Not all implant “surfaces” are the same. In the U.S. today, smooth, round implants are the default for most patients.
Textured (especially macro-textured) devices have fallen out of favor because of safety concerns and limited aesthetic advantages in routine augmentation.
By Dr. Tim Neavin • Updated
Quick answer
- Most patients do best with smooth, round implants. They feel soft, move naturally, and work well in modern techniques (dual-plane, precise pocket control).
- Why texture existed: To help “grip” tissue—mainly for shaped (anatomic) implants to resist rotation, and historically to try to reduce capsular contracture in certain planes.
- Safety note: Certain macro-textured models have been recalled in prior years due to association with BIA-ALCL. Use today is uncommon in cosmetic augmentation.
How I decide surface type
I start with your goals, soft-tissue quality, and pocket plan—not “texture” first. With proper planning, smooth, round silicone covers the vast majority of cosmetic cases.
- Desired look/feel: Smooth implants typically feel softer and move more naturally with the body.
- Pocket & plane: Dual-plane/submuscular placement, careful dissection, and sizers give the control texture once tried to provide.
- Rippling/edges: More about fill, shell, and coverage than surface alone. We choose implant and plane accordingly.
Safety considerations (important)
- BIA-ALCL: A rare lymphoma linked most strongly to certain macro-textured implants. Risk varies by device; smooth implants have the lowest known association.
- If you already have textured implants and feel well: Routine preventive removal is not generally recommended purely for texture. We examine, review your device history, and decide together.
- Screening: For silicone implants, independent of surface, periodic imaging (MRI or high-resolution ultrasound) may be advised to assess silent rupture.
Bottom line: we bias toward smooth implants for cosmetic augmentation because they pair safety with reliable aesthetics.
Do textured or shaped implants ever make sense?
Rarely in cosmetic augmentation. In some reconstructive contexts or unique anatomy, specific devices may be considered. For standard augmentation, smooth, round devices are my default.
FAQ
Are textured implants “banned”?
Some macro-textured models were recalled; others are simply not commonly used. Regulations and availability vary by device and region.
Does texture lower capsular contracture?
Evidence is mixed and depends on pocket plane and technique. In modern dual-plane surgery, contracture rates are more about execution and aftercare than surface alone.
Can smooth implants rotate?
Rotation matters most for shaped implants. With smooth, round implants, rotation doesn’t change breast shape.
Comparing fill choices? Read our guide to saline vs. silicone implants.
For the full procedure overview, see the breast augmentation guide.