Textured versus smooth silicone implants. What are the key factors I should consider in selecting smooth versus textured?

It appears as though many Plastic Surgeons in the United States prefer smooth over textured silicone implants. I have read that most of the rest of the world prefers textured implants. What explains this difference? What are the key factors I should consider in selecting smooth versus textured?

Doctor Answers 6

Comparing textured versus smooth silicone implants requires some background knowledge

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This is a great question on a couple of levels.  First, the conversation about texturing in general is an important one to have.  In my opinion the reason why most American surgeons prefer smooth implants is because change comes slowly, and we are behind the rest of the world when it comes to silicone implant technology.  I have colleagues in Europe and Latin America who haven't used smooth implants in over 10 years - they use exclusively textured.  This is because number one, the texturing allows for more control over the position of the implants because of the friction against the tissues, and number two, it has been known for some time now that the incidence of capsule contracture is measurably less when textured implants are used.  I try to use as many textured implants - round or shaped - as I can in my practice now.  There will always be some situations in which a smooth implant works best, but in general, I think texturing offers many more advantages and fewer disadvantages that are less likely to cause a problem.  There may be some slight increased risks of rupture or rippling with textured devices, but the bottom line is that there is no perfect device, and what we have to do is select the one that has the least amount of all risks across the board and the greatest chance of giving us the most aesthetically pleasing results.  

This leads to the next issue, and that one s more complicated.  Each of the 3 companies in the US (I'll only address US implants, as that is where I practice) has their own proprietary texturing and their own proprietary gel.  These are very important considerations, as the method used for texturing could improve the results or increase the risks compared to another.  The same goes for the gel - one gel may perform better than another.  In addition, the one with the "best texturing" may not be the one with the "best gel" also.  Suffice it to say that all 3 companies make excellent implants in general, and I use them all because they all have strong points and weak points, and in one case, I may need the strength of one type of implant more than the other, whereas in another I might be willing to compromise on what I think is the weak point in order to gain the strength of that implant for that particular case.  I will stop here because I don't want to launch into a wild and confusing discussion about all of the characteristics of breast implants, but I did want to point out that these days the selection of implant isn't always as easy as deciding on one characteristic.  This is why it is important to consult with a board certified plastic surgeon who has the experience with and the access to all of the different types of implants available to help you decide exactly which implant will work best in your individual situation.  Good luck.

San Diego Plastic Surgeon

Textured vs Smooth Implants

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Smooth is generally preferred however textured has been associated with a lower rate of capsular contracture (although new research has found that this may not be the case anymore).

Textured vs smooth implants

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You are correct that textured implants are favored elsewhere, whereas smooth implants are used more frequently here in the united states. Currently most US studies addressing this issue show no difference in capsular contracture between smooth and textured in submuscular augmenation.  Almost all US literature points to decreased capsular contracture in the subglandular position using textured. Foreign studies can sometimes be a little bit difficult to factor in to the current US based literature.  That is in no way trying to indicate that foreign studies are inferior.

I use mostly smooth implants beneath the muscle because I get consistently good results and have not seen an increase in capsular contracture using smooth implants.

If you would like more information regarding breast augmentation you can download my free breast augmentation planner at aBetterBreast.com

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 299 reviews

Textured versus smooth implants how to choose.

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Very generally speaking textured breast implants have a thicker shell and tend to be more palpable and somewhat firmer than smooth walled implants.  In addition if you happen to develop a fold in your breast implant is going to feel firmer and possibly be more visible than a fold in a smooth walled breast implant.

Personally I saved textured implants for patients who are at high risk for capsular contracture.

However if you want anatomically shaped breast implants you will have to have textured as these implants are not made in the smooth walled.

For a detail discussion comparing textured versus smooth breast implants please read the following link:

Textured versus smooth silicone implants. What are the key factors I should consider in selecting smooth versus textured?

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The surface of the outer shell of breast implants can be either smooth or textured. There are pros and cons of each and the best implant for any particular patient depends on many factors including individual anatomy and desired outcome. Smooth implants usually have thinner shells and move more freely in their pocket than their textured counterparts. Many plastic surgeons believe that the thinner shell allows smooth implants to feel more natural. Implants with smooth surfaces are less likely to ripple. Textured implants were designed to lower the risk of capsular contracture, but whether it achieves that is open to debate. The textured implants may have a greater chance of leakage or deflation. One type of implant, known as the anatomical or teardrop-shaped implant ("gummy-bear" or form-stable), is only available with a textured surface, because this surface helps keep these contour shaped implants in position and diminishes the risk of rotation and distortion. Some of the differences of the implant surface characteristics depend on whether the fill material is saline or silicone gel.

Good results can be achieved with both type of implants. What is far more important than the type of the implant is your plastic surgeon'straining artistry, skill, and experience.

Currently, most plastic surgeons in the U.S. prefer smooth implants. You should discuss your concerns in person with a plastic surgeon, who should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAP).

Robert Singer, MD FACS

La Jolla, California

Robert Singer, MD
La Jolla Plastic Surgeon
4.6 out of 5 stars 22 reviews

Textured vs. smooth implants

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Advantages of textured implants include:
  • Lower capsular contracture rate
  • Lower rate of implant migration over time
  • A "one breast" feel
Disadvantages of textured implants include
  • Higher rate of rippling
  • Less ability to influence them unnaturally with a push up bra.
I had used smooth implants for the majority of augmentation patients for years.  Over the past two years I have been using an increasing percentage of textured and it is my preferred approach for most cases.  The most compelling reason that I prefer them is that I feel that they tend to stay where I have designed them - I like the control that they offer.  The major disadvantage of rippling is something that I have seen very infrequently with highly cohesive implants. 

The patient who I would argue really "needs" textured implants has a tendency towards poor soft tissue support or a tilted chest wall shape that would encourage the implants to move to the sides or down over time.

York Jay Yates, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 190 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.