Textured round vs textured shaped vs smooth round, in dual plane position, what's the difference in a revision breast surgery?

I received 3 difference suggestions from board certified PS during consultations for revision surgery to correct existing capsular contracture: Allergan 410 silicon implants, Sientra smooth round silicon, and Mentor textured round silicon, around 300cc, in the dual plane position, my current implants are 20 yrs+, 270cc, textured round silicon above the muscle; if I wish to avoid the rotation risk of the shaped implants, would textured round implants be the most prudent choice?

Doctor Answers 10

Revision Breast Augmentation

Hello,

The risk of rotational deformity from a form stable implant (<1%) is less than the risk of malposition from a smooth round implant (5 to10%). Your decision to choose round textured or smooth, or form stable should not be based on that relatively low risk.  There are other factors that are more relevant, both positive and negative, regarding these three choices. This discussion should be an in person dialog, but I will elucidate some of the high points here.

Round smooth implants are most popular in this country, but in the rest of the world round textured. Prevailing thought is that round smooth ripple less, and that the risk of capsular contracture is the same as textured in the subpectoral position. Conversely, textured round implants have lower rates of dropout and lateral malposition. A Sientra study from a year ago suggested a correlation between textured implants and lower risk of capsular contracture regardless of placement, but a cause and effect relationship was not established. 

Form stable implants are firmer, so there is probably no increased rippling due to a thicker and stiffer, textured shell. Form stable implants enjoyed a lower risk of all complications in the FDA trial that got them approved.  Still, they are not for everyone. They are firmer and stiffer than round smooth implants, and for many having revision surgery, I caution them on this. The Natrelle 410 is firmest, and Sientra the softest.  Form stable implants give a more reliable upper pole enhancement, which is their main benefit. Additionally, the Mentor texturization is the coarsest, which may help reduce contracture and dropout/malposition.

Regardless of implant choice it's important that the entire capsule is removed and the new implant is placed in a subpectoral position (dual plane); this will help reduce the risk of another contracture.  

I hope this was helpful for you.

Best of luck!


Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Options for correcting capsular contracture

Under muscle placement (dual plane) is probably more important than the type of implant for capsular contracture. There is probably no benefit to shaped vs round, and texturing may make a slight difference so round textured would be a good choice in most cases. 

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 47 reviews

Implants

Thank you for the question and submuscular positioning of textured round or smooth implants would be a good idea along with the use of a protein matrix to help prevent recurrence.

Dr. Corbin

Frederic H. Corbin, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 60 reviews

Breast Implant Revision

Thank you for your question about breast implant revision.

Yes, textured round implants in the sub muscular pocket might be a good option for you.

To be sure, see two or more experienced, board-certified Plastic Surgeons for a complete evaluation to make sure you are a good candidate and that it is safe for you to have surgery.

I hope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 150 reviews

Shaped vs round and texturing

Thanks for the question. It's good to obtain several opinions in difficult cases like long standing implant exchange. The use of anatomic shaped implants in breast augmentation remains a controversial topic and there are arguments both for and against their use in aesthetic breast surgery from several experts at our national meetings. Most commonly, patients who have a small cup size and need a better transition of the upper pole. Shaped implants can also help control the breast shape in difficult revisions. All shaped devices are textured to decrease rotation, and they are firmer than round gel implants. I have used a significant number of shaped implants from all 3 brands, and they can rotate despite good pocket control and drains. This may be a risk you don't want to chance in elective surgery where you could have to pay for a revision. Interestingly, in the US most surgeons use smooth implants in breast augmentation, while textured implants are more common in the rest of the world. It ultimately comes down to your surgeon and his experience obtaining a nice result.

Wesley G. Schooler, MD
Santa Barbara Plastic Surgeon
4.8 out of 5 stars 17 reviews

Which Breast Implant

Textured round implants would be OK as would textured shaped implants, but year after years national polls indicate the shaped implants have little to no advantage and definitely sometimes a rotational disadvantage. As to brand, it is nothing more than surgeon's preference, but the Sientra probably has the most coherent silicone.

Ronald V. DeMars, MD
Portland Plastic Surgeon
5.0 out of 5 stars 24 reviews

Capsular contracture and implant choice

Hello and thank you for your question.  You will get different opinions from different plastic surgeons as different people have different techniques/strategies that work for them.  It would be helpful if you submitted photos to better assess your situation as I have no basis to determine whether or not you need a dual plane technique vs a submuscular position.  In general, textured implants recently have been shown to have a slight advantage in protecting against capsular contracture.  A submuscular pocket along with several other strategies have been found to be helpful too.  Round implants do not have the risk of rotation that anatomic implants hold, but all of the options you were given are viable options in the right hands.  In cases of capsular contracture, my personal preference is to use Sientra textured implants as I prefer the protective effects of texturing and I like the feel of the Sientra implants as they are not too hard nor too soft in my opinion and feel just right.  I would most likely place your implants in a new pocket that is submuscular since you had capsular contracture in the subglandular position previously. Hope this helps.

Sean Kelishadi, MD
Orange County Plastic Surgeon
5.0 out of 5 stars 22 reviews

Textured implants for correction of capsule contracture

Thanks for sharing your question.

I think its great that you have visited with more than one surgeon.  Its important to feel comfortable with your surgeon and feel like you understand your plan.  Without an exam it is difficult to be certain what your best option for correction might be.  I happen to like using the textured implants with highly cohesive gel.  However, I use all different types of implants depending on a particular patient's needs.  We have more choices than ever for breast implants and I believe this allows us to get as close as possible to selection of an implant that is truly tailored to a certain patients frame and goals for post-operative result.  

In general, a plan that allows for exchange to new implants with transition to a new plane should help correct your issue.  When creating this new pocket it is possible to create a specific space appropriate for either a shaped implant or a round implant.  Also, the risk for rotation of a shaped implant should be minimized with appropriate pocket control and planning.  

Make sure you are comfortable with your surgeon, and I suspect you will also feel confident about your implant choice as well.

Best Wishes

Steven M. Camp, MD
Fort Worth Plastic Surgeon
4.9 out of 5 stars 87 reviews

Capsular Contracture and Implant Choice

There are a number of factors which have been proven to have an effect on the development of capsule contracture. The rate of contracture in sub-mammary/sub-glandular augmentation is higher than that seen in sub-pectoral augmentation.

Additionally, the rate of contracture seen in textured devices is lower than the rates demonstrated in cases where a smooth device is employed. Textured devices are also less likely to rotate as there is capsular ingrowth (which has a velcro like effect) holding the implant in place. Controlling for device rotation is most important in shaped anatomic implants. Rotation is irrelevant in round devices (it is round upside down and right side up).

With regards to the particular implant options you have listed, there are round and shaped, smooth and textured variations. The round vs. shaped implants debate depends on the specific character of your breasts (Do you need preferential upper pole fill?). A textured device will further decrease the risk of repeat contracture.

Ultimately, to avoid the risk of device rotation entirely, a round device would be a reasonable choice.

Your board certified plastic surgeon can guide you in making this choice.

Donovan Rosas, MD
Westchester Plastic Surgeon
5.0 out of 5 stars 7 reviews

Revision options

There are many options for revisions and all the ones you mention sound reasonable.  I generally prefer smooth saline implants under the muscle.  I don't see the advantage of teardrop shaped implants at all.  Saline or silicone is really a matter of personal preference. Silicone are more expensive and have a higher risk if capsular contracture, but saline implants ripple a bit more. 

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 25 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.