The difference between textured and smooth implants ?
The silicone envelope containing the internal silicone gel is manufactured either with a rough surface or a smooth surface. The rough surface is called a ‘textured’ implant and the smooth implant has no surface irregularities and is completely smooth with a shiny surface. Historically in the UK, the majority of implants used have been textured implants since they reduce the incidence of capsular contracture . Recently, it has been discovered that textured implants are associated with a condition called ALCL. Smooth implants have not been associated with ALCL
What is ALCL ?
ALCL stands for Anaplastic Large Cell Lymphoma (ALCL) which a rare form of lymphoma. A lymphoma is a cancer of the white cells. The white cells are the blood cells which normally fight infections and provide immunity. The research into ALCL continues since there is no clear answer why ALCL develops around textured breast implants.
What is the incidence of ALCL ?
The latest data from the MHRA reports that the current estimate in the UK for ALCL is 1 per 24000 (1/24000). As of this date there have only been 61 confirmed cases . At the same time it is important to realise that there are approximately 40,000 patients undergoing breast implants every year so this is a very small number.
In the United states the FDA cite an overall risk of 1in 30,000 ( 1/30,0000). The range has been estimated at between 1/2200 to 1/86000 based upon variable risk between different types of manufacturer. It should be noted that these figures relate to implants manufactured by only Allergan and Mentor. The risk from textured Allergan implants is reported at 1/ 2200 and the risk with mentor implants at 1/86000. As a result of this textured Allergan implants have been removed from the market. There is no data available from other implant manufacturers and it is though that Allergan implants have a particular very rough type of surface which predisposed to ALCL.
The data available in the UK relates to an average across all types of manufacturers including UK and European manufacturers of implants.
How is ALCL detected and treated ?
ALCL presents many years after breast implantation with a swelling in one or other breast. This swelling is of the whole breast and relates to some fluid called a seroma developing around the breast implant but within the capsule which surrounds the breast implants. A scan is required and a sample of fluid around the breast implant is taken for further tests. A diagnosis of ALCL is made on positive testing of any lympoma cells ( cancer white cells) found in the fluid. The treatment consists of removing the breast implants including the capsule. ALCL is treatable and to date there has only been one death reported in the UK which met the criteria for ALCL.
What factors are important in deciding on textured or smooth breast implants ?
Since ALCL only occurs in textured breast implants many patients might assume that smooth implants are the only option. However, there are many factors to consider before making an informed choice. One of the most important considerations is the risk of capsular contracture. A capsular contracture is the hardening of the membrane which can occur around breast implants resulting in distortion in shape and discomfort of the breast . Historically, textured implants have been the most commonly used in the UK with the reason being that they have a lower chance of causing capsular contracture. The risk of developing a capsular contracture with textured implants is estimated in a range up to 10% but with smooth implants the risk is estimated in a range up to 20%. This is an important factor to consider since in choosing smooth implants there may be a considerably higher chance of re-operations and potentially earlier replacement surgery than what may be required with textured implants.
The other factors to consider is the fact that textured implants provide a non-slipping surface which maintains the position of the implant. Smooth implants cannot adhere to the surounding breast tissue and are therefore more liable to malposition and rotation. Again this can result in a higher rate of reoperation.
Patients who prefer anatomical or ‘tear-drop’ shaped implants
Due to the risks of malposition and rotation risk of smooth implants anatomical implants are only manufactured in a textured variety. Therefore, if any patient prefers an anatomical shaped implant this would have to be a textured implant.
Making a decision between smooth and textured implants
It is always important to fully consider all the above factors and ask any further questions at the time of consultation in order that you can make a fully informed decision before proceeding with surgery. It is also important to appreciate that the science and research is continually changing and that no surgeon can provide any guarantees about any product and the risks involved which can change as further information comes to light in the future.
More information is available below
Read more about breast implants on the main webpage