Do smooth anatomical implants exist?

Question

Anything I've come across has all been textured to keep them from rotating but I've multiple concerns w/ textured implants (ALCL, unnatural movement etc). I'm looking to get a subfascial placement (under the muscle fascia - not subglandular) and don't think rotating will be as big a factor. And I don't want to go w/ round b/c rippling & I want a more natural/gradual slope but don't have enough tissue to accomplish that w/ round implants. *Pls no comments about sufascial being a "gimmick"* Thanks

Donovan Rosas, MD · Answer

Shaped devices and texture go hand in hand.The purpose of texture (in the case of shaped implants) is to prevent device rotation. In contrast to round devices, shaped implants need to maintain a particular orientation within the pocket. If a round device rotates, it is still round. If a shaped device rotates, it no longer conforms to the classic tear drop shape.
The texture acts as a sort of "velcro" allowing capsular in-growth and holding the orientation in place. For this reason, shaped implants are always textured.
Textured devices also have a lower rate of capsular contracture, however, when placed submuscular the difference is negligible.With regards to your particular situation, a shaped device will deliver a more gradual slope when placed above the muscle (the downward pressure of the muscle across the upper pole of the device essentially converts round submuscular implants into shaped devices; studies have shown that when placed submuscular most cannot tell the difference between the devices post op).
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

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

Thank you for your important question.  Unfortunately all anatomical breast implants are textured.  That is why the wall of the textured implant is thicker so it is strong enough to maintain the anatomical shape.  Smooth-walled implants are only available in round.

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