Why are the textured and smooth implants, and which is a better choice for me?The answer to that question depends on a number of factors, including what it is you are starting with, what your lifestyle is like, what breast volume you would like to have and what is pleasing to you aesthetically. Sientra, Allergan and Mentor all have product lines for cosmetic breastaugmentation that include the traditional round / non-form-stable implants in both smooth and textured surfaces, and shaped / form-stable implants all of which have textured surfaces.Textured surface implants were originally developed with the hope in mind of reducing the rate of capsular contracture. The general consensus in the plastic surgery literature for many years has been that there does not seem to be a significant difference in the contracture rate between smooth and textured surface implants, however some recent data from Sientra shows that their textured surface implants may have a significantly lower rate of capsular contracture. (There are a number of steps that a surgeon can take to reduce the risk of capsular contracture. Up until recently, most U.S. plastic surgeons have preferred to use smooth / round silicone gel implants. This bias comes from years of using smooth / round saline implants, until the FDA gave approval to cohesive silicone gel implants in 2006. Saline implants were available in smooth and textured versions, however the textured shell saline implants had a higher deflation rate and fell out of favor.Smooth / round silicone gel breast implants are appealing in that the gel inside is cohesive (i.e. it is in a solid state and sticks together, as opposed to the liquid silicone gel of older silicone gel implants) but not highly cohesive, which makes them the softest and 'squishiest' breast implants that are available. They best mimic natural breast tissue and are, in general, less likely to be palpable and visible than textured surface / round gel implants. The fibrous capsule that one's body forms around the implant does not adhere to the smooth surface, so smooth implants are very mobile - which also nicely simulates natural breasts, but has the potential downside of contributing to implant displacement ('bottoming out', 'lateral drift') over time.Textured surface implants are intended to promote adherence of the fibrous capsule (which the body naturally creates) to the surface of the implant. Adherence to the implant surface, if it occurs, helps to stabilize implant position and reduce the likelihood of unfavorable implant position changes over time - such as 'bottoming out' and 'lateral drift'. Adherence may also reduce the rate of capsular contracture. All shaped / form-stable implants are textured, as it important for the fibrous capsule to adhere to the implant surface and maintain the implant's vertical orientation. If the capsule does not adhere to a shaped implant then the implant may rotate, creating an aesthetically undesirable breast appearance.The process for creating the textured surface of the implant shell varies significantly between the three companies, and as you might expect the performance of the companies' textured implants varies as a result of these differences. Currently the plastic surgery literature suggests that Sientra's textured implant surface may have the highest degree of tissue adherence, and the lowest rate of capsular contracture.I use both shaped / form-stable breast implants (again, all shaped implants are textured) and round / non-form-stable breast implants (both textured and smooth versions). I strongly prefer shaped / form-stable implants for slender patients who are starting with an A-cup breast volume and in whom the inframammary folds need to be lowered. For patients whose lower poles (bottom of the breast) are already fairly full preoperatively, and who are starting with a fuller-than-A breast volume, I usually recommend round implants. In patients with preoperatively full lower poles I prefer to use textured surface round implants when breast skin tone is good, and smooth surface round implants when there is some skin laxity but not enough to absolutely require a simultaneous mastopexy. With breast skin laxity there is a greater chance of implant palpability and visibility, so my preference is for smooth implants in that setting.These are general concepts but not necessarily absolute choices, and many additional factors are evaluated when selecting the ideal implant for each patient. The thought process behind implant selection takes into consideration not only what is likely to contribute to a successful outcome immediately postop, but also what is likely to remain stable and aesthetically ideal over time. For example, and athletic patient who is a distance runner is best served, in my opinion, by textured surface breast implants, as the textured surface provides a greater likelihood of the implants remaining in an aesthetically ideal position over years of sustained high-impact exercise.
