Breast Augmentation & Breast Implant Information Web - Frequently Asked Questions

Smooth vs. Textured – What should I choose? First of all, it is important to note that like many other decisions you will make in connection with your breast augmentation, this is one that you will need to make with your plastic surgeon. Given your own individual needs and the surgeon’s preferences, there may be good reasons to go with one versus the other. Textured Implants -- Capsular Contracture. As early as the 1950s doctors had attempted to implant substances or devices to augment the breast, including sponges, body fat, etc. A problem that has persisted, despite the effectiveness of modern implant designs, is capsular contracture. Foam coverings and all types of solutions were attempted to prevent the scar tissue, which naturally forms around any foreign object, to become unacceptably hard (see FAQ on capsular contracture). The most recent evolution of the concept is textured surface implants, although a textured surface is not a new concept. Because of the way scar tissue forms around an implant, a textured surface is supposed to prevent scar tissue fibers from laying down uniformly in a parallel fashion and thus tightening up. According to a number of studies, a textured surface is not likely to reduce the risk of capsular contracture. Other studies find a reduction in contracture. Anatomical Implants. Textured implants are also in order in most anatomical placements as the anatomical or contoured implant is meant to have a top and a bottom (it is tear drop shaped). Without texture, the implant could “flip,” leaving the implant upside down and misshapen in appearance. While this can be corrected manually or surgically, it is not an ideal happening. A textured surface on the implant is intended to cause the tissue to adhere to the implant enough to prevent its free rotation. Rippling, Deflation, Shell. One problem that causes many surgeons to not use textured implants is the apparent increase in the chance for visible rippling, according to many surgeons. The same characteristics of the textured surface that cause the scar tissue to form irregularly around the textured implant also cause it to appear rippled in appearance. A recent study also claims that textured implants have a higher deflation rate and are firmer to the appearance. Smooth Implants. Capsular Contracture. Due to the controversy over whether textured implants will actually reduce the rate of contracture significantly enough to warrant other potential disadvantages discussed above, doctors who prefer to use smooth, round implants quite often place them under the muscle. Placement under the muscle is also claimed to reduce the incidence of capsular contracture and this view is held by a consensus of surgeons. Round Implants. Unlike anatomical implants, round implants do not require texture because they can rotate within the capsule and pocket without any change in appearance. Rippling, Deflation, Shell. Proponents of smooth shell implants claim that they are less likely to cause visible rippling (especially if placed below the pectoral muscle) and more natural to the touch because they are made with thinner walls than the textured, anatomical implants. Note: Round implants can be textured and anatomical implants can be smooth. However, it is usually recommended that anatomical implants be textured due to the potential for unacceptable rotation of the implant. For interesting viewpoints on many of these issues, please check out the books in the Resources section by Dr. Tebbetts and by Dr. Guthrie. Updated: 01/17/07

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