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

Are textured silicone implants firmer? Do they still feel very natural? I'm a thin girl, 5'3" and 100 lbs. I'm having my surgery in a week and a half and I'm really stressing. My doc gave me two size options ... 322 cc or 440 cc ... isn't there something in between? And he said he was using textured implants.

Doctor Answers 22

Size sounds wrong...

You have already received many accurate answers about smooth v. textured.

But at 5'2" and 100lbs, those sizes are far in excess of what will fit within your tissue. Of course, I haven't measured you, but I've never examined a patient yet with your height and weight whose breast tissues are wide and lax enough to fit implants that large.

That is said, of course, presuming that you don't want to look overly fake and cause some permanent damage to your tissues. When implants are large, they create an unnatural look. Worse is that over time such implants compress and thin breast tissue, stretch out skin, and even create a crater in the rib cage.

I see a lot of patients who need correction following earlier breast augmentation, and these problems are real, embarrassing, and often are not totally fixable.

Don't sweat the smooth v. textured thing --the bottom line is that each has subtle trade-offs and neither is absolutely better than the other. You can research it all you want, but the fact is that no surgeon on the planet knows for sure which would be better for you.

But the analysis of breast dimensions and implant dimensions has been studied, published, and is logical. How can you fit a size 8 foot into a size 7 shoe? It's the same thing with implants. I suggest you not fret over the textured/smooth thing and revisit the issue of size.

Los Angeles Plastic Surgeon
4.5 out of 5 stars 48 reviews

Textured vs Smooth silicone breast Implants

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.

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 120 reviews

Smooth versus textured silicone implants

Two types of textured implants are available in the USA, Mentor Siltex and Allergan Biocell. I have had almost 30 year's experience with textured implants. There are two reasons to consider using textured rather than smooth implants. The first is reduced capsular contracture and the second is the prevention of anatomic implants "flipping over".

The negatives for textured implants is a higher rupture rate and a stiffer shell.

Today, most surgeons place almost all implants behind the pectoral muscle. This negates most of the capsular contracture advantage of textured over smooth implants.

Textured saline implants have more wrinkling than smooth saline implants.

With 30 years and thousands of implants, I reserve textured silicone implants for revision surgery to correct capsular contracture. Smooth silicone implants are softer, have fewer wrinkles, and last longer.

I would get a second opinion regarding size. Most implants come in 25 cc intervals; 375, 400, 425, 450 etc, You are small framed at 5'3" 110 lbs. Your surgeon should measure the base width of your breast and find an implant that is no wider than your breast. I would be concerned that the suggested implants are too wide for your chest,

Good Luck!

Richard L. Dolsky, MD (retired)
Philadelphia Plastic Surgeon
5.0 out of 5 stars 4 reviews

Stop and see another surgeon first

Frankly, a majority of my practice is women of your size. I'm sure you have a slight frame with narrow shoulders and hips. Buttocks is probably small to moderate if you''re Caucasian. The average size silicone implants I use in a patient of your size are the Mentor 285cc-325cc. Remember IT'S ALL ABOUT PROPORTION! You should have tried on sizers with a sports bra and decided what you like. Very frankly unless you want to have every man talking to your breasts, the 440cc implants are way too big.

There is no need for textured implants. All primary augmentations, nowadays, should be performed with the implants placed under the chest wall muscle. If this is done there is no difference in the rate of capsular contracture between saline and silicone smooth implants and between smooth and textured implants. Texturing is done usually with contoured implants to allow the capsule to grow into the implant and prevent it from rotating.

You do not need textured implants, you likely do need implants on the order of 285-325cc and they should only be smooth placed under the muscle. It's okay to step back and rethink.

Christopher L. Hess, MD
Fairfax Plastic Surgeon
4.4 out of 5 stars 34 reviews

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

augmentation procedures have continued to improve and techniques have evolved
and implants have advanced. At this time
there is a wide range of implants from which patients have to choose from for
their breast implant. One of the choices
is whether the implant is textured or smooth.
The answer depends on several factors and cannot be made alone without
considering the entire procedure.
One, shaped
implants should always be textured. The
texturing is used to keep the implant in the exact position and orientation in
which your plastic surgeon placed the implant.
The shaped implants a designed to give patients a very natural shape and
slope, but to accomplish this they have to keep their orientation. The
texturing helps accomplish this task. Second, if the
implant is placed above the muscle texturing is beneficial in decreasing the
chance that a significant amount of scar tissue will form around the
implant. The benefit of texturing when
the implant is placed below the muscle is has not been proven and this tends to
be up to plastic surgeon preference. The benefit of
smooth implants is that they can typically be placed through a smaller incision
than textured implants. They also tend
to have a little softer feel after the augmentation as the implant will have a
little movement in the pocket giving it a natural appearance and feel.
In the end they
are both great implants depending on your particular situation both implants
have their place in breast implants surgery. Please discuss
your breast implant surgery with your board certified plastic surgeon who can
help guide you and help you achieve your aesthetic goals.

Johnny Franco, MD, FACS
Austin Plastic Surgeon
4.9 out of 5 stars 123 reviews

Pros and Cons of Textured Silicone Implants

In my practice, textured silicone implants are most useful for women who have full but droopy breasts and will need a lift to reshape the breast. The textured silicone implants serve as "Velcro" fixing the overlying breast flaps, as long as the volume is not excessive, because eventually gravity will win and the breast implant will "drop". The optimal selection of an implant requires a dialogue between the patient and physician. Please be an active participant in your health care and express yourself, otherwise you run the risk of having someone else's vision instead of your own.

Critics of the textured silicone implants cite their rigidity, palpable and possibly visible folds or knuckles and potentially a higher chance of deflation. Like the majority of U.S. surgeons, I generally prefer the smoth walled silicone ge for their mobile and tactile qualities. The textured devices are favored abroad and generally sell at a premium compared to the smooth devices.

With regards to the choice of 322-440cc, there are intermediate choices, which may better fit your body, given your height and weight. A useful guideline is to choose an implant whose base width is about the same as your chest. Do contact your surgeon and request resizing. Good luck.

Lavinia K. Chong, MD
Orange County Plastic Surgeon
4.8 out of 5 stars 58 reviews

Textured vs. Smooth Implants

Textured implants were created to minimize the risk of capsular contracture. The literature is equivocal; some studies report it does and some studies report it does not. The textured tend to stay where you put them. They also may scallop or ridge more. Smooth tend to "jiggle" better and will ride high early post-op but will fall into the pocket over the first few weeks to months. I personally like the smooth implants more myself.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Textured breast implants feel firmer, smooth breast implants feel more natural

Textured implants were designed to lessen the risk of capsular contraction or hardening of the breast implant. I only use them if a patient has had a previous breast implant which has hardened with capsular contracture.

There are many size options. If you are stressed cancel your surgery and seek another opinion.

See before and after photos of breast augmentation.

Textured vs smooth

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 SHIFTING
The 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.  
Years 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.  

Jonathan Hall, MD
Boston Plastic Surgeon
4.9 out of 5 stars 36 reviews

Go with smooth walled implants.


In New York, we have seen a lot of problems with textured implants, and no advantages. Textured implants can produce rippling. We use round, smooth walled breast implants.

I think 440 cc's is ridiculously big for your frame, and even 322 cc's may be too big. You have no idea how many questions we answer at RealSelf from women who are miserable with their too large implants.

We use disposable implant SIZERS during surgery to see which implant looks best, before opening the permanent implants. This takes the guess work out.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.