Textured or smooth implants? (Photo)

Question

I have been recommended a textured implant. I am not happy with the BIA-ALCL risk that it carries and it is probably a make or break decision for me. My issue is, I have pectus excavatum, I've been told it's mild & I also have a small breast gap. I am concerned that if I go for the smooth implant I could end up with symmastia but if I go for the textured I could risk developing cancer. 2 surgeons have said smooth but the surgeon I would like to perform my surgery recommended textured.

Donovan Rosas, MD · Answer

Round devices do imitate shaped anatomic devices when placed in the submuscular plane due to the downward pressure of the muscle across the upper pole of the implant. Studies have shown that most (doctors and patients) cannot distinguish between the two post operatively. There is, however, a benefit to shaped anatomic implants when placed subglandular.
That being said, in my practice, round devices are preferred for a number of reasons: lower risk of rotation, cost, BIA-ALCL. I also prefer submuscular devices due to lower incidence of contracture.
The presence of native breast tissue serves to camouflage the device. In those patients with a reasonable amount of native breast tissue, the implant will be effectively hidden irrespective of plane. In those with a paucity of breast tissue (and a planned subglandular approach), the shaped anamtomic/tear drop implants hold a distinct benefit of softening the upper pole transition. This point becomes moot when placed submuscular or in patients with adequate breast tissue.
Each approach has both costs and benefits as do the differing devices. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other.  
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Benjamin Baker, BMBS MBA FRCS(Plast) · Answer

A smooth implant would not increase your risk of synmastia, this will be determined by where the implant is placed by the surgeon and this risk can be minimised with good surgical technique. There are pros and cons of smooth versus textured implants - a nanotextured implant such as Motiva may be a good compromise. The risk of ALCL will depend on which textured implant is being recommended. In any case, the risk of BIA-ALCL is very low (1 in 20000 to 1 in 60000) in comparison with developing a breast cancer (1 in 8 to 1 in 9 women in the UK).

James N. Romanelli, MD, FACS · Answer

Well, great question.  The rates of ALCL for textured implants ranges between 1 in 3/000 to 1 in 30,000.

But it is just a risk you don't need to take.  And a mild pectus excavatum is irrelevant.  In my judgement, I can see no role for textured implants, not even for textured tissue expanders.

Best of luck,
Jim Romanelli, MD

Daniel Barrett, MD · Answer

Dear Holhol97,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Wayne I. Yamahata, MD · Answer

If you are takin a poll, I would favor smooth implants. I think your risks of symmastia are low and as long as the surgeon performing the procedure is aware of your pectus excavatum, he or she can take the precautions necessary when creating the pockets for the implants.

Ted Eisenberg, DO, FACOS, FAACS · Answer

In the over 7500 breast augmentation patients of mine (all smooth implants), not one has developed symmastia. A number of these patients also had pectus excavatum. Good luck. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Gary M. Horndeski, MD · Answer

I never recommend textured implants because of the risks with BIA-ALCL.  Implants placed retro-pectoral will not cause symmastia.

Best Wishes,

Gary Horndeski, M.D.

Ronald J. Edelson, MD · Answer

Mist surgeon don’t use textured implants anymore. Although the risk of  ALCL is rare the texturing really does nothing so I would go with smooth or get another opinion

Azita Madjidi, MD, MS, FACS · Answer

Smooth or texture does not make a difference in the cleavage area or creating symmastia. Your cleavage is dictated by the width of your sternum regardless of its shape and symmastia is a technical error in wanting to reduce the cleavage and dissecting over the sternum, 
I always put smooth implants and avoid textured implants unless I have a specific reason to place a textured implant for a very specific case.

Oliver Harley, FRCSEd(Plast) · Answer

thanks for your question - this is a really difficult conundrum for you.  As a woman in the uk you have approx a 1:8 risk of standard breast cancer whether or not you have breast implants.  BIA-ALCL with textured implants is 1:3,000-50,000 depending on which manufacturer - i think Mentor textured implants have lowest reported rates which were calculated at 1:51,000 by researchers in 2021  - Whilst it is important for you to understand this risk from textured implants, it is a risk that is so much smaller than one that you already have.  To put this in another context, approx 1700 people die in road accidents annually in uk out of a population of 67 million - therefore your annual risk of dying on the road is approx 1:40,000 so if you us the road for walking, cycling or driving like most of us do, this is more dangerous than having textured mentor breast implants!

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