Why Do Most US Doctors Prefer Smooth Implants Vs Textured?

Doctor Answers 8

Smooth implants are easier to place

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Smooth implants have less coefficient friction allowing them to be placed through smaller incisions and are easier to reposition within the pocket.  After textured implants become attached they have less movement with postural changes. 


Best Wishes,


Gary Horndeski, M.D.

Texas Plastic Surgeon
4.6 out of 5 stars 230 reviews

Smooth perferred over textured

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because the revision rate was much higher with textured implants due to their friction and adherence.  In addition, they usually ruptured sooner then smooth implants.  The newer cohesive, form stable implants are different and they do not ripple.  But they must be placed perfectly and that is the challenge.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Smooth Versus Textured Breast Implants - Is One Better?

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Other doctors have already provided a lot of excellent info that I agree with.

One study adds additional facts. It showed that textured implants double the rate of rippling versus smooth implants. The rate went from 7% to 14%.

The appearance or attractiveness of the breasts was not changed with either implant.

Smooth implant are also easy to insert and handle and may need smaller incisions than textured surfaces.

I hope this helps you as well


Christopher Saunders, MD
Wilmington Plastic Surgeon
4.8 out of 5 stars 78 reviews

Textured vr. Smooth Implants

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Dear Newmeaug13,  This is not as easy of a question as it sounds. You have to go back into history to gain perspective on this issue.  In the 1990's, when the FDa placed a moratorium on silicone gel implants, only saline filled implants were available for augmentation in the USA.  Many plastic surgeons rapidly became unhappy with the increased rippling and puckering encountered with textured saline implants and converted to smooth wall implants.  When the moratorium was lifted and silicone gel implants became available in the USA, many plastic surgeons converted to silicone gel implants but stayed with the smooth wall shells that they had grown used to using.  Given some of the newer implant technologies including cohesive implants, shaped implants, and newer texturing surfaces, there may be a trend towards increased use of textured implants in the future.  In Europe and other parts of the globe where silicone implants were never or minimally restricted, textured implants still are the most commonly used shell surfaces. 

Herluf G. Lund, Jr, MD
Saint Louis Plastic Surgeon
4.7 out of 5 stars 88 reviews

Textured vs Smooth implants

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Thank you for your question.  The outer shell between smooth and textured implants is quite different.  Smooth implants, as the name implies, have a smooth outer shell and scar tissue forms around the implant in a more organized way.  There tends to be less visible rippling and wrinkling of the implant by the scar tissue.  Textured shells were developed to try to disrupt the scar tissue that forms around implants.  On a microscopic level, textured implants look like mountains and valleys.  The theory is that the scar tissue grows into this intricate design and there is less effect of the capsular contracture that can form around implants.  The downside is the scar tissue can grow into these intricate grooves and valleys and create a rippling or wrinkling effect that can be seen or felt on the breast.  Many surgeons reserve textured implants for patients who have trouble with capsular contracture.  

Hope this helps.


Brian C. Reuben, MD
Salt Lake City Plastic Surgeon
5.0 out of 5 stars 37 reviews

Why a smooth breast implant

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From reading this site you find that all doctors do not agree, however our opinion is that smooth implants have less tendency to ripple, and move and flow better with the natural breast tissue. Also we find that the leak rate is lower for a smooth implant.

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

Reason Smooth Implants Are Preferable

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I always use smooth implants.  I, too, feel that there is a significnatly higher incidence of rippling when textured implants are used.

John Whitt, MD (retired)
Louisville Plastic Surgeon

Textured vs Smooth Breast Implants

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In my experience textured implants, because of the manufacturing process, create a slightly thicker shell which has the potential to cause more rippling and visible, palpable problems with the implant.  This is especially true with saline implants. Shaped implants generally require a textured surface to promote "sticking" or adherence of the implant to your own tissue to prevent rotation of the device. If a shaped device rotates inside your body the result is unpredictable. The studies indicate there is little difference in capsular contracture between smooth and textured implants as long as they are under the muscle. Hope this answers your question. Most plastic surgeons in the US use smooth silicone gel filled implants placed under the muscle.

M. Dean Vistnes, MD
Bay Area Plastic Surgeon
4.9 out of 5 stars 51 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.