Sientra: Textured vs. Smooth?

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

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. 

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.

Hi,Textured Sientra implants in the largest published study showed less capsular contractures.  They may migrate less, also.  Sientra uses a proprietary process to texture their implants.   Because of this Sientra is the only implant
company who has a warrantee (C3)if you develop a capsule after receiving their
textured implants. They have a special process which makes the texture.
This implant shell is unavailable elsewhere.  Sientra only sells to BC plastic surgeons (by
ABPS - The American Board of Plastic Surgery) who are members of
ASAPS (The American Society for Aesthetic Plastic Surgery) and or a member of
ASPS (The American Society of Plastic Surgeons). All the best,  "Dr. Joe"

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.