A Patient’s Guide to Choosing Between Smooth and Textured Breast Implants

If you are someone who is considering breast augmentation or revision surgery, choosing the right breast implants is an important decision. This choice needs to be made after considering not only the aesthetic but also medical and functional outcomes that would be ideal for you. This guide focuses specifically on one key decision: choosing between smooth and textured breast implants.

At BB Clinic, we don’t look at breast implants in isolation, but have a comprehensive approach towards it – that considers your overall health, physical functionality, and aesthetic goals as integral aspects of your wellbeing. Each patient presents unique anatomical considerations, medical history, and personal needs that influence which implant type may be most appropriate.

Our intent in this breast implants guide is to provide evidence-based information about smooth vs textured implants, their characteristics, their pros and cons, safety concerns such as BIA-ALCL, to help you choose what’s best for your unique body and goals. Having said this, please note that this information is not a substitute for medical advice. Your specific circumstances require personalized assessment and recommendations from a specialist surgeon who has undergone appropriate training and has extensive experience in breast surgery procedures.

What Are Smooth and Textured Breast Implants?

Breast implants come in various sizes, shapes, and materials—but their surface texture is one of the most important distinguishing features. They can largely be categorized as smooth and textured breast implants. Even though both types serve the same core purpose—to enhance the size and shape of the breasts—they differ significantly in feel, appearance, placement, longevity, and potential health risks.

Smooth breast implants feature a silicone shell with a uniform, polished outer surface. This smooth exterior allows the implant to move freely within the breast pocket, creating a more natural movement that mimics natural breast tissue dynamics. These implants are commonly used in patients seeking round implants with a softer aesthetic.

Textured breast implants, on the other hand, have a slightly rough surface that grips the surrounding tissue more firmly. This design was originally developed to help reduce the risk of capsular contracture (a complication where scar tissue hardens around the implant) and to keep anatomically shaped implants (i.e. teardrop-shaped) in place. The textured surface can limit implant movement and rotation, making them ideal for certain surgical techniques or body types.

Both of these options are available in saline or silicone gel fills and can be placed either above or below the pectoral muscle depending on your anatomy and surgical plan.

Historical Context

Both implant types were developed to address specific clinical needs identified by surgeons. Smooth implants were the original design, introduced in the 1960s, while textured options emerged in the 1980s as a response to concerns about capsular contracture (abnormal scarring around implants) and implant positioning challenges.

Pros and Cons of Breast Implants

Each implant type offers some distinct advantages and risks. Here’s an overview of the most commonly known pros and cons for each.

Pros and Cons of Smooth Breast Implants

Smooth breast implants have been gaining popularity due to their softer feel and favourable long-term safety profile. Unlike textured implants, smooth implants do not adhere to the surrounding tissue. This allows the implant to move naturally within the breast pocket, often producing a more lifelike and dynamic breast contour – especially when the patient changes position or moves.

Advantages of Smooth Breast Implants

• Natural movement and feel: Smooth implants closely mimic the behaviour of natural breast tissue, especially in patients with good skin elasticity and adequate natural tissue coverage.
• Softer texture: The thinner shell and highly cohesive silicone gel used in modern smooth implants contribute to a more natural tactile feel.
• Smaller incision: These implants are generally easier to insert, due to their smoother and softer surface texture – thus requiring a smaller surgical incision and more discreet scarring.
• Durability: Some studies have suggested that smooth implants offer a comparative higher durability as compared to textured implants. However, this outcome is also largely dependent on surgical technique.

Some Disadvantages with Smooth Implants

• Higher risk of movement or rotation: The lack of adherence to tissue may lead to displacement over time, though this is less of a concern for round implants.
• Potential for visible rippling: Particularly in patients with thinner skin or less natural breast tissue, rippling may be more noticeable than with textured alternatives.
• Capsular contracture concerns: Some studies suggest that smooth implants may carry a slightly higher risk of capsular contracture. However, surgical technique, pocket dissection, and post-operative care can be important factors in minimising this risk.

Smooth implants are typically recommended for patients undergoing primary breast augmentation who prioritise a natural feel, minimal scarring, and a proven safety profile.

Pros and Cons of Textured Breast Implants

Textured breast implants have a rougher outer shell that encourages tissue adherence. This design was originally developed to reduce implant movement, rotation, and the incidence of capsular contracture—particularly in teardrop (anatomically shaped) implants.

Advantages of Textured Breast Implants

1. More stable placement: The texture allows the implant to ‘grip’ surrounding tissue, reducing the likelihood of implant rotation or shifting, which is critical for anatomically shaped implants.
2. May reduce capsular contracture: Some studies have shown that textured implants may slightly lower the risk of capsular contracture when placed over the muscle.
3. Stable aesthetic outcome: This type of implant is often used in breast reconstruction cases, where a consistent and well-defined shape is necessary.

Some Disadvantages with Textured Implants

• BIA-ALCL risk: The Therapeutic Goods Administration (TGA) in Australia has identified a BIA-ALCL risk with certain types of textured implants. Even though the absolute risk remains low, it has led many surgeons and patients to prefer smooth implants.
• Less natural movement: Because they adhere to the tissue, textured implants can feel firmer and may not move as naturally as smooth ones.

• More noticeable incision/scar: Slightly larger incisions may be required to insert these implants, leading to potentially more visible scarring.
• Firmness: Some patients report a firmer feel due to the textured surface and tissue adherence.

Today, textured implants are used more selectively, often in reconstructive procedures or cases where implant stability is paramount. Patients considering textured implants should discuss the benefits and risks in detail with a qualified surgeon, including the latest regulatory updates from the TGA.

Medical Considerations for Implant Selection at BB Clinic

At BB Clinic, we carefully evaluate various medical factors before deciding on the breast implant option for our patients.

As a specialist breast surgeon, Dr Yunaev conducts a comprehensive assessment of each patient’s unique anatomical characteristics, including chest wall dimensions, existing breast tissue quality and quantity, skin elasticity, and tissue thickness. These factors significantly influence how different implant types will interact with your body’s tissues over time.

Let’s look at 3 instances to understand this better:

1. Women who are considering breast surgery to address functional issues due to overly large breasts – such as neck and back pain, skin irritation, or activity limitations, breast implants are part of the solution following a reduction or reconstruction. In such cases, we consider the altered tissue landscape and mechanical forces that will affect long-term results.
2. For postpartum women – who represent a significant portion of our patients at our clinic – there are different factors that need to be considered. Pregnancy and breastfeeding often result in volume loss, tissue stretching, and changes in breast positioning. In these cases, the choice between smooth and textured implants may be influenced by the degree of skin laxity and whether additional procedures like a breast lift might be combined with implant placement.
3. For reconstruction patients, factors such as the quality of remaining tissue, previous radiation treatment, and overall health status become particularly important determinants in implant selection. The surgeon must consider not just the immediate aesthetic outcome but how different implant types might perform within compromised tissue environments.

At every step, Dr Yunaev approaches implant selection as a medical decision-making process, drawing on his understanding of breast anatomy, implant mechanics, and surgical techniques. This specialized knowledge allows for truly personalized recommendations based on each patient’s medical history, physical examination findings, and specific needs rather than following generalized trends or patient preferences alone.

Closing Thoughts

Making the right choice isn’t about following trends or pursuing a particular look – it is about finding the option that best meets your medical needs while considering functional outcomes and aesthetic goals as part of your overall health journey. Whether you’re planning your first surgery or exploring revision options, understanding your breast implant options is key to making an informed, confident decision.

Are you looking for guidance safe breast implants? We invite you to book a consultation at any of our locations across Sydney.