What Are the Pros and Cons to Textured Vs. Smooth Implants?

Texture vs smooth is a great question that can get complicated. In full disclosure I have used textured implants from all 3 companies in the US and choose different texture for different purposes.  TEXTURE MAY DECREASE SHIFTINGThe most common implant used around the US is a smooth round silicone implant.  But they can move more and can shift to the sides or inferiorly with time.    So texture gives the implant more "grip" and may prevent it from shifting as much with time.  So in a patient with looser tissues who is at more risk for implants shifting the texture may be a benefit. It may be  helpful when the fold is lowered to decrease additional dropping of the implants and malposition of the fold. It is always used with anatomic implants to prevent rotation and flipping of the shaped implant.  TEXTURE MAY DECREASE CAPSULAR CONTRACTUREYears ago there was an implant in the US with polyurethane around it (MEME) that had a very low risk of capsular contracture- they haven't been on the US market for many years because of a possible risk as the polyurethane would break down and release other chemicals.  But doctors in practice before my time spoke very positively of the low rate of contracture.  Current studies show a benefit of textured silicone in reducing capsular contracture when implants are placed above the muscle- not as much of a difference when below.  And methods such as nipple shields during surgery/ no touch technique/ antibiotic irrigation to decrease biofilm formation may be even more important.TEXTURE MAY INCREASE RISK OF PSEUDOCAPSULE FORMATION AND LATE SEROMAThere are important differences in the aggressiveness of the textures of breast implants in the US.  The most aggressive texture is a salt loss method-salt crystals are placed on the implant during manufacture and are then dissolved, leaving a texture.  This texture may allow tissues to adhere better-but has also been linked to a higher rate of late fluid collections (seromas) and pseudocapsule formation-the tissues can tear away from the implant with activity and lead to several layers of scar tissue forming around the implant.  Another company doesn't discuss their method of texture but is in between in aggressiveness.  And one company simply stamps the texture into the implant and has the least aggressive texture.  Interestingly the "coefficient of friction" which is a physics measurement of the implant grip, is the same with the most and the least aggressive textures.  Could this less aggressive stamped in texture be equally effective at reducing shift of the implants but with a much lower risk of late seroma and pseudocapsule formation than the salt loss texture?  Finally, BIA-ALCL (Breast implant associated anaplastic large cell lymphoma) is a VERY rare type of cancer that develops in the fluid or capsule around an implant.  It was reported in April at our national meeting that 278 cases (out of millions of women with breast implants) have been reported around the world, with the majority of the cases being associated with the salt-loss texture and only 5 case being associated with the least aggressive texture.  Breast augmentation is about understanding the tradeoffs.  It is important to have a detailed discussion with your board certified plastic surgeon about the various tradeoffs/benefits of texture and how they apply to your case.  I find that I am now using round textured silicone gel implants in more of my primary breast augmentation patients.  I feel that the tradeoffs are in favor of the least aggressive texture in these cases. Also, there are many different implant choices and size options.  440 seems extremely large for a "thin girl" who is 5'3" and 100 lbs.  You might look into the "Five critical decsions in breast augmentation using five measurements in Plastic Reconstr Surg 2005".  It is important to find an implant that fits your tissues properly without overly stretching your tissues.  An implant that is too big can cause more problems down the road.   

Shaped implants are Silicone. In my practice, about 15-20% of the patients are good candidates for silicone #shapedimplants.

Breastaugmentation procedures have continued to improve and techniques have evolvedand implants have advanced. At this timethere is a wide range of implants from which patients have to choose from fortheir breast implant. One of the choicesis whether the implant is textured or smooth. The answer depends on several factors and cannot be made alone withoutconsidering the entire procedure.

One, shapedimplants should always be textured. Thetexturing is used to keep the implant in the exact position and orientation inwhich your plastic surgeon placed the implant. The shaped implants a designed to give patients a very natural shape andslope, but to accomplish this they have to keep their orientation. Thetexturing helps accomplish this task.

Second, if theimplant is placed above the muscle texturing is beneficial in decreasing thechance that a significant amount of scar tissue will form around theimplant. The benefit of texturing whenthe implant is placed below the muscle is has not been proven and this tends tobe up to plastic surgeon preference.

The benefit ofsmooth implants is that they can typically be placed through a smaller incisionthan textured implants. They also tendto have a little softer feel after the augmentation as the implant will have alittle movement in the pocket giving it a natural appearance and feel.

In the end theyare both great implants depending on your particular situation both implantshave their place in breast implants surgery.

Please discussyour breast implant surgery with your board certified plastic surgeon who canhelp guide you and help you achieve your aesthetic goals.