Textured vs. Smooth Implants

OCDAmy

How many women are still getting textured implants even with the slight risk of lymphoma? My understanding is that textured stay in place better than smooth and the cancer risk is low. My PS said she will do either but is moving towards smooth because of the risk. I'd love some feedback on what type of implants you chose and why. If you have smooth do you have any problrms with them staying in place

beach2beach

Hi OCDAmy,

I chose the smooth. Did it have anything to do with the chance of ALCL, a little, but he honestly told me the risk was just a tiny bit more with the textured than with the smooth. I had some dropping, but was told that prior to surgery and was told it was normal to expect some settling. Not having had big boobs prior, these are not bigger, but rounder. If I remember him correctly i thought he said textured may ripple more often than smooth. I havent noticed any movement with them. I do have some rippling on the sides, but at this point I'm not looking into surgical options yet to help correct it.(The PS said if I wanted to go a size up it may not ripple) The PS sewed in an Alloderm pocket to cradle them I guess you could say. I read that you have TE"s so maybe that is not done with the. I did not choose to go with TE's because my PS said my skin was so tight he thought it would give me a lot of trouble so I opted for direct to implants.

OCDAmy

Beach, thank you so much for your reply. I think I read that if you want an anatomical implant like teardrop shape they are only available in the textured. My PS is suggesting the round smooth implants. I am going to ask to see some pics next time I am there so I can see the difference. I have to wait to get the implants until May because I had rads. I don't need my breasts to look perfect but after all I have been though, it would be nice to have them look good.

Maggie2

I have been so surprised at how different the protocols and procedures are for patients. The PS switched to TE's during the surgery because he felt the skin on one side was under stress and too thin for Direct-to-Implants. He did put in Allerderm.  I am also wondering about round vs highly cohesive gel anatomicals when it's time to switch out TE's.  He said the smooth round tend to ripple more.  Go figure.  It's like with stitches, surgical glue, wearing a post surgical bra, and showering... each doctor has their own opinions.  He also said there is a reduced risk of capsular contracture with the textured.  Experiences, or opinions? 

OCDAmy

From an article I read recently....even more confusing from what we are all hearing!

Smooth Breast Implants

The majority of breast augmentation surgeries use smooth breast implants, which can move without drag once it's placed inside the breast pocket. These implants normally have a thinner skin than their textured counterparts, which contributes to them feeling softer than the textured kind. They also have these benefits:

• Smooth implants last a long time, normally longer than textured
• The smooth type costs less than the textured type, partially because they are more common
• The smooth implants have a lower chance of rippling once placed

Textured implants were thought to lower the chance of capsular contracture, where the scar tissue around the breast implant tightens and hardens. Evidence of this benefit hasn't been clear though, and surgeons don't fully agree whether it gives the patient a better chance against capsular contracture. Because of that, many surgeons utilize smooth breast implants. In order to reduce the risk surgeons will sometimes place them under the muscle tissue instead.

Textured Breast Implants

The reason textured breast implants were created was to keep the implant from moving around within the breast pocket created by the surgeon. By giving the implant a slight roughness, the surface of the implant adheres to the tissue around it, keeping them in their initial positions. This becomes particularly important with implants that are teardrop shaped, keeping them aligned properly within the breast tissue. If a teardrop shaped implant were to move around, the breast would become distorted and irregularly shaped.

The original notion of textured implants was to help lower the chances of capsular contracture, which is mentioned above, but mainly is when the scar tissue around the implant hardens and squeezes the implant into irregular shapes. Since creation though, there has been no conclusive medical evidence that the claim is correct.

Textured breast implants are known to leak and ripple more often than smooth implants, but textured implants don't become displaced nearly as much. The textured implants also cost more than smooth implants do, so that might factor into your decision if you're deciding which implants to pursue.

Maggie2

OCDAmy, you are right. This is getting even more confusing. Do you recall the source or link for this article? I’d llike to ask my PS about it.

SpecialK

Keep in mind that the article cited above is for augmentation, not breast reconstruction - which is very different, and the patient would still has their own breast tissue. The lymphoma risk is predominantly tied to the anatomical implants, which are all textured - and it has to do with the specific type of textured exterior of the implant. That said, the risk appears to be pretty small. Generally, anatomical implants need to be planned for before the expander is placed, and also need a very tight pocket to keep the implant from rotating. These implants are teardrop shaped, so rotation in the pocket will create an odd shape since there is no breast tissue in front of the implant. Also, generally the anatomical implants ripple less because of both the textured surface keeping the skin more adhered than smooth implants, and because the interior of the implant is considerably firmer. Smooth round, in my experience here on BCO, tend to ripple for more people, but that is highly individual based on how much tissue is left behind after surgery, the type of skin one has, how thick the pectoral muscle is, and whether or not rads was needed. The decision to use dermal matrix, or allograft material, is based on skin/muscle integrity and the individual patient - it is often used with expanders and placed at the time of the initial surgery.

OCDAmy

Special K, thank you for this information. What type of implant did you have?

SpecialK

Sorry, I had a whole post typed out and it disappeared!

I have had several implants and a complicated reconstruction history. I initially had a skin and nipple sparing BMX with expanders immediately placed, but had some skin healing issues and after a number of surgeries, lost the left TE. After chemo it was replaced and I filled slowly and exchanged to Mentor smooth round high profile silicone implants. After a couple of years I had perforation of the allograft material (very unusual) and in a repair/replacement surgery my damaged skin tore open. During several more skin repair surgeries I swapped the left for the same type of implant, but 150ccs smaller than the right side. Ultimately I lost the reconstruction on the left totally, and it was out for 18 months. I had one fat graft to the flat side to improve vascularity and skin integrity, then left my first PS and changed to another who did another fat graft to the flat side and cleaned out the residual allograft material. I eventually had a new TE placed, filled and exchanged the TE on the left for a 450cc Natrelle Inspira textured round implant, and downsized the right Mentor by 200ccs to an Inspira also. I lost the right nipple in that surgery in order to accommodate the smaller implant and pull the skin taut, I later removed the left one in another surgery along with a fat graft. My PS used Inspiras to deal with my skin issues, and provide the fullness and projection with less ccs of volume. My skin is very thin, and I have abnormally thin pectoral muscles as well, and the textured surface is thought to ripple less.

OCDAmy

SpecialK, wow you have been through it all! I'm not sure what to do but I'm leaning towards the smooth round, my PS uses Natrelle Inspira.

SpecialK

Lol! I don't talk too much about my surgical history because it is likely to scare the pants off people! I have had a total of 17 surgeries - which includes BMX and ALND with 15 reconstructive, but have managed to stay out of the OR for the last 14 months, and I have two like objects in my chest at the same time - yay! The Inspiras come in both textured and smooth, I like them because you can use a smaller volume implant - so less weight, while getting more forward projection. They previous Mentor felt kind of wide on me, but I also believe the first set of implants was too big. I am not very tall and I am petite - usually wear a size 2-4 top, and I am a little short-waisted so I looked top heavy. The Inspiras are basically the same volume as the removed breast tissue from BMX, I look just slightly larger than I was naturally, but the implants sit on the front of me, without side-foob.

NotVeryBrave

I have textured, anatomical implants that were placed pre-pec with Alloderm at the time of the BMX. I have rippling with both and the right one has rotated so that I have a flat place on the outside and extra fullness on the inside.

I'd rather not have even the tiny increased risk of Lymphoma. Since I've had rotation with textured, it makes me more concerned about that with smooth. I'm putting off any further surgery for a while for many reasons - one of which is fear of making things worse.

OCDAmy

I see how you could get rippling if your implants are pre pec but how does it happen if your implants are under the muscle? I just assumed the muscle would hide rippling?

SpecialK

In my case, my pectorals are so thin I might as well have pre-pectoral implants, but I don't have rippling with my current implants. Some have had such thorough removal of breast tissue that the skin is laid back over the muscle - true for me, and the shape of the pectoral muscle doesn't completely mimic the shape of the implant. Rippling often occurs in the same area on most women, cleavage, outer lowersides and sometimes upper pole. Some PS don't make the pocket tight enough so distortion occurs when you move and causes rippling. Implant type - textured rounds and saline are thought by some to cause more rippling - can be a factor too

BringOn2017

Hi Amy I opted for the textured anatomicals extrahigh profile 665ccs. I knew about the slightly increased risk as the FDA warning was published in March less than 3 weeks after my bmx and Te insertion. At the time I had panicked, particularly as I had always said I would go flat rather than undergo reconstruction! I sort of changed my mind overnight once I knew my histology result. Then when I came to having the exchange, once I realised that anatomicals are always textured and that smooths are always round, and I had a good look at the numbers I figured that the increase in risk with textured is very small. My PS also thought the same. He did also recommend yearly US of my breasts or FOOBs. Also treatment of ALCL involves surgical removal rather than chemo, as far as I know, and I think I can live with that. 

Good luck with your decision.

beach2beach

The rippling I have on the sides also. Being thin and I guess I would also my muscles are the same. You really have to think that most boob jobs you see are implants on women with their breasts intact. So they have layers of fat/glandular tissue to cover it. We don't have that so we are relying on whatever thickness our muscles are to cover it.

If smooth implants shift, can you shift them back without surgery? Would seem since we have nothing but the muscle i wonder if they could just push things back into place.

OCDAmy

Oh goodness, I hope they can't be pushed and move! My TEs are so darn tight and not moving at all I just can't image how an implant is going to move. I should be getting my exchange surgery in May or June.

Fembot

I have a Natrel textured anatomic highly cohesive 'gummy' implant. I asked my PS about the increased lymphoma risk, quoting an article I had read. She knew the article and the statistics but explained the risk was very very low. I'm not good with numbers yet she is, and doesn't feel the stats are a deterrent. I believed her.

As a side note, for reconstruction using implant the most rippling comes with saline, less with silicon and even less with gummys

rmgrmg

Does smooth saline ripple more than textured saline?