Choosing between textured & smooth breast implants.

Although we’re primarily a breast implant sizing service, we get asked a lot of other questions by our patients. One of the more common questions is “which are better, textured breast implants or smooth breast implants?”
The short answer is: Smooth is usually better for round implants, and anatomical implants are always textured anyway.

The long answer is, as usual, very long, and involves figuring out which option is best for you.

The history of textured breast implants.

The outer shell, or baggy, of all breast implants is made of tough, very stretchy silicon rubber. When breast implants were first invented in the 1960’s, the outside surface of that shell that touched the inside of your body was always smooth and shiny.

In the 1990’s, surgeons and implant manufacturers realised that a proportion of breast implant patients developed capsule formation. Capsule formation is when your body, instead of ‘walling off’ the implant with a thin layer of scar tissue, produces a really thick layer of scar tissue which shrinks and makes the breast feel very hard. Implant manufacturers convinced surgeons (largely) that if the surface of the breast implant was slightly roughened, like velvet, capsule formation would be less likely to happen. The theory was that the layer of scar tissue that every person forms around the outside would be less able to shrink and cause problems if the implant surface was rough.

Lots of experimental studies were done, to determine what proportion of women with textured implants had capsule formation in the years and decades after their surgery, and compare that to the proportion of women with smooth implants who developed capsules. In general, the studies showed that there was slightly less risk of capsule formation when textured implants were used. But it’s worth emphasising that the risk was only slightly less.

Each implant manufacturing company had a slightly different amount of roughness on the surface of their implants, which was great because it enabled each company to claim their kind of textured implant was better than all the others!

Advantages of textured breast implants.

Today we don’t really think that the risk of capsule formation is significantly less in textured implants. Today we think that capsule formation has several causes, and there are other things that can be done during and after surgery to minimise the risk of capsule formation.

The one key benefit of textured implants today, is that they ‘velcro in place’. This can be a useful thing in some patients where the surgeon is worried that the implant may displace, or slowly go out of position in the months and years after the surgery.

Texturing is also mandatory with anatomical shaped implants, which might rotate out of position if they did not have the texturing to velcro them in place.

Disadvantages of textured breast implants.

However, the implant ‘velcroing in place’ can also be a disadvantage. Natural breast tissue can be ‘moved around’. It can be pushed up in a pushup bra. It can be pushed together in a cross your heart bra. It can be flattened in a sports bra. Breast implants that are ‘velcroed in place’ can look great in still photos, but in real life can be unmoveable.

A second disadvantage is that textured implants are associated with a much much higher risk of ALCL than smooth shell breast implants. Again, it is worth emphasising that the overall risk of ALCL is very small to start with.

Advantages of smooth beast implants

The main advantage of smooth breast implants is their ability to move around. Just the opposite of the ‘velcroed in place’ textured implants. Surgeons using smooth implants usually dissect a slightly bigger cavity, or pocket, than is needed to fit the implant in. The smooth implant can then ‘swim around’, just slightly, inside that larger pocket. This means the implant can be pushed up, pushed together, or pushed down more like natural breast tissue can be. This is not something that you would notice when looking at before and after photos on the internet, but you might notice it when that same person is dancing, or exercising, or even lying on their back on the beach, and their implants are falling out to the side a little bit like normal breast tissue would.

Patients with smooth implants will often be told to ‘massage’ the implants. This is not really massage, but should be called ‘implant displacement exercises’. It is squeezing the breast to force the implant to move up (and down) inside the pocket to stretch the pocket out and make sure the deliberately larger pocket does not shrink down around the implant.

Smooth implants can be put in through a slightly smaller incision, and are usually slightly cheaper, but those are minor considerations.

Conclusion.

Textured breast implants were designed to offer an advantage in minimising the risk of future capsule formation, but this is not a big enough factor to really make them a significantly better option than smooth breast implants. In some cases, the ‘real life’ cosmetic results of smooth round breast implants may be better than textured round breast implants. When anatomical implants are used, they are always textured to prevent rotation of the implant.

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