Breast Implant Primer – Shell Texture
In previous blogs, I’ve discussed various characteristics of breast implants to explain how I customize my choice of implant for you. In this blog, we’ll discuss implant texture.
The implant surface can be manufactured smooth, or rough like sandpaper, hence the common references of smooth or textured. Once inside your breast, the implant touches your body tissues. Your tissues respond to the implant by producing a thin layer of scar tissue that surrounds the implant, called a scar capsule. At times, that scar capsule can tighten or contract around the implant, in a process called capsular contracture or “CC”.
CC can cause your breast to feel hard, and to be misshapen, requiring additional surgery to correct. Implant manufacturers have tried to prevent CC by influencing the interface between the outside of the implant shell and your tissues, so that the scar capsule will not contract. One of the ways the manufacturers alter the interface is by changing the texture of the outside surface of the implant – the surface that is in contact with your body – offering smooth or textured implants.
The scar capsule around smooth implants is smooth and the scar and implant can slide on each other. The original theory behind using a textured surface to prevent CC was that the scar tissue would form following the ins and outs of the texturing, producing a scar capsule that could stretch like a zig zag stitch in clothing. With rougher textured implants, the implant is attached to scar capsule, just like a Velcro™ attachment.
Research studies on large numbers of women comparing capsule contracture rates of smooth vs textured implants have shown that the rate of CC is slightly lower when using textured implants. The reduction is not huge, so we have to consider the risks and benefits of smooth vs textured implants when choosing the right implant for you.
As you age, or following pregnancy or weight gain or loss, your breasts may droop. If the implant is fixed to your chest wall, it tends to stay in place and your breast tissue may “fall” off the implant, like a waterfall or a slinky toy. This produces an unnatural appearance to the breast. On the other hand, when I perform a breast lift along with a breast enlargement, the fixed position of the implant may help to prevent the breast from drooping. These are considered in choosing the implant type.
With tear drop shaped implants, your breast will look funny if the implant rotates, putting the larger part of the teardrop on the upper portion of your breast. The Velcro™ effect of textured implants prevents the implants from rotating, so all shaped implants are textured. Round implants don’t have a large and small side, so rotation is not an issue and the orientation is unimportant.
Over the past decade, plastic surgeons have found that there is a rare form of lymphoma that seems to be associated with breast implants, but almost only textured breast implants. The reason for the association is not known, and fortunately, the cure of the lymphoma generally just involves removing the implant and scar capsule. While there have been a very few cases with smooth implants, the risk is much higher with textured implants.
In the United States, by far smooth implants are more popular than textured. In my practice, I use both types of implants, but I reserve textured implants for only certain patients. At your consultation, this will be discussed in detail, and we will jointly reach a decision that’s correct for you.