\nSurface class<\/strong><\/td>\nRoughness (Ra)<\/strong><\/td>\nExample products<\/strong><\/td>\nRegulat<\/strong>ions<\/strong> 2026<\/strong><\/td>\n<\/tr>\n<\/thead>\n\n\nSmooth<\/strong><\/td>\n| Under 10 \u00b5m<\/td>\n | Most modern round implants<\/td>\n | Available worldwide<\/td>\n<\/tr>\n | \nMicrotextured<\/strong><\/td>\n| 10\u201350 \u00b5m<\/td>\n | Mentor Siltex, several CE-marked lines<\/td>\n | Available in most markets<\/td>\n<\/tr>\n | \nMacrotextured<\/strong><\/td>\n| Above 50 \u00b5m<\/td>\n | Allergan Biocell (withdrawn)<\/td>\n | Banned in EU, France, Canada; recalled in US<\/td>\n<\/tr>\n | \nPolyurethane-coated<\/strong><\/td>\n| Separate class<\/td>\n | Polytech and others<\/td>\n | Banned in France; restricted elsewhere<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/span>Textured vs Smooth Implants<\/span><\/h2>\nWhich are better, textured or smooth implants? It depends on your case.\u00a0Textured silicone implants<\/strong>\u00a0buy stability at the cost of a rare but serious risk. Smooth implants remove that risk and accept others.<\/p>\n\n\n\nRisk<\/strong><\/td>\nTextured implants<\/strong><\/td>\nSmooth implants<\/strong><\/td>\n<\/tr>\n<\/thead>\n\n\nCapsular contracture<\/strong><\/td>\n| Lower rates<\/td>\n | ~2.8\u00d7 higher odds<\/td>\n<\/tr>\n | \nRotation risk<\/strong><\/td>\n| Anchored by tissue ingrowth<\/td>\n | Can rotate (critical for teardrop shapes)<\/td>\n<\/tr>\n | \nBIA-ALCL risk<\/strong><\/td>\n| Only known risk factor<\/td>\n | No confirmed causal link<\/td>\n<\/tr>\n | \nFeel and movement<\/strong><\/td>\n| Slightly firmer, less mobile<\/td>\n | Softer, more natural glide<\/td>\n<\/tr>\n | \nRippling \/ palpability<\/strong><\/td>\n| More palpable in thin patients<\/td>\n | Less visible rippling<\/td>\n<\/tr>\n | \nPost-op massage<\/strong><\/td>\n| Not advised<\/td>\n | Often recommended<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/span>Where Textured Silicone Implants Outperform<\/span><\/h3>\nAnatomical (teardrop) implants<\/strong> are the strongest remaining case for textured surfaces. A round implant looks the same at any angle; a teardrop implant that rotates 40 degrees produces visible deformity requiring revision surgery. Texture prevents that.<\/p>\nTextured surfaces also help in\u00a0thin-tissue and reconstructive patients<\/strong>, where the implant sits close to the skin and needs stability rather than mobility. In these cases a surgeon may reasonably favour a micro-textured device.<\/p>\n<\/span>Where Smooth Implants Have the Advantage<\/span><\/h3>\nFor the majority of primary augmentations with\u00a0round implants placed submuscularly<\/strong>, smooth shells now dominate for a straightforward reason: they capture most of the aesthetic benefit while eliminating the one risk that carries mortality.<\/p>\nSmooth implants also feel more natural in motion, ripple less visibly, and are simpler to risk-monitor. Manufacturers have responded with smooth-surface anatomical models and laser-etched texturing that stabilises position without the aggressive roughness linked to ALCL risk.<\/p>\n <\/span>BIA-ALCL and Textured Implants: The Real Risks<\/span><\/h2>\nBIA-ALCL <\/strong>(breast implant-associated anaplastic large cell lymphoma<\/strong>) is a cancer of the immune system, not breast cancer.<\/strong>\u00a0It forms in the scar tissue capsule around the implant and occurs most frequently in patients with textured surfaces.<\/p>\nThe only known risk factor for BIA-ALCL is textured implants. Which is why regulators acted on the device rather than on surgical technique. The estimated lifetime risk is 1 in 2,207 to 1 in 86,029 for women with textured implants, based on confirmed cases and two decades of textured implant sales data.<\/p>\n When the manufacturer is known, approximately 91% of world cases involved exposure to a Biocell implant. At the other end, Siltex micro-textured devices showed a BIA-ALCL risk of 0.0012% in the most extensive data available.\u00a0American Society of Plastic Surgeons<\/a>uspto<\/a><\/p>\n \n\n\nRisk<\/strong><\/td>\nFigure<\/strong><\/td>\nSource<\/strong><\/td>\n<\/tr>\n<\/thead>\n\n\nLifetime risk, textured implants (all)<\/strong><\/td>\n| 1 in 2,207 \u2013 1 in 86,029<\/td>\n | ASPS<\/td>\n<\/tr>\n | \nShare of cases linked to one macrotextured line<\/strong><\/td>\n| ~91% of cases with known manufacturer<\/td>\n | FDA<\/td>\n<\/tr>\n | \nRelative risk, that line vs other US textured implants<\/strong><\/td>\n| ~6\u00d7 higher<\/td>\n | FDA<\/td>\n<\/tr>\n | \nReported risk, micro-textured (Siltex)<\/strong><\/td>\n| 0.0012%<\/td>\n | Core Study data<\/td>\n<\/tr>\n | \nConfirmed cases worldwide (Aug 2024)<\/strong><\/td>\n| 1,577<\/td>\n | Global reporting<\/td>\n<\/tr>\n | \nDeaths worldwide (Aug 2024)<\/strong><\/td>\n| 63<\/td>\n | Global reporting<\/td>\n<\/tr>\n | \nTypical time to onset<\/strong><\/td>\n| 8\u201310 years post-implantation<\/td>\n | ASPS<\/td>\n<\/tr>\n | \nRisk with smooth implants<\/strong><\/td>\n| No confirmed causal link<\/td>\n | FDA<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
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