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).

Hi and thanks for the question. There is no real difference between dual plane and sub muscular breast augmentation and as you don't appear to have much sagging (ptosis) the degree of dual plane dissection you would need is minimal.  Smooth and textured implants will produce an identical early cosmetic result for the same volume and dimension implants.  However, there are differences in them in the long term and in how some advise they be "looked after". Smooth implants are not usually placed in a precise pocket so they are supposed to move around.  Patients are often advised to massage the breasts to keep the pocket large and the capsule soft and pliable. Textured implants should not be massaged.  Since the smooth implants move around more just like natural breast tissue, the breasts tend to feel softer and more natural than textured implant breasts.  Unfortunately over time this can result in the implants sliding out over the outside of the chest when you lie down (lateral drift) and to drop into the lower pole of the breast whenever you stand (bottom out). Smooth implants will also tend to animate more (change the breast shape with muscle contraction) so if you are in the gym a lot, they may not be for you.
Textured implants tend to maintain their position and shape a little better over time but the can feel less natural, especially when there is not much tissue covering them.  
Recent evidence suggests a higher (but extremely low) risk of developing breast implant associated anaplastic large cell lymphoma with textured implants.  Your surgeons should have discussed this with you.
Good luck
Dr Mark Hanikeri MBBS, FRACS

Thanks for your question!  In general there are smooth and textured implants which can be both round and shaped.  A textured implant stays where it is no matter what you're doing, while a smooth implant can move around much like a normal breast so it looks and feels more natural.  For that reason most patients and surgeons prefer a smooth implant.

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. 

Both type of implants have pros and cons.  The presumed benefit of textured-surface implants is that they allow scar tissue ingrowth into the shell surface which can help hold the implant in place.  This would help prevent long-term migration of the implant which can sometimes occur in smooth implants in the submuscular plane due to constant muscular lateral and inferior pressure. Some surgeons wrongly assume that submuscular placement of textured-surface implants lowers capsular contracture incidence compared to smooth implants, but this is not true.  In addition, textured saline implants have a higher leak rate and higher rate of visible rippling compared to smooth implants.  Textured silicone implants also have a higher rate of seroma formation.  The main reason I would suggest avoiding textured implants is that only textured implants have been linked to ALCL, a rare type of lymphoma.  As long as you make a well-informed decision, either one may be right for you.

In my practice I will only use smooth wall implants.  There are a few studies that have raised concerns with the texturing of some implants causing ALCL.  I recommend getting a little more informed on these studies prior to making your final decision.

For  the most part, for most surgeons, the submuscular and dual plane placement of breast implants are really the same. The difference would be if the implant is placed above the muscle, either on top of or below the muscle fascia.Both the subglandular (on top of muscle) and submuscular (under muscle) approaches to breast augmentation are used today by plastic surgeons. There are advantages and disadvantages to each of these approaches. For the use of a sub glandular implant, most plastic surgeons would consider how much glandular breast tissue will lay above the breast implant to allow it to be more hidden. In thinner patients, with sub glandular implants, especially saline, visible wrinkling can be a problem. There are just a few advantages to the sub glandular placement. For the first few days or so, it is certainly less painful to put in a sub glandular than a sub muscular breast implant. The sub glandular placed implant will look more properly in position earlier without the overlying tension of the pectoralis muscle allowing the implant to ride higher in the chest for a few weeks. Also, in the case of a patient with a wide breastbone and the wish for a narrower cleavage, the placement above the muscle will allow for more movement of the implant towards the center of the chest thus narrowing the space between the breasts. In patients with thin overlying breast tissue, especially with larger implants, the outline of the implant is more visible through the tissues with the implant placed above the muscle. We do know that the rate of capsular contraction is higher in implants placed above the muscle than implants placed below. The sub muscular approach has a few advantages. One important one is that mammography is a little easier to do and to read when the implant is placed below the muscle. There is also less wrinkling, less visibility, and less rate of capsular contracture. Other than being more painful for a few days after surgery, another issue with the sub muscular placement is animation. When the pectoralis muscle is activated, it will push the breast implant upward as well as outward which can be visible through the skin. Another consideration in this choice of whether the implant is sub glandular or sub muscular is that in today's modern breast implant surgeries, most of the time, a dual plane approach is utilized. In this way, the upper part of the breast implant is placed below the muscle and the lower part can be placed either on top of the muscle or below the lining of the muscle called fascia. With this approach, the bottom of the implant in the sub muscular placement can be in the same place and position as if the implant was placed on top of the muscle. This is the technique used by most plastic surgeons today. Each surgeon has their own preference and I would recommend that you seek out the consultation with a board-certified plastic surgeon and asks them what their choices for you would be and why. Good luck with your surgery.