Textured v smooth? Round v anatomical?

Are textured implants more difficult to recover from? Also, are the anatomical implants more "natural" looking than the round? What is the benefit v. risk?

Doctor Answers 9

Textured v smooth? Round v anatomical?

I appreciate your question.

The best way to determine implant size is based on chest wall measurements that fit your body. Once we determine that we can choose the profile based on what you want or need to achieve.

Implants under the muscle, there is less risk of capsular contracture. Anatomic implants tend to give a more natural shape with more nipple projection.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Beverly Hills Plastic Surgeon
5.0 out of 5 stars 93 reviews

Silicone implants explained

First, the good news is that no liquid silicone is still on the market in the U.S. So that means, currently, every FDA approved silicone implant in the US is silicone gel.
Second, the term gummy bear impants is not technical and has no specifications (I am an engineer so I like universal, clearly defined, industry wide specifications). Therefore, it has no useful meaning and just confuses patients. It was coined by a plastic surgeon to differentiate between older generation liquid silicone and the then new gel implants he was trialing. It now is inaccurately used by some to refer to the thickest "form stable" gel, but since that is inaccurate the confusion only deepens.
Now for the complex details: Silicone breast implants can have 1) Varied gel thickness or cross linking of molecules, 2) Round or Anatomic shape, 3) Smooth or textured shell and 4) Variable fill ratio.
Silicone Gel ThicknessAgain all silicone gel implants in the U.S. are cohesive by definition. Then there are highly cohesive (thicker gel) or ultra-highly cohesive “form stable” gel.
Cohesive Gel << Highly Cohesive Gel << Ultra Highly Cohesive Gel
Softer more natural -------------------------->Very Firm and less natural
Higher rippling potential ------------------------> Less Rippling potential
The thicker the gel, the less rippling potential, but the firmer and less natural the breast. So in the case of gel thickness, when most women don’t have to worry about rippling in their textured silicone implants, more is not always better.
Silicone Implant ShapeThen there are round and anatomic shaped implants. Each patient will have their own view on these and it has a lot to do with their age range, demographics and desired result. The vast majority of breast augmentation patients want full round, cleavage and therefore they would be disappointed with an anatomic shape. If you desire a more discreet look of silicone breast forms they may be a consideration, but they only come in thicker gel condemning you to a firm less natural feeling breast, when a lower profile round silicone implant can still give the natural teardrop shape, but more natural feel.
Smooth vs. Textured ShellTextured silicone breast implants were introduced in an attempt to reduce capsular contracture by "disorganizing" the scar. Studies have been mixed about whether this theory is true in patients. Now texture has more to do with trying to keep anatomic devices in the proper orientation! Imagine an upside anatomic teardrop implant. The textured shell itself is thicker and less pliable when manufactured and the devices move less so it can be a firmer and less natural breast implant, many times a negative, but in the case of a lift may be beneficial. Although EXTREMELY rare it bears noting that all cases of ALCL reported have been with textured implants. So because it's, in my opinion, still just a theoretical benefit for the vast majority of primary breast augmentation patients, and may cause problems, I use mostly smooth unless a patient requests the textured or if I am trying to have the texture hold an implant in place on a large lift.
Fill RatioThe Allergan Inspira line and Sientra 106 line is the same gel and shell as the Natrelle line and 105 line respectively (meaning cohesive) but is filled approximately 5-7% more giving a “fuller” look without as much volume as the next style up. It also has less rippling potential, a big positive in extremely thin patients, without as much increase in firmness as thicker gel. My thinner patients are really moving towards the Allergan Inspira and Sientra 106 implants for less rippling and more fullness than mod+, but not quite as much volume as the high profile.
Ultimately, no breast implant manufacturer has proven that their device looks or feels better once implanted despite all the marketing hype. Anytime there are many choices, it is because they all have positives and negatives. The implant manufacturers prey on the unknowing consumer to pick a device with flashy advertising, or the “newer is always better” marketing campaign strategy.

I make specific recommendations to each and every of the 500+ augmentation patients I see annually based on: 1) dimensional planning 2) expressed goals 3) amount and quality of tissue to hide the implant.

Only a board certified plastic surgeon specializing in breast augmentations (meaning they do 300+ a year) will have the expertise, knowledge and experience to understand and explain these subtle differences to you. Don’t trust your result to an office that gave you a video, booklet or patient coordinator rather than the surgeon to answer these important questions about silicone breast implants. I attached a link with even more information. Best of luck.  

Evan Feldman, MD, FACS
Texas Plastic Surgeon
5.0 out of 5 stars 88 reviews


There are many different issues related to implants that are best reviewed in person. There are many choices and some implants work better for some patients more than others. Best of luck.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Breasts implants types

Dear Kate,
  It is much wiser to choose a doctor rather than an implant. When you select your surgeon based on your due diligence, go with his or her's recommendation.
  Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive. Pay special attention to the cleavage area, the perkiness, the symmetry and the natural look. Check also the 'realself' reviews for positive experience reports.
  In my cosmetic plastic surgery practice of over 28 years, I use almost exclusively smooth, round, moderate profile saline implants, made by Mentor and placed under the muscle through sub areola incision. The reasons for doing so are too many to discuss in this session. I will be glad to provide them to you if you contact my office.
 Textured implants have a shell that is  too thick and the implants are associated with high rate of seromas. Anatomical implants require small pocket , to prevent rotation, which increases the risk of breasts hardening with unnatural look and feel.
                            Best of luck,
                                              Dr Widder

Shlomo Widder, MD
McLean Plastic Surgeon
4.8 out of 5 stars 126 reviews

Textured v smooth? Round v anatomical?

Recovery from breast augmentation with texture breast implants is no more difficult than from smooth round implants.

I no longer use textured breast implants (all shaped implants are textured) because a very rare form of cancer called anaplastic large-cell lymphoma (ALCL) occurs only in textured implants and not in smooth round implants. For more information on textured implants please read below:

Implant Type

The shape of the implant is only part of the equation to getting a nice result from breast augmentation.  The type of pocket can also facilitate the overall shape and result.  In addition, implant dimensions and size matters as well.   In terms of picking the right implants to achieve your goals, generally speaking, I consider two factors when selecting implants for my patients:

1. Dimensional planning
2. Gel Implant Sizing system

Dimensional planning – The measurements of your chest wall are taken. Also, the breast dimensions including the height, width, and current dimensions of each breast form the basis of dimensional planning. Based on these measurements, the implant size is recommended. This will give you a unique breast implant that is suited for your body frame. However, there are some limitations of what size we can recommend. For instance, some implants may just be too big for a narrow chest wall. Your surgeon can review this with you during the consultation.

Gel Implant Sizing system – During the preliminary breast implant consultation, you will be provided with an option to “try on” a variety of implant shapes and sizes. You can also visualize the possible outcomes of your surgery which helps you to get that perfect size to give you the shape that you longed for. This way your preferences are known and you can then pick a range of implants that will “fit” just right to give a soft natural fuller look. Hope this helps.

Houston, TX

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 212 reviews

Textured v smooth? Round v anatomical?

Thank you for your question.  These are valid points that every patient should have.  Clinically one should not have any difference recovering from textured or smooth implants.  In regards to anatomic vs. round the differences can be noticed.  Some say that after time a round implant settles into a teardrop shape but in my observations the anatomic can put more projection in the lower pole of the breast and less of a upper pole fullness.  I would start with a face to face consult with a Board Certified Plastic Surgeon who has experience in breast surgery. During your visit your surgeon should be evaluating your health to determine if you are a good surgical candidate and examining your tissues to get a sense of what type of procedure your tissues will allow. There should be a thorough discussion of the risks, benefits, and tradeoffs of smooth vs. textured and round vs. anatomic.  During the consult you and the surgeon should be understanding of the goals and realistic outcomes of your choices. Once an exam and opinion is rendered then you can decide if surgery is right for you. Good luck.

David J. Wages, MD
Peabody Plastic Surgeon
4.8 out of 5 stars 24 reviews

Difference between different implants

These are excellent questions.  I can give you some general information related to your questions and try to clear up some of the mystery for you.

1) textured vs smooth.  Textured implants are just that: textured at the surface instead of smooth.  The contents are the same.  Textured implants were designed with the idea of decreasing capsule formation and therefore lessening the risk of capsular contracture.  Whenever you place a foreign material inside the human body, it normally forms a capsule around that object.  In some cases, that capsule can be thick and can lead to symptoms (eg. pain), changes in the feel of the breast (the breast will be harder), or changes in the shape of the breast (the capsule can "contract" and alter the breast's appearance).  Interestingly enough, in Europe most surgeons routinely use textured implants whereas the practice is not nearly as standard here in the United States.  In the US, surgeons will often choose textured implants for patients undergoing revision for capsular contracture.  There is debate among surgeons and patients over how the smooth vs textured implants may feel differently.  There is NO difference in recovery between textured and smooth implants.  

2) anatomical implants.  In the appropriately selected patients, anatomic or shaped implants can render a more "natural" appearance.  These implants contain a thicker gel designed to hold the shape of a tear drop.  I will consider these implants for smaller patients who wish to avoid the rounded, unnatural appearance - which might be more prominent in their body type with round implants - and in some reconstructive patients who have had a mastectomy.  These implants are more firm to the touch (due to the thicker gel contents) and some patients are turned off by that as compared to the standard round implants. These implants are also more expensive than standard round implants.  I think most patients can get an excellent and natural-appearing result with round implants assuming the correct implant size and shape (eg. moderate verses high profile) are selected.

I think this captures most of the info in a general sense although there are additional nuances.  Take the time to discuss these differences with your surgeon(s) so you feel comfortable and confident moving forward.

Hope this helps!

Charles Galanis, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 20 reviews

Breast implant comparisons

The recovery from breast implant surgery is much more predicated upon the method used by the surgeon then which type of implant is inserted. A short recovery technique has been described using only sharp ele electrocautery dissection and virtually no blood loss. Also, the word natural means so many different things to different people that bringing a picture of what you'd like to look like and what you consider natural can help tremendously. For the patient with little breast tissue and anatomically shaped implant can provide for a nice slope from the chest wall to the nipple. That in my mind better replicates the look of a natural breast. I have had, however patients tell me that a more natural look is where  there is a prominence of fullness in the upper pole of the breast. Risk-benefit ratio again is more predicated upon the making of the pocket than the type of implants that are used. The only added risk for an anatomical implant is rotation which in my experience is quite rare. Good luck with your anticipated surgery.

Marc J. Salzman, MD, FACS
Louisville Plastic Surgeon
4.7 out of 5 stars 55 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.