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The Allergan Biocell textured implant recall brought textured breast implants into the spotlight, raising questions about BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). While the headlines were alarming, the actual risk remains extremely low — approximately nine cases per three million women with breast implants.
Understanding when textured implants make sense requires looking beyond the fear and examining the real benefits and risks.
What Makes Breast Implants Textured
Textured breast implants have a rough surface designed to grip surrounding tissue. This texture prevents the implant from moving around in the pocket, which can be crucial in certain situations.
Both saline and silicone implants come in textured versions, available in round and anatomical (teardrop) shapes.
When Textured Implants Prevent Problems
The main advantage of textured implants is preventing bottoming out — when implants stretch the lower breast skin and drop too low. This creates an unattractive appearance where the breast loses its upper pole fullness.
Textured implants may also reduce capsular contracture rates, though the data isn't definitive across all texture types.
Who Needs the Extra Grip
Most patients don't need textured implants. We reserve them for women at higher risk of bottoming out, which we determine using two simple measurements:
Nipple angle: Women whose nipples point upward are more prone to bottoming out than those whose nipples project straight forward or downward.
Lower breast length: Measure from your breast fold to your nipple. If this distance exceeds 2.5 inches, your bottoming-out risk is higher. Under 2 inches means lower risk.
BIA-ALCL: Understanding the Real Risk
BIA-ALCL is a rare lymphoma that can develop around textured implants. The numbers put this in perspective: fewer than 1,000 cases worldwide against an estimated 100+ million breast implants placed since the 1960s.
Not all textured surfaces carry equal risk. The recalled Allergan Biocell had a particularly aggressive texture. Other textured implants show different risk profiles.
When diagnosed early, BIA-ALCL is highly treatable, often requiring only implant removal and capsulectomy.
Our Approach to Implant Selection
For most patients, smooth implants are the better choice. The bottoming-out prevention that texture provides simply isn't necessary when your anatomy doesn't predispose you to the problem.
When we do recommend textured implants — for patients at genuine risk of bottoming out — we discuss the trade-offs openly. The decision becomes whether preventing a likely cosmetic complication justifies accepting an extremely small cancer risk.
This isn't a decision we make lightly, and it's always the patient's choice after full disclosure.
Frequently Asked Questions
Should I remove my textured implants?
If you have no symptoms and weren't affected by the Allergan recall, removal isn't automatically necessary. Regular monitoring with your plastic surgeon is appropriate. Any unusual swelling, pain, or changes around your implants warrant immediate evaluation.
Are smooth implants always safer than textured?
Smooth implants don't carry BIA-ALCL risk, but they have their own potential complications, including higher rates of bottoming out in susceptible patients. Safety depends on choosing the right implant for your anatomy.
Can textured implants be replaced with smooth ones?
Yes, textured implants can be replaced with smooth ones during revision surgery. However, this may increase bottoming-out risk if texture was originally chosen for anatomical reasons. We evaluate each case individually.
The key to successful breast augmentation is matching the implant characteristics to your anatomy and goals. Whether that means textured or smooth implants depends on your individual risk factors and preferences.
Ready to discuss which implant type suits your anatomy? Schedule a consultation to review your options with Dr. Schwartz.
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