If you’re considering breast implants, you may be aware that there are numerous choices involved. From size and shape to gel consistency and profile, the options can feel endless. One choice you will also hear about is whether an implant has a smooth or textured surface.
While an implant’s surface might seem like a relatively small detail, it can influence how it behaves within the breast. Textured implants were developed partly to help stabilise the implant and reduce movement. Smooth implants have a completely smooth outer shell and can move a little more easily. In this article, we explain the differences between the two and why it matters.
Smooth vs Textured Implants: What’s the Difference?
Your breast implant’s surface has an outer shell made of silicone. This surface can either be smooth or textured.
- SMOOTH IMPLANTS: These implants have a smooth outer shell and can move more freely within the breast pocket. They are available only in round shapes. If you want a smooth implant, a round implant will be your only option.
- TEXTURED IMPLANTS: These implants have a rougher outer surface designed to interact with surrounding tissue. Textured implants provide greater implant stability. Texturing has also been associated with a lower rate of capsular contracture in some circumstances.
Why Were Textured Breast Implants Developed?
One reason textured implants were developed was to help keep the implant in position. This can be especially important with anatomical (teardrop-shaped) implants. Unlike round implants, anatomical implants have a specific shape. If they rotate within the breast pocket, they can look quite odd and unnatural.
A textured surface can help the implant adhere to surrounding tissue, reducing movement and the risk of rotation. For this reason, anatomical breast implants are always textured.
On the other hand, round implants can be either smooth or textured, because if they move in the breast pocket, they still look relatively natural.
What is BIA-ALCL
When discussing textured implants, it’s important to discuss BIA-ALCL. This stands for breast implant-associated anaplastic large cell lymphoma, which is a rare type of cancer of the immune system.
NB: BIA-ALCL is not a type of breast cancer, and breast implants do not cause breast cancer.
BIA-ALCL can develop in the scar tissue or fluid surrounding a breast implant.
Research has linked BIA-ALCL to textured implants. Risk varies by the type and degree of texturing, and the TGA states that risk increases with greater implant surface texturing.
It is important to remember that BIA-ALCL is rare, with a journal publication in May 2019 estimating the risk of BIA-ALCL in textured implants to be between one in 2,800 and one in 86,000, depending on the brand of textured implants.
In August/September of 2019, following this publication, the TGA took regulatory action against certain higher-risk textured implants. Specifically, a number of textured implants were removed from the Australian market.
Textured breast implants with the least risk of BIA-ALCL are still available in Australia.
If you are reading this and already have one of the higher-risk textured implants and have no symptoms, the TGA does not recommend removal or replacement.
You can read the latest information and advice on breast implants and BIA-ALCL on the TGA website here.
If treated early and with appropriate management principles, BIA-ALCL can result in complete remission. However, you still should discuss the topic of BIA-ALCL during your consultation before deciding on breast implant surgery.
Does Textured Mean Better?
In short, not really. Textured implants can offer particular advantages, especially when implant stability matters (e.g., with anatomical implants). But this doesn’t mean that textured implants are automatically the right choice for everyone.
Choosing the most appropriate implants for you involves balancing several factors, including your anatomy, the type of implant considered, and the potential pros and cons of different implant surfaces.
For example, if you’re considering an anatomical implant, texturing is essential because the implant needs to maintain its orientation. If a round implant is being considered, it doesn’t matter so much if the implant moves in the pocket, as it will still look the same. Therefore, both smooth and textured options may be considered.
What About Capsular Contracture?
Capsular contracture is one of the more well-known potential complications of breast implant surgery. It occurs when the scar tissue capsule that naturally forms around an implant becomes unusually thick and tight. This can cause the breasts to feel firm and may sometimes result in distortion or discomfort.
Textured implants have historically been associated with reduced risk of capsular contracture in certain situations. However, capsular contracture can occur with both smooth and textured implants, and multiple factors influence the overall risk.
Choosing the Right Implants for You
Your implant’s surface is only one part of the decision. During your consultation, Dr Dona will assess numerous other factors, including:
- Your breast shape and symmetry
- The position of your nipples
- Your breast tissue and skin quality
- Your chest and rib cage measurements
- Any existing breast droop (ptosis)
- The amount of breast tissue available to cover the implant
- The implant shape and profile
- Your individual preferences and objectives
These factors will help Dr Dona determine which implant options are clinically suitable for your body and appropriate for your desired outcome.
There Is No Single Implant That’s Right for Everyone
No two people are the same, and consequently, breast implant selection must be individualised.
Textured implants can provide greater stability and are used for anatomical implants, while smooth implants offer a different set of characteristics and are available in round implant designs.
Importantly, the decision should not be based on implant surface alone.
If you’re interested in breast implants, we recommend you book an initial consultation with Dr Dona in his Sydney-based rooms. He can explain the available options, including the potential pros and cons of each, and help you understand which choices may be appropriate for your anatomy and individual circumstances.
