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Should I choose a smooth or textured breast implant for my breast augmentation?

Jul 25, 2022

What is implant texturing?

Breast implants surfaces come in 2 varieties: smooth and textured. During the breast implant manufacturing process, the default implant type is smooth. Texturing is an additional manufacturing step that imprints the surface of the silicone shell, using a variety of different techniques, to create a rougher surface. Implants are currently classified as being ‘smooth’, ‘microtextured’ or ‘macrotextured’ depending on how rough their surface is.

So why does texturing matter?

Textured implants are thought to integrate better with the body’s tissues and are, therefore, less prone to migration or rotation. Therefore, they are preferred in some implant-revision cases or in breast reconstruction and data from clinical studies in breast augmentation have also shown that capsular contracture rates are lower with textured implants.

In recent years, texturing has come under the spotlight because of the association with certain types of textured implants and breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). BIA-ALCL is a blood cancer (lymphoma) that arises within the capsules of breast implants, which can be easily treated. Nearly all cases of BIA-ALCL have arisen in implants with certain types of textured shells. The implant types that have the greatest association with BIA-ALCL have been recalled but, at present, it is thought that texturing does increase the risk of BIA-ALCL.

Should I choose a smooth implant over a textured one, then?

 Choosing between a smooth and textured implant can be difficult. Smooth implants are associated with higher rates of implant malposition (either lateral malposition or bottoming out) and capsular contracture. Clinical studies show that the implant revision rate for malposition can be as high as 20% by 1-year with smooth implants. Therefore, in some cases of implant revision it may be beneficial to use a textured implant that is likely to integrate better and not move. Conversely, the risk of textured implants is their association with BIA-ALCL even though this risk is extremely low (1 in 15,000 implants).

So, by choosing a smooth implant you decrease the risk of a very rare complication (BIA-ALCL) but increase the risk of a more common complication (malposition or capsular contracture). It’s very important that you can have this nuanced discussion with your surgeon and choose the implant type that is right for you – whether it is smooth or textured. Ultimately, this means choosing a surgeon who is comfortable using both smooth and textured implant devices, so you have the full range of options available to you.

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