Why does Europe primarily use textured implants whereas the US still primarily uses smooth?

I love your question, I think it is an important one and one that you will find a variety of opinions on.   For what it is worth, here is my journey as a plastic surgeon regarding texture, this will explain why and how I feel about texture. 
2003 - Started practice, only saline available in which case smooth MUCH better regarding rupture and rippling2006 - Silicone moratorium ended, silicone available.   Common sense transition was from smooth saline to smooth round silicone2012 - Sientra becomes FDA approved including the first FDA approved shaped device in the U.S.    Shaped implants are always textured so at this point many of us had to reconsider pros and cons of texture.   For the benefits of reduced CC and improved stability of implants I started using more and more textured implants and by 2014 was using upwards of 80% textured (round and shaped).Current - Over time I have seen a few cases where a textured implant was more palpable that I would like or had some degree or rippling.   I have also seen an uptick in seroma (non-ALCL) and implants not dropping into the pocket with texture.   Additionally there are the ALCL concerns (VERY small risk but higher with texture than smooth).   For these reasons I have decreased my rate of texture a bit, I am currently only using textured implants in those cases where it has the most benefit.   In my practice I have not seen a difference in CC with submuscular textured vs smooth (I have seen less than 1% CC with either) so this is not a strong consideration for me.  I would consider the largest benefit in implant stability in the extreme weight lifter and patients with chest wall shape and soft tissue support that would have a higher risk of lateralization or bottoming out of the implant.   I am currently using texture approximately 30% of the time. 

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implant
#toobig #breastimplant

Smooth implants usually have thinner shells and move more freely in their pocket than their textured counterparts. Many plastic surgeons believe that the thinner shell allows smooth implants to feel more natural. Implants with smooth surfaces are less likely to ripple. Textured implants were designed to lower the risk of capsular contracture, but whether it achieves that is open to debate. Capsular contraction can occur no matter what type of implant is used.
 
The textured implants may have a greater chance of leakage or deflation and may be associated with a very rare form of lymphoma called anaplastic large cell lymphoma (ALCL).  Currently, most plastic surgeons in the U.S. prefer smooth implants. You should discuss your concerns with your plastic surgeon, who should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAP).

Robert Singer, MD FACS 

La Jolla, California