Do smooth implants really increase the risk of capsular contracture compared to textured?

Question

in your experience what is the percentage of incidence of capsular contracture with smooth implants? I was very surprised to discover that in the US they are much more frequently used than in Europe.

Robert M. Lowen, MD · Answer

There have been studies that show that above the muscle textured implants have a slight advantage compared to smooth, but below the muscle there is no difference. I am looking at a table of contracture rates from the FDA Core clinical trials for primary augmentation, 7 years for Allergan, 6 years for Mentor and I can see why doctors and patients try to figure a way to lower them: 16.2% for Allergan and 9.8% for Mentor, both gel. But since in my own practice, the contracture rate is under 2%, I question what other factors are at play in causing these high rates other than the textured surface.Using John Tebbets, MD's method of forceps cautery dissection under direct vision for a bloodless dissection, and using betadine irrigation, Keller funnel no touch, powder-free new gloves to handle the implants, I very infrequently see a capsular contracture.  Since the rates are so low with smooth implants, I see no reason to use textured implants. With the rare but worrying risk of BIA-ALCL associated with textured implants, I have even less reason to use textured implants.

Finny George, MD · Answer

Hi, thank you for your question. 
The implant shell is only one factor that affects the development of capsular contracture. Factors that increase the likelihood of contracture are: bacteria, tissue trauma & blood. Factors that decrease the formation of a contracture are: good technique, antibiotic irrigation, implant pocket, textured implants & massage. 
Certain types of textured implants have also been associated with a rare kind of lymphoma. This may also be a reason why some patients and doctors are moving away from using textured implants. 
With proper technique, sub-muscular placement and implementing other precautions, your risk of contracture will be low with the use of smooth implants. 
I hope this helps. Best of luck!

Ronald J. Edelson, MD · Answer

After all these years we still don’t have a good handle on why some patients get capsular contracture.  Many theories but no proof.  Your best chance to avoid capsular contracture is to use saline implants under the muscle.  They almost never encapsulate.

Diane I. Duncan, MD, FACS · Answer

Thanks for your question! I've never seen smooth implants have a higher rate of contracture in my practice. That being said, I only place smooth anyway and my contracture rate is very low. Patients that present with textured implants don't seem to have any lower rate than those presenting with smooth. Best of luck!

Tom J. Pousti, MD · Answer

There are many factors, besides type of breast implant utilize, that determine the risk of capsular contracture. As long as breast implants are placed in the sub muscular (duel plane) position, the incidence of encapsulation is the same, regardless of the surface coating (smooth versus texture) of the breast implants. I hope this helps.

Mahmood Kara, MD - Account Suspended · Answer

Hello. Thank you for your inquiry. It is important to have an in-person assessment regarding your concerns as it is difficult to determine virtually. Textured is not recommended.

Exact end results and cup sizes are usually quite difficult to calculate as everyone has a different starting point.

There are many different factors that go into choosing a breast implant size which will correspond with your body dimensions while concurrently achieving your aesthetic results. Some of these factors are: Implant size (CC's), Implant profile (Low, Moderate, High), Placement of the implant (Subglandular vs. Dual Plane) etc. We utilize smooth round cohesive silicone gel 'gummy bear' implants for the best results.

During a consultation your aesthetic goals are heard and taken into account with the measurements of your breasts and the integrity of your tissue, as well as level of ptosis (sag). From here we collectively can find your 'perfect fit'. You are able to try out sizers and different implants in our office such that you can get an idea of what size you would be post-operation. We also offer Crisalix 3D plastic surgery virtual simulator during our in-person and virtual consultations to preview potential results. After your consultation, you will receive your very own implant sizers to take home with you (at a small cost) whether or not you decide to go forward with your procedure.

I usually recommend that my patients stop smoking, take vitamin C daily, and avoid aspirin/ibuprofen and vitamin E 3 weeks prior to surgery. I specialize in the 24-hour Recovery method which minimizes trauma to the breast and decreases pain post-operatively.

We encourage you to look at our website and Instagram (drkaraplasticsurgery) for lots of before and after pictures!
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.

During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery.

We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind

Jon Ver Halen, MD, FACS (license suspended) · Answer

Hello and thank you for your excellent question. You are correct - smooth implants have a slightly increased risk of capsular contracture, compared to textured implants. That being said, textured implants are becoming much less common owing to the risk of breast implant associated ALCL. In addition, refinements in surgical technique, submuscular placement, use of breast implant funnels, and use of singulair and accolate postop have significantly reduced the risk of capsular contracture for all breast implant patients. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate you. Preoperative visualization with Crisalix can simulate what your body will look like after surgery and can help you make your decision. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!

Do smooth implants really increase the risk of capsular contracture compared to textured?

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