Breast Implants: Consideration #4: Smooth v. Textured

The shell of a breast implant can be smooth (as shown on the left) or textured (as on the right).

Biophysicists first developed texturing in their attempt to decrease capsular contractures.

• All foreign materials (whether knee replacements, artificial heart valves, or metal rods for stabilizing bones) stimulate inflammation and surrounding scar.
• • The body thinks, "What the hell is this thing?!  I need to protect myself."
  • The resultant inflammation produces the scar.
• Capsular contracture is the specific term for the scar around breast implants.
• While all breast implant patients have some degree of capsule, in 7-9% of patients the scar can be excessive. 
• • The breasts can be too firm;
  • they can be distorted;
  • they can even be painful.
• Below is a patient from Hawaii who presented to my Ventura office with severe capsular contractures.  Ouch.

Textured shells were supposed to decrease the incidence of capsules and to minimize their extent when they did form.  The rationale was that any scar formed around textured implants would be irregularly oriented, and thus less likely to become hard, firm, or distorting.

Most studies, however, have not supported this theory.  Textured implants become hard ("contracted") as often as smooth implants.

Moreover,...

• Textured implants have thicker shells.  Thus, to begin with, textured implants are a bit firmer.
• Textured implants tend to produce more rippling.

Now you know why 92% of Board Certified Plastic Surgeons in the USA use smooth implants rather than textured implants.

So, why do we ever use texturing?

• Rarely, some patients benefit from tear-drop-shaped implants.  The texturing helps to stabilize the implants so that they maintain their orientation.  (Please read my post from 3 days ago.)
• Tissue expanders used in breast reconstruction also have an "anatomic" shape.  Whenever I am treating a mastectomy patient who is interested in a prosthetic breast reconstruction, I always use textured devices to create a pocket for a permanent implant.

(By the way, the Hawaiian patient had a happy ending--albeit after a corrective surgery....)