Breast implants can have either a smooth surface or a textured surface. The textured implants are rough on the surface similar to sandpaper (although the material is the same as the normal implant shell). The question then becomes why choose one surface over the other?
How Textured Implants Got Started
Originally, all breast implants were smooth on the surface. One of the most common issues with breast implants was their tendency to develop capsular contracture, which is a thickening and tightening of the thin layer of scar tissue around the breast implant. Many techniques were tried to reduce this scar tissue layer. One theory that developed was that texturing the surface of the implant would allow the surface of the implant to interact with the scar tissue layer and decrease its thickness and tightness.
Textured Implant Benefits
Evidence has shown that when the implant is placed directly beneath the breast (on top of the chest wall muscle), the likelihood of capsular contracture is decreased when using a textured implant. It is not clear that the same benefit exists when a textured implant is placed underneath the chest muscle. In cases where implants are under the chest muscle there seems to be some benefit in reducing the risk of capsular contracture simply by having the implant in a submuscular location. Capsular contracture rates are improved but are not notably different between textured or smooth implants when using submuscular placement.
Textured Implant Drawbacks
One of the disadvantages of texturing is that it tends to increase the risk of visible rippling or implant surface waves that can be seen through the skin. This is a particular problem associated with saline implants in smaller breasted women who have their implants over the chest muscle. Visible rippling is less of a concern with silicone implants and less of an issue with women who have ample breast tissue to pad or camouflage the implant. Rippling also is uncommon when the implants are placed under the chest wall muscle.
Making the Choice
So who should get textured implants? All women who have breast augmentation with shaped breast implants will automatically get a textured implant. Currently all the shaped implants are only available with textured surfaces. The reason for this is that the texturing also tends to hold the implant in position a little better. Since the shaped implants could potentially rotate within their pocket, the texturing decreases this likelihood and thus for these implants provides a more reliable result.
Round implants may be either smooth or textured. Every plastic surgeon will have his/her opinion as to the best situations to use textures or smooth breast implants. Since textured implants, in my opinion, tend to show rippling easier and since this is already an issue with saline implants, I tend to avoid this saline/textured combination when placing implants over the chest muscle – especially in smaller breasted women. When placing an implant beneath the chest muscle, I also tend to use a smooth surface implant since there does not appear to be any significant advantage to a textured implant in this position.
Nevertheless, women who have recurrent capsular contracture and who are changing implants would, in my opinion, benefit from the use of a textured implant placed in a submusclular position.
