Standard breast implants have a smooth clean surface while textured prostheses have a rough outer surface. Mentor has a very fine texturing to their textured implants, similar to about 100 grit sandpaper. Allergan textured implants have a much rougher outer surface. Plastic surgeons in Columbus, Ohio are pretty much split between using Mentor or Allergan implants.
Textured Implants: The Beginning
The notion of putting a textured surface on breast implants began in the 1980's. At that time, the biggest problem with breast implants was the frequency of capsular contractures which were very common with the old 'low bleed' silicone gel breast implants. An implant manufacturer, which no longer exists, developed a polyurethane foam covered silicone gel implant which appeared to solve the problem of capsular contracture and they became very popular. Unfortunately, it was later discovered that polyurethane, heated up to 2000*F and injected into a rat caused a form of cancer in the rodent. The FDA then removed these implants form the market but the concept of texturing the surface of the silicone shell was born.
Textured implants have an additional shell attached to a smooth implant in order to create the rough surface. The purpose of texturing is to allow in-growth of scar tissue into the interstices of the shell's surface to try and reduce the risk of capsular contracture. There is some evidence to show that texturing is successful in reducing the risk of capsular contracture, particularly when the implants are placed on top of the pectoralis muscle. There is little evidence to suggest that texturing makes much of a difference with respect to capsular contracture when they are placed under the muscle, which is a better position for breast implants.
Shaped Textured Implants
Implant Manufacturers have come up with a large number of different shaped implants over the past couple of decades in an effort to compete with one another. In order to avoid rotation of shaped implants, which can result in an unnatural appearance, most of them have a textured surface to allow scar tissue in-growth.
Textured Implant Problems
There are several problems with textured implants. Since the shell is thicker, they are easier to feel through the skin and breast tissue than smooth implants and, therefore, tend to feel less natural. Textured breast implants also have a higher risk of deflation than smooth surfaced implants despite the fact that they are about 30% more expensive. All breast implants tend to ripple or wrinkle along the outer edge of their surface which tends to be more noticeable in thinner patients with minimal breast tissue. Textured implants also have a higher incidence of rippling than smooth implants and silicone gel implants tend to have less rippling than saline implants.
Textured breast implants have recently been implicated int he development of a rare form of cancer called Anaplastic Large Cell Lymphoma or ALCL. This is a very rare form of lymphoma that can occur in a breast implant capsule and is not an actual breast cancer. It is so unusual that the FDA has not recommended taking textured implants off of the market nor do they suggest that women who have them get them removed.
Smooth implants have not been linked to ALCL.