What's the difference between smooth and textured implants?

Why the texture (or lack thereof) makes a difference.

Years ago, breast implants were one-size-fits-all (almost literally). Now, patients have many, many options — not just about size and what they want their implants filled with, but also about the shape of the implant, as well as the type of implant shell.

Case in point: the saline/silicone debate only refers to what’s inside of the breast implant. The shell itself is another matter. When you get breast implants, the surgeon first places the shell of the implant, and then fills it with silicone or saline. So why does the shell matter? It matters for many reasons — from comfort to risk of capsular contracture.

Why Texture Matters
Both silicone and saline can have either a smooth or a textured shell. With a smooth shell, you don’t have to worry as much about wrinkling. Because the smooth shell is rather thin, they feel softer than textured shell implants. Smooth implants also tend to move with activity, more like a natural breast does. However, for an implant to have a smooth shell, it must also be round (see the next article about round versus shaped implants).

The downside of smooth shell is that if you’re going with silicone implants, there is a higher rate of capsular contracture than with textured silicone implants. The data show about 34 percent rate of capsular contracture with smooth silicone implants versus 15 percent rate with textured silicone implants. (Most plastic surgeons believe the actual numbers are considerably smaller.)

The Tradeoffs
So, why do some women still opt for smooth silicone? Because with textured implants, the shell feels more like sandpaper. These implants are usually firmer than smooth implants, since the texturing requires a thicker shell. That means that if your skin is thinner, or if you have fairly small breasts and/or not a lot of breast tissue, you will be more likely to feel textured shell implants. Often, surgeons recommend that if you’re having implants placed above your chest muscle, you opt for smooth shell.

Of course, if capsular contracture is of concern, you can opt for smooth shell saline implants. Studies have shown the rate of capsular contracture to be about the same (somewhere between 8 and 14 percent) regardless if the saline implant is smooth or textured.

The final thing to consider is the style of implant, round versus tear-drop (the round versus tear-drop style is discussed in more detail in the next article). If you opt for tear-drop shaped implants, the implants must have a textured shell. The texture allows the implant to adhere to your breast tissue. That’s critical, because you want the tear-drop shape to stay in place. If it rotates, it looks out-of-whack.

To help figure out what type of shell makes the most sense for you, make a list of your biggest concerns about breast implant surgery, and your biggest “must-haves.” Together, you and your surgeon can fit the pieces together and determine which makes the most sense for you.

Frequently Asked Questions Reviewed by Dr. Richard Baxter in Seattle, WA. To learn more about Dr. Baxter, please go to www.aboutplasticsurgery.com/doctor-profile/richard-a-baxter-md-facs-227.