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5 Tips for Choosing the Perfect Breast Implant, Part 2: Smooth vs. Textured

If you've decided to have breast augmentation, you've got some choices to make with the help of your board-certified plastic surgeon. In addition to deciding on saline versus silicone implants, implant size, shape, profile, and manufacturer (all of which we are going to cover in this series), you'll have to decide on whether you'd prefer smooth versus textured breast implants.

Breast implants are typically categorized by two components: 1. the implant filling,  and 2. the outer shell they are made of. In plastic surgery, breast implant manufacturers make breast implants that are smooth and textured to the touch. Your ideal breast implant ultimately depends on your vision for how you want your breasts to look and feel. That said, understanding the differences between textured and smooth breast implants will empower you to find the perfect pair for you.

 Read more on saline versus silicone breast augmentation here.


Why Are There Two Different Textures For Breast Implants?

Breast implant surface textures have evolved with time, starting in the 1960s when the first silicone gel breast implant was manufactured by Dow Corning Corporation. In the 70s second generation gel implants became available which offered a silicone shell and polyurethane textured shell to reduce the risk of capsular contracture and improve the feel of the breast implants in women's breast augmentation.  Safety concerns around the polyurethane shell's effect on breast tissue caused manufacturers to develop a third generation textured implant with a textured surface made out of silicone. Fast forward to 1992, when the FDA issued a moratorium (that was eventually lifted in 2006) on all third generation silicone gel implants, requiring all implant manufacturers to provide additional safety and effectiveness data, and the United States transitioned to saline breast implants.

Today, plastic surgeons offer both smooth and textured breast implants, based on their patient's unique needs and goals.


Smooth Surface Implants

Smooth surface texture breast implants

Smooth breast implants are characterized by their smooth outer shell. They are soft, slick, and gummy to the touch. If you were to get a smooth breast implant wet, the water would roll right off of the implant.

This type of implant is not as thick as the textured breast implant shells. Smooth implants do not attach to the surrounding body tissue and move within the capsule that naturally forms around the breast implant.

Patients have a high satisfaction rate with the natural look and feel of smooth surface implants. 


Textured Surface Breast Implants

textured surface breast implants by Dr. John Burns

Textured silicone implants have an outer shell that feels like soft rubber sandpaper. The texture allows the implant to adhere more firmly to the body's tissue, creating a less mobility.

The shell of the implant is clear and you can see right through the implant. Smooth implants are much more popular and have been successfully used for years.

Textured implants have a rough surface sort of like soft sandpaper. They have an opaque surface, feel more rough, and are less slippery when wet.

Theoretically, textured surface implants have a few advantages:

  • Lower incidence of capsular contracture formation BUT ONLY with sub-glandular placement. If implants are placed below the pec muscle, both smooth and textured implants have the same, albeit low, incidence of capsular contracture. Learn more about capsular contracture here.
  • They adhere to the breast tissue. Some surgeons believe they will better resist gravity with less implant movement, and less incidence of migrating lower over time: bottoming out.
  • Shaped or anatomic (teardrop) implants are uniquely made with a textured surface. These implants are designed not to rotate or move around in the implant pocket, thus, the textured surface helps them stay in place, preventing implant malposition.

That said, textured implants have come under close scrutiny recently due to their associated with a rare neoplastic condition known as: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). This is a rare type of T-cell lymphoma (cancer of the immune system) that has been reported to rarely occur in the capsular tissue surrounding textured implants. BIA-ALCL Risk Estimates reported incidence is about 1:30,000. One brand of textured implants was removed from the market in response to the FDA investigation.

For this reason, many surgeons use only the smooth implants in order to avoid and eliminate this low risk of ALCL. Thus, in summary, smooth implants are almost always chosen due to their reliability, low incidence of complications, and beautiful outcomes.



Breast augmentation specialist, Dr. John Burns is one of the leading breast augmentation surgeons in the United States. Having performed well over 5000 primary breast augmentation cases alone, Dr. Burns was selected as one of America's Top Plastic Surgeons by Newsweek and Statista. He offers, both virtual and in-office, complimentary breast augmentation consultations for women seeking breast augmentation in Dallas and throughout the United States, and the world.