Implant exchange from smooth to textured: reuse same pocket?

I have used textured implants in patients who ave a stretch pocket, as I do think they "stick" better. The same pocket is usually used, and whether or not you keep the original capsule depends on  it's condition and the decision making of your surgeon, so be sure and discuss that before your procedure. 

There is no benefit of taking out smooth implants and replacing with textured implants in the same pocket.  You need a new pocket.  Many plastic surgeons have stopped using textured implants because of BIA-ALCL.  If you concern is migration of the breast downward then you need to consider an alternative such as a lift or smaller implants.  Unfortunately, you have not provided photographs or told us your bra size.  However, 600 cc implants are very heavy, weigh over 1 lb each and usually result in descent that will not be stopped by textured implants.Best Wishes,Gary Horndeski, M.D.

Dear r_andrea,
if you want textured implants, you will probably need removal of capsules, but the pocket can probably remain the same. Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hi and thank you for the question. I don't think this plan is going to help you for two reasons. First, the texture on the Sientra and Mentor implants isn't very aggressive. So it doesn't allow those implants to stick as well to the capsule. The Allergan texture was the most aggressive, but it causes ALCL in a small percentage of patient and is no longer used. The other issue is the implant size. A 600 cc implant weighs about 1.5 pounds. That weight combined with minimally textured devices doesn't do much for implant position stability. All that being said, there is nothing at all wrong with switching from smooth to textured. If you go through with it, I would remove the existing capsule - if you just place a textured device into a mature capsule it will not stick. Best of luck to you.
Dr West

I would obtain a second opinion.  Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has been associated with textured breast implants.  This is a very rare cancer that develops from a type of White Blood Cell (lymphocyte). It starts in the implant capsule and can spread throughout the body. Treatment is surgery + - chemotherapy and some people have died from it.The implants implicated were manufactured by Allergan, and have been removed from the marketplace.  The implants you have mentioned are made by Sientra, not Allergan, but I personally would not place ANY textured implants at this time.  The potential risk is just too high.Remove and replace procedures are common, especially swapping from saline to smooth silicone gel.  The same incision can usually be used and all the stretching and pulling of tissues that occurred from the first procedure has already happened. It is an outpatient procedure with a quick recovery.  Always consult with a Board Certified Plastic Surgeon who performs these procedures frequently to assure the best possible result.Good Luck!

As I am sure you know, textured implants do have a risk for BIA-ALCL which is a lymphoma seen in a very small number of patients with textured breast implants. That being said, the benefit of a textured device would only be seen if the capsule was removed, as a textured implant will not integrate into an existing capsule. You should see a board certified plastic surgeon in your area to get a formal opinion through an in-person consultation.
Best of luck,
Vincent Marin, MD
San Diego Plastic Surgeon