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Authored by: Dr. Sam Sukkar, MD on September 1st, 2025
Textured breast implants have a slightly rough surface designed to help them stay in place and reduce certain complications. They are often used in both cosmetic and reconstructive breast surgeries. They can offer benefits for some patients, but they also carry specific risks that should be understood before making a decision.
For anyone considering breast augmentation or reconstruction, comparing textured and smooth implants can help match the right type to personal goals and health needs. Knowing the facts about safety, benefits, and aftercare makes it easier to have an informed conversation with a qualified surgeon.
Textured breast implants have an outer shell with a rough or grained surface. This design can help the implant stay in place and may reduce certain complications, but it also carries specific risks that patients should know about before surgery.
A textured breast implant has a shell with a slightly rough surface instead of a smooth finish. The texture can be fine or more pronounced, depending on the manufacturer. The surface is designed to help the surrounding tissue attach to the implant. This can reduce movement and rotation inside the breast pocket.
Some surgeons use textured implants to lower the risk of capsular contracture, a condition where scar tissue around the implant becomes tight. However, studies show mixed results, and some research links textured implants to a rare cancer called breast implant-associated anaplastic large cell lymphoma.
Patients may choose between saline or silicone gel fillings, but the textured surface refers only to the outer shell, not the material inside.
Smooth breast implants have a polished, slippery surface. They can move more naturally within the breast pocket, which some people prefer for a softer feel. Textured surface breast implants, on the other hand, tend to stay fixed in position. This can be important for shaped implants that need to maintain orientation.
Choosing between them depends on the desired look, implant shape, and the patient’s risk tolerance for possible complications. Some surgeons now prefer smooth implants due to safety concerns, while others still use textured surfaces in specific cases.
Textured breast implants have a slightly rough outer shell that interacts with surrounding tissue in a way that can improve stability and reduce certain complications. They are often chosen for specific procedures where implant movement or rotation could affect the final result.
The textured surface allows tissue to grow onto the implant shell. This creates a light grip that helps hold the implant in place. This feature can be especially helpful for teardrop-shaped implants, which have a sloped contour designed to mimic a natural breast shape. If these implants shift, the breast may look uneven. The textured surface lowers this risk.
In cosmetic breast augmentation, some surgeons prefer textured implants for patients with active lifestyles. The added stability can help maintain the intended position over time. Compared to smooth implants, textured implants are less likely to slide within the pocket created during surgery. This may reduce the need for revision procedures due to implant displacement.
Patients considering breast augmentation with textured implants should discuss placement options, as stability can also depend on whether the implant is placed under the muscle or breast tissue.
Rotation is a concern mainly for shaped implants. With round implants, rotation does not change the appearance much, but with teardrop-shaped implants, even slight movement can affect symmetry.
The textured shell helps prevent this by creating friction between the implant and surrounding tissue. Over time, the tissue may attach more securely to the implant surface, making rotation less likely.
Studies have shown that textured implants may also lower rates of capsular contracture in certain placements, which can indirectly reduce implant movement. However, this depends on surgical technique and patient factors.
In reconstructive breast surgeries after a mastectomy, surgeons often use textured implants to help maintain breast shape during healing. The texture can help the implant stay in the correct position while the tissue settles.
For patients with less natural breast tissue, stability is important to prevent visible shifting or rippling. Textured implants can provide this support without relying solely on surgical pocket design.
When rebuilding the breast after cancer treatment, implant rotation could cause asymmetry between the reconstructed and natural breast. The textured surface helps reduce this risk, especially with anatomical implants.
Textured breast implants have been linked to certain medical risks that patients should understand before surgery. Some involve rare cancers, while others relate to scar tissue changes or regulatory actions that affect product availability.
BIA-ALCL is a rare type of non-Hodgkin’s lymphoma that can develop in the scar tissue and fluid around a breast implant. It is not breast cancer, but a cancer of the immune system.
Most confirmed cases have been linked to textured breast implants, especially those with a more aggressive surface texture. The FDA reports that the risk appears higher with certain brands and models.
Symptoms can include persistent swelling, pain, or a lump near the implant. These may occur years after the initial surgery. Diagnosis often involves imaging and testing fluid or tissue around the implant.
Treatment usually includes surgical removal of the implant and surrounding scar tissue. In some cases, chemotherapy or radiation may be needed. Early detection greatly improves outcomes.
The body naturally forms a capsule of scar tissue around any breast implant. In some cases, this tissue tightens and hardens, a condition called capsular contracture. Capsular contracture can cause the breast to feel firm, change shape, or become painful. It may affect one or both breasts. The severity is often graded from mild (Grade I) to severe (Grade IV).
Textured implants were once thought to lower the risk of capsular contracture compared to smooth implants. However, newer research shows mixed results, and some studies report no clear benefit. Treatment can involve surgery to remove or release the scar tissue, and sometimes replacing the implant. Preventive steps during surgery, such as minimizing contamination, may reduce the risk.
The FDA monitors breast implant safety and updates recommendations based on new evidence. It has issued safety communications and labeling changes to help patients make informed decisions.
In 2019, Allergan voluntarily recalled certain textured breast implants after studies linked them to a higher risk of BIA-ALCL. Details of the recall can be found in the FDA recall notice. The FDA also advises regular follow-up and imaging, such as MRI or ultrasound, to check implant integrity. Patients are encouraged to report any unusual symptoms promptly.
Some countries have restricted or banned certain textured implants, reflecting global differences in regulation and risk assessment.
Textured and smooth breast implants differ in how they interact with surrounding tissue, how they look and feel, and how long they tend to last. The implant surface can also affect which shapes and surgical techniques work best for a patient’s needs.
Smooth breast implants have a soft outer shell that allows them to move more freely within the breast pocket. This can create a more natural movement, especially with round implants. Textured implants have a slightly rough surface. This surface helps the implant stay in place, which is important for teardrop-shaped implants that must keep their orientation.
In terms of feel, smooth implants often feel softer to the touch because the shell is thinner and moves more naturally. Textured implants may feel firmer due to the thicker shell and the way tissue grows around them.
Some patients notice that smooth implants can shift position more easily over time, while textured implants are less likely to rotate. However, textured implants may be slightly more visible under thin skin because of their surface texture.
Both smooth and textured implants are designed to last many years, but they are not lifetime devices. Implant lifespan depends on factors like shell material, placement, and the patient’s body. Smooth implants tend to have a lower rate of rupture over time compared to some older textured designs. However, both types can eventually wear down and require replacement.
One important safety note is that textured implants have been linked to a rare condition called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). While the risk is low, it has led some patients and surgeons to prefer smooth implants. Durability also depends on whether the implant is filled with silicone gel or saline. Silicone implants, whether smooth or textured, often hold their shape longer than saline-filled options.
Surgeons often choose smooth implants for patients who want a softer feel and more natural movement. They are commonly used in cosmetic breast augmentation with round implants placed under the muscle.
Textured implants are often selected for teardrop-shaped implants because the texture helps prevent rotation. This can be especially useful in breast reconstruction after mastectomy, where maintaining shape is important. For patients with active lifestyles, smooth implants may feel more comfortable during movement. On the other hand, textured implants can provide better stability in cases where implant shifting is a concern.
The choice between smooth and textured surfaces also depends on skin thickness, breast tissue amount, and the desired final look. In some cases, a surgeon may recommend one type based on the patient’s anatomy and surgical goals.
Choosing between smooth and textured breast implants depends on a person’s health, surgical goals, and comfort with the potential risks. A clear understanding of the benefits, limitations, and safety profile of each option helps patients make informed choices that align with their needs.
They are sometimes used in reconstructive surgery after mastectomy, especially when a shaped implant is preferred to restore a natural breast contour. This surface texture can help prevent rotation of these anatomical-shaped implants. However, textured implants are not suitable for everyone. Some studies link them to a rare cancer called Breast Implant-Associated Anaplastic Large-Cell Lymphoma (BIA-ALCL). Patients should discuss these risks in detail with their surgeon.
People with a history of certain immune conditions, or those who prefer a lower-risk profile, may be better suited to smooth implants. In cosmetic breast augmentation, textured implants are now used less often in some countries due to safety concerns.
A thorough consultation is essential before making a decision. The surgeon will review medical history, breast tissue characteristics, and desired appearance. Open communication is key. Research shows that patient-physician discussions about benefits and risks help ensure informed consent and realistic expectations.
Surgeons may also use imaging or sizers during the consultation to help patients visualize outcomes. This step can make the decision process clearer and more personalized.
Several factors guide implant selection:
Brand reputation and marketing can also influence decisions, though scientific evidence should remain the primary guide. In some cases, a patient’s anatomy or surgical goals may make one option clearly better than the other. A tailored approach ensures the choice supports both health and appearance.
Patients with textured breast implants benefit from clear follow-up routines, awareness of possible risks, and attention to long-term health changes. Regular checks can help detect issues such as scar tissue hardening, silent ruptures, or signs of rare implant-related cancers early.
The FDA recommends MRI scans for silicone breast implants three years after surgery and every two years after that to check for silent ruptures. Ultrasound may be an alternative if MRI is not available.
Annual breast exams with a primary care provider or plastic surgeon help track changes in implant position, firmness, or skin texture. Some clinics use a baseline imaging test soon after recovery. This gives doctors a reference point for future comparisons. Patients should also keep a record of their implant type, placement date, and manufacturer.
One of the most common complications is capsular contracture, where scar tissue around the implant becomes tight and hard. This can cause pain, shape changes, or firmness in the breast.
Other warning signs may include:
Patients with textured breast implants should be aware of the rare risk of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This cancer often presents as swelling or a mass years after surgery, even if the implant was removed earlier. Prompt medical evaluation is important if any of these symptoms appear.
Textured implants may carry a higher lifetime risk of BIA-ALCL compared to smooth implants. The American Society of Plastic Surgeons reports that some patients may have a risk as high as 1 in 100 in certain cases, according to recent findings.
Long-term care also includes watching for slow changes in breast shape, firmness, or symmetry. Even without symptoms, implants are not lifetime devices and may eventually need replacement or removal.
Patients can reduce risks by maintaining regular follow-ups, reporting changes quickly, and staying informed about updated FDA safety recommendations. This helps ensure any complications are addressed before they become more serious.
Textured implants have a rough outer shell. This design can help the implant stay in place and reduce movement inside the breast pocket. Smooth implants have a soft, slippery surface that allows them to move more freely within the breast. They may feel more natural but are less stable in position.
Current research shows that BIA-ALCL is mainly linked to textured implants. Smooth implants have not been clearly associated with this cancer. The overall risk for any implant is considered low, but monitoring for symptoms like swelling or lumps is important.
In the United States, most surgeons no longer use textured implants due to safety concerns and patient preference. In some countries, textured implants are still available, but their use has declined as smooth implants have become more common.
Most breast augmentation procedures in Houston typically cost between $5,000 and $8,500, depending on factors such as implant type, surgeon experience, facility fees, anesthesia, and additional services.
Textured breast implants offer unique benefits, particularly in improving implant stability and reducing the risk of rotation, making them a practical choice for certain reconstructive and cosmetic procedures. However, their use has declined in recent years due to the association with rare but serious conditions like breast implant-associated anaplastic large cell lymphoma (BIA-ALCL).
For patients considering augmentation or reconstruction, understanding the differences between textured and smooth implants is key to making an informed decision. A thorough consultation with a qualified plastic surgeon is the best way to weigh risks, benefits, and personal goals before selecting an implant type.
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Dr. Sukkar earned his Doctor of Medicine (M.D.) degree from Louisiana State University School of Medicine in 1992 after graduating summa cum laude with a Bachelor of Science in Microbiology. He then completed an intensive General Surgery Residency at the University of Texas Hermann Hospital before being selected for a highly competitive Plastic Surgery Fellowship at Northwestern University in Chicago, one of the most prestigious training programs in the country.
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