What are the pros and cons of smooth and textured implants? (Photo)

Dear pammy.p,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

When patients discuss textured implants, they are often referring to shaped anatomic/form stable implants. The texture is necessary to maintain the appropriate orientation of the device. A tear drop shaped device looks very different upside down vs. right side up. The texture acts as a sort of internal velcro holding the device in place. Round devices don't need texture as they are round regardless of orientation. (Note: textured devices also have a lower rate of capsular contracture when compared to smooth devices, however, when both are placed under the muscle the difference is negligible.)Thus the question of textured vs. smooth is in fact a question of round vs. shaped. In my practice most patients will choose a smooth round device. When placed in the submuscular plane, the aesthetic differences are minimal. The downward pressure by the muscle across the upper pole of the round device forces it to assume a more tear drop appearance. Recent studies have shown that both patients and surgeons have difficulty distinguishing between the 2 implant types post-operatively. Additionally, shaped implants are more costly and have an increased risk of rotation.Finally, although very rare, the few documented cases of BIA-ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) have all been in cases of textured devices. Until more data is available many are shifting their practice back to smooth round devices.As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Thank you for the question and picture.  Based on your anatomic starting point, I think that should you should have a very nice outcome with a well executed breast augmentation procedure.
The difference between these types of implants is the feel and surface characteristics of the outer surface of the implants.  Personally I do not think that there are any advantages of using textured implants and use the smooth round implants almost exclusively.   As you may know, there is a link between texture breast implants and the very rare lymphoma (ALCL) associated with breast implants.  Furthermore, I think that the surface coating of the breast implants are probably the least important factor when it comes to a successful outcome achieved with breast augmentation surgery. Much more important, will be careful selection of your plastic surgeon and careful communication of your goals.  Ultimately, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, and computer imaging) will be critical. 
 Generally speaking, the best online advice I can give to ladies who are considering breast augmentation surgery (regarding breast implant type/size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining breast implant size/type/profile will most likely help achieve your goals. 
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. For example, I have found that the use of know words such as “natural” or "C or D cup” etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.