Dr. Brooke R. Seckel
If you have decided that you want to have breast augmentation surgery there are many decisions that you will have to make with the advice and help of your board-certified plastic surgeon. In addition to deciding on implant size, location of incision, and implant under or over the muscle, you will also have to decide between smooth breast implants and textured breast implants.
Breast implants consist of an outer silicone rubber shell which surrounds and contains either silicone gel or saline. Smooth breast implants have an outer silicone rubber shell which is very smooth, shiny and slippery. Smooth implants do not attach to the surrounding body tissue and are usually freely moveable within a tissue membrane or sack that forms around the implant and is called a capsule.
Textured breast implants have an outer silicone rubber shell with a rough, pebbly, irregular surface almost like soft rubber sand paper. Textured implants attach to the tissue capsule around them and are less likely to move.
One problem that can occur after breast augmentation is when the tissue capsule or membrane surrounding the breast implant becomes very tight. This condition is called capsular contracture and causes the breast to feel hard.
In the 1980’s textured breast implants were developed with a rough surface like sandpaper because research suggested that breast implants with a rough surface were less likely to cause capsular contracture.
A research study published in the 1993 Journal Plastic and Reconstructive Surgery found that there were significantly fewer capsular contractures in patients receiving textured breast implants compared to those who received smooth implants. Another controlled study in the 1996 Journal of Plastic and Reconstructive Surgery had similar findings. However a prospective study published in the 1997 Journal of Plastic and Reconstructive Surgery found no difference in the rate of capsular contraction between textured and smooth implants.
As a result of the conflicting studies many plastic surgeons do not believe there is strong proof that textured implants reliably reduce the rate of capsular contracture.
When textured or smooth breast implants are placed beneath the chest muscle in a patient with adequate breast tissue overlying the muscle it can be impossible to feel the difference between the two.
However, textured breast implants have a thicker wall than smooth implants and thus can feel firmer. In addition, textured implants are more likely to have palpable folds and ripples. Thus in very thin people with little breast tissue, if the textured implant is placed on top of the muscle it is more likely to be felt than a smooth implant.
Before and after breast augmentation with a smooth round 350cc breast implant
Under ideal circumstances with implants beneath the muscle and adequate breast tissue over the muscle, you cannot see a difference between textured and smooth breast implants after breast augmentation. However, the risk of visible folds and ripples is greater with textured implants than with smooth implants. This is particularly true in thin patients with little breast tissue and more so if the textured implant is placed on top of the muscle under the breast.
Smooth walled silicone and saline breast implants are the most common choice of breast augmentation patients and plastic surgeons today. The new cohesive silicone gel smooth walled breast implants approved by the FDA in 2006 are much improved over the smooth walled implants in use prior to the 1980s. Today, when possible, breast implants are placed beneath the chest muscle which provides better coverage, less chance of visibility, and less risk of capsular contraction. The combination of an improved smooth-walled implant and modern plastic surgical techniques have reduced the chance of capsular contraction to well below 10% and with the best techniques as low as 2%.
Many plastic surgeons have a preference for textured round breast implants and continue to use them routinely. In addition, the new anatomic shaped or teardrop shaped breast implants are only made with a textured shell. The textured implant shell is firmer and stiffer and thus holds its shape better than a smooth implant. Therefore, if you choose to have a shaped breast implant you will have to have a textured breast implant.
Textured breast implants are also often used to replace implants after removal of a capsular contraction. This is done in an attempt to prevent the recurrence of the capsular contraction.
Recent studies have reported that a lymphoma tumor called an Anaplastic Large Cell Lymphoma has been discovered to occur around the shell of textured breast implants. This tumor has only been found associated with textured breast implants and no cases have been found associated with smooth walled breast implants. The occurrence of this tumor is rare and an estimated risk of this tumor when textured implants are used is 1 in 30,000. This tumor occurs usually between 4 to 8 years after the textured implants are placed. The first sign is swelling due to fluid buildup.
Most cases have been successfully treated with removal of the textured implant and the tumor. Although the occurrence of Anaplastic Large Cell Lymphoma is rare, the fact that it does not occur with smooth walled implants pushes me to favor smooth walled breast implants for elective, cosmetic breast augmentation.
Your decision to choose between textured and smooth breast implants can only be made during your consultation with a plastic surgeon who is board-certified by the American Board of Plastic Surgery and very experienced in breast augmentation. Your plastic surgeon will explain the differences and help you decide. Most likely if you are having standard round breast implants you will choose a smooth breast implant. However, if you chose a teardrop shaped breast implant you will have a textured breast implant. If your plastic surgeon is one who prefers round textured implants be certain that the implant will be placed beneath the chest muscle and not under the breast on top of the muscle if at all possible.
If you are interested in learning more about breast augmentation surgery, or other procedures such as stretch marks removal, double chin treatment and buccal fat pad removal (cheek reduction) contact the Boston Plastic Surgery Specialists today.