I have been a Sacramento plastic surgeon for over 20 years. Over the course of my plastic surgery practice I have used all the different forms of implants that have been developed. In a short review I would like to go over the history of breast implant development. At first we only had round implants, both saline and silicone. They worked well but had limitations. Textured implants were developed to try to solve two problems in breast augmentation.
What are the problems with textured breast implants?
1. One of the most common complications in breast augmentation is capsular contracture. What is capsular contracture in breast augmentation? This problem is caused by scar tissue that forms around the breast implant becoming hard and tight. There are various grades of breast implant capsular contracture. Everyone forms a capsule, as long as the capsule remains soft, breast augmentation will look an feel fine. However in some patients the capsule starts to tighten around the implant. This will cause deformity of the augmentation and possibly pain.
What can you do to reduce capsular contracture? The best approach is try to avoid it, but that is easier said then done. We don’t know exactly why it occurs, possibly due to bio film or sub-clinical infection. That is why I like to start all my patients on antibiotics for one week after surgery. Also, there may be benefits from using Vitamin E after surgery as well. Implant massage also is helpful but if started too early can lead to post operative bleeding. I like to wait one month after surgery before starting gentle breast implant massage. Placing the implant under the pectoralis muscle is also better than placing the breast implant on subglandular pocket (which is over the muscle).
What else can be done to reduce capsular contracture? That is where textured implants come in. It is thought that the textured surface creates more surface area and reduce the risk of the scar tissue around the breast implant becoming tight and hard. Textured breast implant will probably help when the breast augmentation is performed with the implant over the muscle in a subglandular pocket. But when the implant is placed under the muscle in a sub-pectoral pocket there most likely is no benefit. Why not use a textured implant any way? Textured implants do not move as well as smooth implants and may not feel or look as natural as smooth implants in sub-pectoral pocket. I prefer smooth round implants under the muscle in most patients. There are times when oval or contoured implants are needed, or when textured implants should be used.
There is a new study that shows incision site also has an effect on the occurrence of capsular contracture in breast augmentation. Infra-mammary incision (incision under the breast) has a much lower incidence of capsular contracture than nipple incision. This is thought to be due to possible contamination, as the nipple incision goes through breast tissue and milk ducts, whereas infra-mammary incision avoid breast tissue completely.
When do we use textured breast implants?
2. Now that you know textured implants don’t move well when used in breast augmentation, you will understand when we use them anyway. The next big change that occurred in breast implant shape was the development of the oval or contoured breast implants. These are the shaped implants that were initially released as saline implants many years ago. The saline shaped implants did not work well due to the nature of saline not being able to hold its shape. Also these implants were oval in shape, and if rotated would cause breast deformity. Now you understand where textured implants come in. Due to the textured surface they tend not to rotate, making them ideal for shaped or contoured breast implants. Now we have the cohesive breast implants and the highly cohesive breast implants that help in producing a very natural looking breast augmentation in a select group of patients. I like these implants in patients with very small or flat breasts without much shape, or in breast reconstruction patients after mastectomy where no breast tissue exist. In patients with moderate breast tissue or ptosis (saggy breasts) I believe they actually are not indicated.