*Disclaimer: This blog was written and published in Spring 2016.  Since that time, surgeons have shifted away from using textured implants due to connections with BII (Breast Implant Illness).

You’ve decided to have a breast augmentation—the easy part is done! Now you’ll have to make a number of other difficult decisions with the help and guidance of a board-certified plastic surgeon, which include determining implant size and shape (factors like height, width and projection all come into play) incision location and whether to opt for smooth or textured breast implants. Your selections will affect your final result. What it comes down to, however, is what best fits your body to deliver the look you desire.

So, what is the difference between textured and smooth breast implants and which should you choose? As you may have guessed, smooth breast implants have an outer silicone rubber shell that is smooth and slippery. Due to their smooth surface, this type of implant does not attach to the tissue membrane (also known as a capsule) that forms around the implant, but instead moves freely.

Conversely, textured implants have an outer silicone rubber shell that is rough and pebbly. The irregular surface of textured implants provides a more stable position for the implant, allowing it to attach to the tissue capsule around it. This makes it less likely to move and reduces the risk of the implant shifting over time.  Furthermore, as the body develops scar tissue to seal the textured implants into place, it is believed to also lower the risk of capsular contracture, which occurs when scar tissue around the implant hardens. However, whether there is any significant difference in the rate of capsular contracture between textured and smooth implants remains undetermined.

Due to conflicting studies published in the Journal of Plastic and Reconstructive Surgery over the past 30 years, there is lack of substantial evidence that textured implants reduce the rate of capsular contracture, though many plastic surgeons, Dr. Chapin included, support the argument. Since introducing textured implants at Chapin Aesthetics, there has been a significant drop in the rate of capsular contracture, as well as in the number of breast revisions performed due to implant shifting.

Smooth implants, be it silicone gel or saline, continue to be the most popular choice amongst breast augmentation patients. Textured implants however are becoming more common as the new teardrop shaped breast implants are only manufactured with a textured shell. This means that patients who choose to have a shaped breast implant will also have to have a textured implant. Textured implants are designed to be firmer and stiffer with an irregular and pebbly exterior, and thus can hold their shape better than smooth implants. Round implants alternatively, can be selected with either a textured or smooth surface.

So, can you feel the difference between smooth or textured? When placed beneath the chest muscle in a patient that has ample breast tissue, it is impossible to feel any difference between the two. For patients that have little breast tissue, if a textured implant is placed on top of the muscle, it is more likely to be felt than a smooth implant due to its thicker and rougher exterior.

Additionally, if the implant is placed beneath the muscle and the patient has adequate breast tissue, they will be unable to visibly see a difference between the smooth and textured implant. In circumstances where the patient is thin and has little breast tissue, there is a greater change of visibility with textured implants due to their thicker, more rippled exterior.  It is also more likely for the textured implant to be visible if placed on top of the muscle.

Whether you prefer textured or smooth implants for your breast augmentation at the Philadelphia area’s Chapin Aesthetics, the decision will ultimately be made with the help of Dr. Chapin, a board-certified plastic surgeon and breast surgery expert who will educate you on your options and make recommendations based on your frame, body type and aesthetic goals.  If you are in favor of round implants, you can go the route of selecting smooth or textured implants. However, if your preference is for shaped, teardrop implants, your implants will be textured.

Knowing your options and that you have choices will give you the confidence to know that you are making the best and most well informed decision for your body and will be satisfied with the final results.