In this guide6 sections
Breast implants come with a choice that gets far less attention than size or shape: the surface texture of the shell itself. Implants are either smooth or textured, and this single design detail has a genuine bearing on two of the most discussed long-term risks of breast augmentation — capsular contracture and BIA-ALCL. This guide explains why textured and smooth implants exist, what our own surgeons’ research found when they tested the old assumptions against modern data, and why Centre for Surgery has shifted almost entirely to smooth and microtextured implants since 2018.
Why Do Textured and Smooth Breast Implants Both Exist?
When a breast implant is placed in the body, the immune system responds by forming a layer of scar tissue around it — a normal part of healing, called the capsule. This capsule actually helps hold the implant in position. The two implant surface types interact with this capsule differently.
Smooth implants don’t allow the capsule to adhere tightly to the shell, which lets the implant move slightly within the pocket — many patients find this gives a softer, more natural movement, closer to real breast tissue. The trade-off is that, occasionally, a smooth implant can shift more than intended over time.
Textured implants have a surface designed to help the capsule adhere to the shell more firmly, holding the implant more securely in place and reducing the risk of it “bottoming out” or rotating out of position. Textured implants placed above the muscle have also historically been associated with a somewhat lower rate of capsular contracture — which is exactly the question our own surgeons set out to test against current data.
Does Implant Texture Really Affect Capsular Contracture Risk? Our Own Data
Older research linking implant texture to capsular contracture risk was often based on small patient numbers, multiple surgeons with varying technique, and an earlier generation of implants — conditions that make it hard to know whether the same conclusions still hold today. Our surgeons set out to test this directly using Centre for Surgery’s own patient data.
The review covered patients who underwent breast augmentation with us between 2016 and 2022, all with cohesive gel silicone implants. Roughly one-third had smooth implants and two-thirds had textured implants. Across this group, capsular contracture developed in five patients with smooth implants and three patients with textured implants — a difference that, once analysed, was not statistically significant.
In other words, in our own patient data, implant texture alone did not meaningfully predict who developed capsular contracture. Surgical technique — particularly the steps taken to limit bacterial contamination of the implant pocket during surgery — appeared to matter more than texture itself. This tracks with the wider “bacterial biofilm theory” that’s now the leading explanation for capsular contracture generally; our detailed guide on capsular contracture causes, symptoms and treatment covers this mechanism, the Baker grading system, and the full range of treatment options.
The overall takeaway: capsular contracture risk is low regardless of which implant surface you choose, and it’s driven far more by surgical technique than by texture alone. Your surgeon can walk you through how this applies to your specific case at consultation.
Why We Moved Away from Textured Implants: BIA-ALCL
Even though our own data didn’t show texture driving capsular contracture risk, Centre for Surgery shifted towards smooth and microtextured implants from 2018 onwards for a separate and more serious reason: Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare cancer that can develop in the scar tissue around an implant.
The overwhelming majority of reported BIA-ALCL cases worldwide have been linked to a specific category of heavily (macro-)textured implants, and no confirmed cases have been reported in the medical literature involving only smooth implants. This evidence became clear enough over recent years that most UK surgeons, including our own team, phased out heavily textured implants altogether as a precaution.
It’s worth keeping this in perspective: BIA-ALCL remains extremely rare, and when caught early is treatable in the great majority of cases without needing chemotherapy. If you already have heavily textured implants from a previous procedure, the accepted medical guidance is that the small risks of an additional surgery to remove and replace them generally outweigh the very low risk of BIA-ALCL developing — leaving your existing implants in place is usually the safer course, unless you’re experiencing symptoms. For the full picture on symptoms, diagnosis, and treatment, see our dedicated guide: BIA-ALCL and Breast Implants.
What This Means for Your Implant Choice
Given our own data shows texture doesn’t meaningfully move the needle on capsular contracture, but does carry a separate BIA-ALCL association at the heavily textured end of the spectrum, the practical case for smooth or microtextured implants is straightforward — which is why it’s our current standard. That said, no implant choice is made in isolation from your broader anatomy, goals, and surgeon’s clinical judgement, and this is exactly the kind of decision that belongs in a proper consultation rather than a generic online guide.
Frequently Asked Questions
Do textured breast implants carry a higher risk than smooth implants?
For capsular contracture specifically, our own patient data (2016–2022) found no statistically significant difference between smooth and textured implants — surgical technique appeared to matter more. For BIA-ALCL, heavily textured implants do carry an association not seen with smooth implants, which is why we’ve moved to smooth and microtextured implants as standard.
What is the difference between textured and smooth breast implants?
Smooth implants allow slightly more natural movement within the pocket but can occasionally shift more than intended. Textured implants encourage the scar tissue capsule to adhere more firmly, holding the implant in a more fixed position.
Is BIA-ALCL common?
No — it’s a rare cancer, and when identified early it’s treatable in around 95% of cases without needing chemotherapy. Our full guide on BIA-ALCL symptoms, diagnosis and treatment covers the complete picture.
Should I have my textured implants removed if I don’t have any symptoms?
Generally, no. Accepted medical guidance is that the small risks of an additional surgical procedure usually outweigh the very low risk of BIA-ALCL developing in patients without symptoms. This is a decision to make with your surgeon, based on your specific implant type and history.
Does implant placement over or under the muscle affect capsular contracture risk?
Yes — placement is one of several factors that influence risk, alongside surgical technique and individual biology. Our dedicated guide on capsular contracture causes and treatment covers all of the risk factors in full.
Why Choose Centre for Surgery
At Centre for Surgery, breast augmentation is performed by GMC-registered plastic surgeons, at our CQC-regulated Baker Street facility, rated Good overall, under TIVA (Total Intravenous Anaesthesia) as a day case. Our surgeons don’t just follow published research — as this guide shows, they actively contribute to it, using our own patient outcomes to make evidence-led decisions about implant choice rather than relying on outdated assumptions.
We use Silimed implants as standard, with Mentor and Motiva also available on request.
To book a consultation, call 020 7993 4849 or email contact@centreforsurgery.com. We’re located at 95-97 Baker Street, London W1U 6RN.
