In smooth implants, the silicone rubber shell is made with a shiny polished surface. In textured implants, the silicone rubber shell is made with a finely rough surface. These textured surfaces are not something attached to the outer surface, but rather the surface itself is made textured rather than smooth. If you picture something that resembles sand paper, but soft made of pliable silicone rubber, you can visualize it.
Textured surfaces come in fine texture, and coarser texture, depending upon the manufacturer. Texturing by McGhan is a larger-size graininess, where the unaided eye can distinguish the individual texture grains or lumps. Texturing by Mentor is a smaller size graininess, and a magnifying-glass is needed to see the individual grains or lumps.
Why have texture at all? The main reason is to try to prevent rotation of the implant once it is in position, which is vital with shaped (non-round or anatomical) implants. Rotating to become upside-down is rare, but if it happens then another surgery is required to replace the implant with a smooth round one. Theoretically, rotating may occur more frequently with transumbilical insertion, which is why Dr. Dowden prefers smooth implants for that method.
Historically, a theoretical reason for using textured implants was to try to decrease the chance of hardening ("capsule contracture"), at least in the short term. There is now great doubt about the effectiveness of texturing as a deterrent to hardening.
Are there any drawbacks to textured surface implants? There is one main drawback, which is that if there is significant rippling or wrinkling, it is more pronounced with textured than smooth. The likely reason is that the shell plus capsule together make a thicker structure. There is another problem in the wrinkling category, which is that the larger-grain textured implant can show Traction Wrinkles, another type of wrinkling unique to textured implants. A slight drawback of texturing is that if the implants have to be replaced, removing them is slightly more difficult than with smooth ones.
In June of 2000, the manufacturers submitted data to the FDA about rates of implant failure. The data showed that smooth implants last longer than textured implants.
Because of a greater tendency to show wrinkling, with textured implants it is especially critical that the implants be filled to their optimum, even if that requires overfilling of certain implant types.
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