This is fortunately not a very difficult decision to make. I prefer smooth implants and I will tell you why. I am not the only one to like smooth implants, in fact the majority of plastic surgeons like them as well.
Before there was textured implants we used an implant covered with a layer of polyurethane. Those days the silicone gel wasn’t really a gel, like Jello. It was more like honey and the implant’s membrane was very thin. The gel used to come out of the membrane and cause irritation of the capsule, a phenomenon called gel bleed. The incidence of capsular contraction (tightening of the layer around the implant) was very high, much higher than today. As it turned out the polyurethane covered implants used to have less incidence of capsular contraction, the breasts stayed softer and more natural. Then we found out that the polyurethane got disintegrated by the body and late contractions developed. These implants are no longer available.
Many different manufacturers were making textured implants, assuming that the textured surface would make the capsular contraction less likely to happen. There were all kinds of textured surfaces. I remember one that looked like a brush and was made by Dow Corning. This implant went off the market along with Dow Corning. The two remaining implant manufacturers Mcghan which is Allergan today and Mentor continued making textured saline implants that I was using.
One texturing resembles sand paper and is called Siltex from Mentor. The other a bit coarser and softer called Biocel by Allergan. Over the years I found out that these textured implants caused rippling and leaked more frequently. There is evidence in the literature that there is less incidence of capsular contraction with the textured surface implants, but in my opinion they do not help the capsular contraction, as matter of fact, I found that the breasts were never as soft as with a soft smooth implant breast augmentation. The textured surface offers one advantage. The implant is less likely to move. This could be good and bad in breast augmentation but it is definitely good in post mastectomy breast reconstruction with expanders and in cases where anatomic or contoured shape implants are used.
Conclusion: I only use textured expanders and switch them to
smooth gel implants at the final stage of breast reconstruction. Almost all my breast augmentations are done with smooth implants. Experience is a great advantage and I am very happy with the choice of implants for my patients. There are many plastic surgeons whom I respect offering textured implants even today, but I feel that there is limited application in my practice, except in a rare situation when the implant position is unstable. As you can see there is a lot of nuances that need to be understood.
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