In the Aesthetic Surgery Journal September 2017 article on implants “Long term safety of textured and smooth breast implants” they had a couple tables on smooth versus textured implants, looking at the benefits and issues with each. I thought it bears repeating. I loved the article, and learned a few pearls. One of the surprising ones for me is that in the US we use a majority of smooth walled silicone implants for breast augmentation, but in Europe they use 90% textured silicone implants. How is it so different? And what are the different issues of each?
The authors of the article created a synopsis of their view of the good and bad of each.
SMOOTH SILICONE IMPLANTS
- THE GOOD:
- soft
- feel and move like a natural breast
- newer generations have less wrinkling
- in reconstruction patients, the movement of the implant in the pocket can make a more natural shape in radiated tissue
- THE BAD:
- higher capsular contracture rates, especially when placed ABOVE the muscle
- greater mobility can lead to bottoming out or lateral migration
- reduced control of pocket
- WHO IS THE IDEAL PATIENT?
- patients who don’t require lowering the inframammary fold
- nonsloping chest wall
- thin soft tissue coverage (less likely to wrinkle)
TEXTURED IMPLANTS
- THE GOOD
- adheres to tissue to stabilize the pocket (so implants don’t migrate over time)
- less stretch in lower pole (so implants can’t bottom out)
- doesn’t move in sloped chest walls
- lower capsular contracture rate especially in subglandular position
- prevents shaped implants from rotating (note: I didn’t know people ever used smooth walled implants for shaped implants- those must rotate!)
- in reconstruction patients, reduce the incidence of wrinkling, especially in front of the muscle
- THE BAD
- may need larger incision
- pocket must be exactly the right position
- potentially higher rate of wrinkling
- higher risk of late seroma
- higher risk of double capsule
- increased risk of snoopy or waterfall deformity in those with heavy or loose breast tissue
- small but increased association with BIA ALCL
- WHO IS THE IDEAL PATIENT?
- revision or sloped chest wall patients to prevent implant malposition
- those with prior capsular contracture
- in augmentations combined with breast lift, can reduce stretch deformity and recurrent drooping
- if stretchy poor soft tissue, reduces risk of bottoming out
- good for reconstructive patients to help idealize volume, width, and projection
- in reconstruction patients, may resist deformation by radiation induced capsular contracture.
My thoughts?
It is interesting. I have been a smooth walled silicone gel breast augmentation fan for years. It is the most commonly used implant throughout the US. I love the movement of the breast. They look and feel so natural. I have many patients where people “can’t tell these are breast implants and not real.”
But I do use textured implants for certain cases. I think of it like hundreds of little pieces of velcro, holding the implant where I put it. I like textured implants for
- those with poor chest wall shape (the ribs slope outward, so the breast implant would slide off into the armpit)
- for breast reconstruction patients
- and for those who have super thin tissue (I worry those patients will stretch and bottom out from the weight of the implant.)
I have had issues with smooth and with textured. I have smooth implant patients with implant migration or bottoming out. I have textured implant patients who feel the breasts are too firm, don’t move, and they can’t push it in a bra to get cleavage.
Pros and cons. As with all things in life, there is no one perfect answer, it is all shades of grey. These are the kind of things I review with you when you come in for a consultation.