move, soften, settle, or drop.The breast tissues will get softer as surgical swelling diminishes, and the breast skin will stretch a bit, so your augmented breasts will feel softer, and perhaps look a little less "tight," but the implants do NOT "settle into place." They must be "there" in the proper position immediately after surgery, because if they adhere as they are designed to do, they cannot move. I'm not sure why this is so hard for both surgeons and patients to understand."Real" breasts are teardrop-shaped only when standing, and they round out and flatten as they drop slightly to the sides of the chest when reclining. Teardrop-shaped implants "stay" teardrop-shaped in every position, which is decidedly unnatural.Because you are slim and petite, with little of your own breast tissue, submuscular placement is the most appropriate choice for reduced risk of implant ripples, ridges, or "edge feel."Although submuscular implant placement is a good thing (this position has been shown to reduce bacteria contamination of the implants and the risk of capsular contracture), textured implants below the muscle (round OR teardrop-shaped) do not further reduce of capsular contracture risk, as submuscular placement already does that! They just cost more, require a larger incision, and do not "move" like natural breasts (since that texture holds them immobile in whatever position or shape they started with)!Ask why textured implants are recommended for below the muscle, as you would be best served, in my humble opinion, by smooth round cohesive silicone gel implants made by Sientra or either of the other two breast implant manufacturers here in the USA). Even if the textured implants cost the same as the smooth round ones, I would still prefer the smooth round implants. Click on the web reference link below for more information in my Comprehensive Guide to Breast Augmentation.  Best wishes! Dr. Tholen

Clayton L. Moliver, MD · Answer

Basic answer is mostly they don't 'settle' the way smooth do. I use them occasionally, especially on very thin patients. But unless you make sure they are placed way down in the pocket, the result can appear a little high. They are textured so they stay where they are placed. I used a bunch last year and have now gone back to smooth on almost everyone. I like the result better in most cases. Also the sientra implants feel a little too firm in my opinion and require a little larger incision.

Brian Windle, MD (retired) · Answer

Congratulations on your decision to have a breast augmentation.  Sientra breast implants do not really settle but smooth implants do not really settle either.  Usually what people refer to as settling is really swelling above the breast implant going away, giving the impression that the implant is dropping.  I can tell you that of all the implants I have used over the years, Sientra breast implants give the most natural looking and most natural feeling breasts.  You will love your Sientra implants.

Ronald V. DeMars, MD (Retired) · Answer

One of the primary reasons for texturing an implant is to allow the tissues to lock onto the implant surface, like velcro, so if they work right, once the are placed they never move. For some patients that is a good idea and for others it is not a good idea. It's the job of the surgeon to decide which style will help an individual meet her goals.

Lori H. Saltz, MD (retired) · Answer

After a breast augmentation there is stretching of the tissues to accommodate the increased volume.  As this occurs the breasts "settle".  A year after surgery the nipples will be, on average, about 1-2 cm lower than they were before surgery.  The implants will also sink into the breast tissues themselves as the lower part of the breast stretches as well.  In a small breast that is completely filled by the implant smooth and textured should settle about the same.  In a breast with some laxity smooth may settle more than textured (at least I have seen this).  Textured implants grip the tissues stay in place.  They must be precisely placed at the time of surgery.  Most critical of all is that the fold has to be placed in the right position for the size implant being used.  The contracture rate for textured implants placed over the muscle is much lower than smooth and I don't use anything else in that situation.  Under the muscle there is perhaps a tiny advantage.  Since I started using textured implants I have seen less malposition and less animation deformity.There is more of a "one breast" feel to textured implants.  Instead of feeling an implant sliding around under the breast they feel like part of the breast.  Most women don't like the way smooth implants sometimes slide out to the side when they lie down.  Textured implants stay with the breast.  Only the Allergen implants get tissue ingrowth and are more firmly adherent to the tissues.  Mentor and Sientra will move slightly within their pockets provided the pockets weren't made too large at the time of surgery.  Only Sientra makes a textured round implant that is filled with a fifth generation "gummy bear" gel so it is a little firmer, but tends to soften over 3-6 months.  It does not cost more than their smooth round implants.  They can be inserted with a Keller funnel through an incision that is not much larger than that used for a smooth implant so that does not influence my recommendation.Shaped implants are made of the most cohesive gel and do require longer incisions and very precise positioning.  Sientra's are the softest.  Shaped implants do cost more, but their shape is very natural.  I especially like them in small tight breasts in women who don't want a round shape.The bottom line is that there are advantages and disadvantages to all the implants.  Some will relate to your particular breast tissues and dimensions and others to the look you want.  The answer is best decided between you and your surgeon.  Every surgeon has their preferences.  I have done thousands of breast augmentations and what I have found is that no one implant or technique fits every woman.  The more I do the more I have come to appreciate the subtleties I need to look for.

Do textured implants settle the same way as smooth ones?

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