Breast Implant Basics - Shapes and Surfaces:
Smooth vs. Textured and Round
vs. Anatomical: What should I choose?
First of all, it is important to note that like many other decisions
you will make in connection with your breast augmentation, this is one that you will need
to make with your plastic surgeon. Given your own individual needs and the surgeon's
preferences, there may be good reasons to go with one versus the other.
Textured Implants and
Capsular Contracture
As early as the 1950s, doctors had attempted to implant substances
or devices to augment the breast, including sponges, body fat, etc. A problem that has
persisted, despite the effectiveness of modern implant designs, is capsular contracture.
Foam coverings and all types of solutions were attempted to prevent the scar tissue, which
naturally forms around any foreign object and which can become unacceptably hard in some
cases. The most recent evolution of the concept is textured surface implants,
although a textured surface is not a new concept. Because of the way scar tissue forms
around an implant, a textured surface is supposed to prevent scar tissue fibers from
laying down uniformly in a parallel fashion and thus tightening up. According to a number
of studies, a textured surface is not likely to reduce the risk of capsular contracture.
Other studies do find a reduction in contracture.
Shaped or "tear drop" implants
Textured implants are also in order in most shaped implant
placements as the shaped or contoured implant is meant to have a top and a bottom (it is
tear drop shaped). Without texture, the implant could "flip," leaving the
implant upside down and misshapen in appearance. While this can be corrected manually or
surgically, it is not an ideal happening. A textured surface on the implant is intended to
cause the tissue to adhere to the implant enough to prevent its free rotation.
Rippling, Deflation, Shell
One problem that causes many surgeons to not use textured implants
is the apparent increase in the chance for visible rippling. The same characteristics of
the textured surface that cause the scar tissue to form irregularly around the textured
implant may also cause it to appear rippled in appearance. A recent study also claims that
textured implants have a higher deflation rate and are firmer to the appearance.
Smooth Implants and Capsular Contracture
Due to the controversy over whether textured implants will actually
reduce the rate of contracture significantly enough to warrant other potential
disadvantages discussed above, doctors who prefer to use smooth, round implants quite
often place them under the muscle. Placement under the muscle is also claimed to reduce
the incidence of capsular contracture and this view is held by a consensus of surgeons.
Round Implants
Unlike anatomical implants, round implants do not require texture
because they can rotate within the capsule and pocket without any change in
appearance. Some women prefer the Pamela Anderson look that can be achieved with
larger, round implants. I personally feel that round implants, placed under the
muscle have a more natural appearance than shaped/contour implants which can appear
somewhat elongated in appearance.
Rippling, Deflation, Shell
Proponents of smooth shell implants claim that they are less likely
to cause visible rippling (especially if placed below the pectoral muscle) and more
natural to the touch because they are made with thinner walls than the textured,
anatomical implants. Note that all saline implants can cause rippling but the risk
of rippling with silicone implants is substantially lower.
Note: Round implants can be textured and shaped implants can be
smooth. However, it is usually recommended that shaped implants be textured due to the
potential for unacceptable rotation of the implant as discussed above.
Finally, it should be noted that a recent and somewhat controversial
study by a plastic surgeon has concluded that the result sought to be achieved by shaped
implants, that is, that the implant has a teardrop shape which is more natural in
appearance, is achieved just as well by round implants.
The study attempted to demonstrate that when a round implant is
imaged within the breast in a woman who is standing, the implant takes on the same
anatomical shape as the anatomical implant. The study also concludes that when lying
down, the round implant is more natural in appearance than the anatomical because the
anatomical implant retains the teardrop shape in this position whereas a round implant
does not.
