Whether you are a woman considering breast augmentation or a woman with breast implants that will consider re-operation in the future, the choice of implant shell is an important factor that you will take into account during the planning of your surgery. Implant shells come in a number of different varieties, and can be largely categorised into two main types: smooth and textured. Over the past few years there have been significant changes in the industry, with a distinct shift in the preference of plastic surgeons regarding their preferred implants. This blog post aims to outline the various pros and cons of both smooth and textured implants to equip women with the right knowledge to make the best decision for them.
Breast Implant History
The first silicone gel breast implant was manufactured in 1962. A decade later the second generation of gel implants was introduced to the market featuring a silicone shell, gel, and polyurethane textured surface which produced a superior aesthetic outcome and reduced the risk of capsular contracture. However, due to safety concerns relating to the breakdown product of polyurethane these implants were taken off the market and a new textured surface was introduced. This textured surface intended to serve similar benefits to the polyurethane implant by reducing capsular contracture rates. There was a subsequent period where saline implants were widely used, shifting the implant shell preference to a smooth silicone shell as this reduced rates of rippling and deflation. Silicone implants became the most common implant type used by surgeons due to further advances in the technology and the limitations of saline implants such as visible deflation following rupture. Textured surfaces remained the preferred option due to the stability in the pocket and aesthetic consistency however over the past decade new findings have emerged that indicate a rare link between some textured implant varieties and breast implant-associated anaplastic large cell lymphoma. We have written a blog post about this rare condition which you can read here.
While a number of textured implant varieties have been banned or suspended under investigation due to this rare link, there are many plastic surgeons who still choose to use textured implants and many patients that still choose this shell. This said, there are also many plastic surgeons that have sought out alternative options to ensure they uphold the highest safety standards for their patients. You may wonder why patients and surgeons would continue to use textured implants when there is a possible link to this rare lymphoma. It’s important to consider the various strengths and limitations of each implant shell variety to better understand the rationale for each.
Textured Implants Pros and Cons
- Reduced risk of capsular contracture. The irregular surface texture of the textured breast implant serves to disrupt the planar arrangement of fibroblasts which can prevent contraction.
- Predictability of placement. The textured implant has a more predictable result with greater adherence to the breast capsule.
- The textured surface can present resistance to movement through friction which has benefits including low rates of bottoming out and malposition.
- The use of textured implants requires exact pocket dissection to ensure optimal results as there is little movement within the pocket and aesthetic results are less forgiving when the pocket is not correctly positioned.
- There is a higher risk of late seromas and double capsules.
- There is a link between textured implants and BIA-ALCL
Smooth Implants Pros and Cons
- Can produce a more natural shape and appearance. The smooth outer-surface of the implant can sit more naturally in the pocket and create a more natural look and feel.
- More forgiving aesthetically when dissecting the implant pocket. The implant will move naturally within the pocket to create a more natural appearance.
- Latest generation implants have less wrinkling as the gel is continuous with the outer shell as opposed to separate.
- Higher capsular contracture rates
- Greater mobility within the pocket. The implant naturally settles to the bottom of the pocket which may stretch the lower pole over time or cause malposition
It is clear from the various strengths and limitations of each shell that the answer of which implant is best is not straightforward, as patients may have different priorities. The question is, is there a happy medium? Is there an implant shell that can synergise the two types? The newest generation of implants suggests that SilkSurface nano-texturing is the way forward.
Dr. Phil Richardson from Brisbane Plastic & Cosmetic Surgery explains that his implant of choice is Motiva implants. Technically these ‘nano-textured’ implants are classified as a smooth implant, thus eliminating the potential risk of BIA-ALCL, which is a huge factor against the use of textured implants. However in to traditional smooth implants, Motiva are characterised by a rigid topography with thousands of contact points per cm to encourage the optimal cellular response and reduce the risk of capsular contracture. The capsular contracture rate for Motiva is less than 1%. There are a number of additional benefits of this new technology including their advanced nanotechnology reducing bacteria and biofilm formation as well as inflammation, and their unique surface reaping the benefits of stability in the pocket that many textured implant varieties historically held against smooth options. The overall complication rate for Motiva implants is 0.36%. This new generation of breast implants seemingly bridges the gap between smooth and textured implants to leverage the strengths of both shells.
Should I choose textured or smooth implants?
If you are a woman considering breast implants, you should consider the various pros and cons of all options at your disposal. You should have a thorough discussion with your plastic surgeon, as depending on your anatomy and medical history you may be recommended a certain shell for unique reasons. It’s important to stay up to date with the latest research in breast implant technology to better understand which implant is pioneering safety and aesthetic outcomes, and it’s equally important to consider what your priorities are. For some patients, the risk of BIA-ALCL is not a factor that will deter them from choosing a textured implant that has lower risk of capsular contracture and movement in the capsule, while for others this risk is substantial and a clear rationale for the use of a smooth implant. Once you have an understanding of what the facts and your own needs, you can then take the steps towards surgery.