Sientra: Textured vs. Smooth?

Aside from the obvious, what is the difference between textured and smooth implants? There doesn't seem to be a visual difference. Is it just about the feel of the implant and what that person prefers?

Doctor Answers 16

Textured vs. smooth implants?

The surface of breast implants can be smooth or textured, regardless of the filler material—silicone gel or saline. Sientra sells only silicone gel implants, but the other two USA breast implant manufacturers sell textured saline implants as well as silicone ones.

When silicone gel implants were used prior to the FDA restrictions of 1992, placement above the muscle was also the preferred implant position for many plastic surgeons. Texturing the surface of the silicone gel implant reduced the incidence of capsular contracture in this position (above the muscle and just below the breast tissue). However, after the 1992 FDA restriction on silicone gel implants and the switch to saline-filled implants, placement above the muscle led to unacceptable wrinkling that could sometimes be felt or seen. This led to most surgeons switching to placement of saline breast implants below the muscle to increase tissue coverage and reduce these concerns. Even placement of saline-filled implants below the muscle will not always eliminate implant wrinkles or ripples, particularly in thin patients and/or patients with very little overlying breast tissue. Since 2006, silicone gel implants are again available for elective breast augmentation, allowing patients to avoid the “water-balloon” feel and visible or palpable rippling seen in some saline implant patients.

Based on the choice of saline or silicone, textured or smooth, and the patient's unique body type, appropriate surgical placement will be determined. Many studies have confirmed lower capsular contracture rates with implant pockets below the muscle. However, using textured breast implants below the muscle can cause unnatural adherence to the chest and restricted natural movement of the breast, and is not recommended.

In addition, saline implants lack cohesive silicone gel to act as a lubricant inside the implant (saline is a poor lubricant), and can allow flexing and creasing of the textured implant shell surface with each movement or breath of the patient, ultimately leading to a higher risk of failure at one of the low spots in the textured surface, with leakage and deflation of the saline implant. The textured implant shell is also thicker and more palpable. Submuscular placement already reduces the incidence of capsular contracture, so smooth breast implants in this location are preferable to adherent textured-surface implants.

Smooth-shell silicone-gel-filled implants are homogeneous with breast tissue and provide the softest, most breast-like, and most natural “feel” of any implant. Since the newest generation of silicone gel implants is also cohesive, they cannot leak. While the vast majority of patients are again choosing submuscular silicone implants for their breast enhancement surgery, I believe that textured implants below the muscles offer no advantages, and possible disadvantages (plus they cost more and require a slightly longer incision).

Choose silicone, smooth, and realize that round implants are teardrop shaped when the woman is standing, and flatten and round out (like natural breasts do) when reclining, whereas textured teardrop-shaped implants REMAIN teardrop-shaped when reclining (decidedly unnatural). For more information, please click on the web reference link below. Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 238 reviews

Sientra Breast Implants Textured vs. Smooth

Of interest is that about 90% of the world outside the United States prefers textured breast implants, where as almost the reverse is true in the USA. I think this trend will change as textured implants such as Sientra's use more highly cohesive silicone gel so that there is less likelihood of rippling. The big advantage is that  a primary augmentation patient will qualify for a free replacement implant if she requires revision surgery to correct a significant capsular contracture within the first two years after implantation. Perhaps most importantly from a patients perspective is that breast implant "massage" is not needed with textured implants, and they don't drift to the side when you lie down.

Sientra’s TRUE Texture™ implants were found to carry a significantly reduced risk of capsular contracture compared to its smooth implants, according to a study published  in Plastic and Reconstructive Surgery. The analysis looked at more than five thousand implants over a five-year follow up process, providing a very robust set of data as a foundation for this finding. It is with this statistical confidence in the resilience of their textured implants against capsular contracture that Sientra introduces the C3 Program.
As with the implants themselves, Sientra’s C3 Program is only available through plastic surgeons certified by the American Board of Plastic Surgery. This is done to improve patient confidence even further — it ensures that surgical procedures using Sientra implants are only done by the most qualified doctors.

Smooth vs. Textured Silicone Implants

Every implant has its own set of pros and cons and there is no perfect implant. However, generally I tend to use mostly textured anatomical implants because I feel these have the most advantages and the least disadvantages. Advantages are texturing over smooth implants including more stable position to the implant, which is less likely to shift over time, lower risk of capsular contracture and the elimination of the need to do breast massage every day after surgery. The shell of textured implants can be slightly thicker and are slightly more palpable through the skin in thinner patients. However, when using a formed stable anatomical implant such as Sientra’s classic anatomical implant, the implant still has a very soft and natural feel and can create an excellent shape in thinner patients. Smooth round implants will feel slightly softer and have a thinner shell, however they are more likely to shift out of position over time because they are not adherent to the tissues and do not have a coefficient of friction that prevents them from sliding around in the pocket. 

Robert Cohen, MD
Santa Monica Plastic Surgeon
5.0 out of 5 stars 39 reviews

Textured vs Smooth Implants

Thank you for your question.  There is not an obvious visual difference between textured and smooth implants.  The biggest difference between the two is the feel of the implant.  Textured implants tend to move a little less than smooth implants.  I've had patients complain that the textured implants feel a little artificial.  It is somewhat easier to create cleavage with a bra when smooth implants are placed.

However, using textured implants to prevent migration of the implant may be beneficial in cases of a chest wall deformity (pigeon cheated individuals) or in cases where there is a risk of bottoming out.

Textured implants have a lower rate of capsular contracture as well.

Hope this helps.  Best of luck.

Troy A. Pittman, MD
Washington DC Plastic Surgeon
5.0 out of 5 stars 2 reviews

Round vs smooth breast implants

For shaped implants both Sientra and Mentor  have 5th generation gel. Each company has different styles and shapes for different body types and desired outcomes. All shaped implants are textured to avoid rotation. Sientra uses a proprietary method of texturing called True Texture that has a proven track record internationally over the past 20+ years. In the FDA clinical trials Sientra had zero rotations, and 4.9% rupture rate. Mentor uses a stamping method for texturing that has uniform shallow groves in the implant called Siltex. In the FDA trials Mentor had a 3.4 % rotation rate, and rupture rate of 10.6% .

Michael Law, MD
Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 113 reviews

Textured as Compared to Smooth Sientra Breast Implants

When comparing smooth and textured implants it is important to let you know there is very little difference in terms of how they will look. There is a big difference in how they will feel and the chance for capsule contracture.

Textured Sientra breast implants have been shown on clinical research, to have a lower incidence of capsular contracture, the number one complication of breast implants. This is because they are designed to "Velcro" to your body and the resultant scar tends to softer and not contract. This also lends to creating a softer, more natural feeling implant.

I have added a video that addresses this question as well as a web reference that may help you.

I hope that helps.

Best regards.

Brian Windle, MD
Kirkland Plastic Surgeon
4.9 out of 5 stars 50 reviews

Textured vs Smooth Implants

Implant texturing is hypothesized the reduce the rates of capsular contracture in subglandular augmentation.  The textured surface impedes the body's ability to form scar tissue around the implant.  Sientra provides a capsular contracture warrenty for 2 years for their textured implants in cases of primary augmentation.

John Burns, MD
Dallas Plastic Surgeon
4.6 out of 5 stars 31 reviews

Textured or smooth

the latest research on Sientra's textured implant shows about 1/2 of the capsular contracture rate when compared to their smooth implants. This difference is for both above and below the muscle location. I think that, along with an exclusive guarantee to replace your implant if you develop a capsular contracture withing the first few years is an added bonus. It is felt at the present time that when operating for a capsular contracture that  a new implant is place dot decrease what is called biofilm which is felt to contribute to capsular contracture. Sientra makes that less of a financial burden if that is to occur.

Julio Garcia, MD
Las Vegas Plastic Surgeon
4.7 out of 5 stars 21 reviews

Textured vs smooth

Using a textured implant can decrease your risks for capsular contracture.  Texture decreases risk for lateral migration (implant sliding under arms) esp when lying down. Sientra offers an additional warranty that others do not. If you developed a capsular contracture in the first 2 years post op they will replace your implant.  
You have it right no real visual difference -especially initially. They will simply maintain position better for longer. 

M. Bradley Calobrace, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 39 reviews


The importance of choosing between Textured Vs. Smooth implants resides in a main concern : Contraction of the Capsule.

In my 23 years of experience I noticed the risks for developing a Contraction of The Capsule is higher when using Smooth implants.

I do prefer Textured Implants over Smooth ones.

Adolfo Sesto, MD
Dominican Republic Plastic Surgeon
5.0 out of 5 stars 38 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.