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

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.

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.

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!