A breast implants surface – smooth or textured?

All breast implants have a silicone covering. The surface of this covering can have two distinctions. Either the implants surface is completely smooth or it has a so called textured (rugged, sandpaper like) surface. The saline breast implants are almost only sold with the smooth surface whereas silicone breast implants can be both smooth and textured.

Textured breast implants most common

Figures from the two largest implant manufacturers Mentor and Allergan show that the majority of the silicone breast implants used in breast enlargements today have a textured surface. There is however a shift towards the smooth breast implants. According to the manufacturers this is because the smooth breast implants have improved and now have a denser surface.

Surface character and frequency of complications

The textured surface was developed with the aim of influencing the bodies healing process and in doing do minimise the risk of capsule contracture which can occur in the following way:

When the body discovers a foreign object an encapsulation of connective tissue (scar tissue) begins. In this case a capsule of scar tissue is built around the breast implant. In some cases this capsule becomes unacceptably hard and painful – a condition known as capsule contracture which is one of the most common complications with breast enlargements.

Difficulty describing the function of the textured surfaces

In studies it has been difficult to prove if the textured surface as any effect and even the most experienced plastic surgeons opinions differ on this question. The textured surface has however proven to minimize the risk of the breast implant moving and ending up in the wrong place. This is important when using anatomical breast implants that have an up and down side, but does not matter when using round implants.

Potential disadvantages of textured breast implants

According to some surgeons, the advantage of textured breast implants also brings about a disadvantage. This involves, in their opinion, that the uneven surface increases the risk of visible unevenness (traction rippling) which is one of the most common reasons for aesthetical dissatisfaction after breast augmentations. Traction rippling occurs when the tissue above the breast implant grows onto the textured surface. After a period of time when the breast implant sinks tension is applied to the skin which causes rippling.

Other surgeons insist that this is not the case and that rippling occurs as a consequence of the breast implant creases and that the skin mimics this creasing. It appears as unevenness under the skin (rippling) and most evident when the patient leans forward. One suggests that the problem of rippling has occurred in later years as a result of the increased interest in larger breast implants, which automatically have a greater tendency to crease.

There are also plastic surgeons that suggest rippling is caused by the tissue pocket that was made to carry the breast implant was made too small. Therefore the breast implant cannot open out completely which then leads to rippling.

Textured breast implants more expensive than smooth ones

Some cosmetic surgeons consider the insufficient scientific support for decreased capsule frequency with textured breast implants, the higher price and possible increased risk of rippling, points towards using an breast implant with a smooth surface.

Observe that the above reasoning is for the use of round breast implants. The anatomical breast implants always have a textured or micro textured surface since they are meant to heal into a specific position in order to produce a nice result.

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