Textured breast implants have a roughened outer shell designed to grip surrounding tissue, keeping the implant in place inside the breast. Unlike smooth implants, which have a slick surface and can move freely within the breast pocket, textured implants create friction that prevents shifting and rotation. They’ve been widely used in cosmetic and reconstructive breast surgery for decades, though their safety profile has come under intense scrutiny since 2019.
How the Textured Surface Works
The outer shell of a textured implant is covered in tiny irregularities that function like Velcro. After surgery, breast tissue grows into the pores and small cavities on the implant surface, anchoring it in position. This tissue integration creates enough friction to prevent the implant from spinning or sliding out of place.
Not all texturing is the same. Macrotextured implants have the roughest surface, with irregularly arranged cube-like cavities of varying sizes and a surface roughness roughly 200 times greater than a smooth implant. Nanotextured (or microtextured) implants have a much finer, more uniform surface that more closely mimics natural tissue architecture. This subtler texture is considered more biocompatible because the cells surrounding the implant interact with it in a way that’s closer to how they’d behave against natural tissue.
Manufacturers create these textures using several different techniques: salt-loss processing (where salt crystals pressed into the silicone shell dissolve away, leaving pores behind), gas diffusion, imprinting, and polyurethane foam coating. Each method produces a different pattern and depth of texture, which matters because the degree of roughness affects how the body responds to the implant over time.
Why Some Implants Need Texture
Round implants look the same from every angle, so if one rotates inside the breast, the shape doesn’t change. Anatomical or “teardrop” implants are a different story. They’re designed with more fullness at the bottom and a tapered upper pole to mimic a natural breast slope. If a teardrop implant rotates even slightly, the breast can look uneven or distorted. That’s why nearly all anatomical implants require a textured shell to lock them in place.
Round implants can be either smooth or textured. Some surgeons prefer textured round implants because the tissue adhesion helps the implant stay exactly where it was positioned during surgery, reducing the chance it migrates upward, downward, or to the side over time.
Benefits Over Smooth Implants
Macrotextured implants have the strongest grip on surrounding tissue, making them the least likely to shift position after surgery. They also promote thinner scar capsules around the implant, with less dense collagen fiber formation compared to smooth surfaces. This matters because thick, tight scar tissue around an implant is what causes capsular contracture, one of the most common complications of breast implant surgery.
An early pooled analysis of over 35,000 implants found that smooth implants carried roughly 69% higher risk of capsular contracture compared to textured ones. However, a more refined analysis of the same data, limited to recent studies with stronger methodology, found no statistically significant difference between the two surface types. The advantage of texturing over smooth surfaces for preventing capsular contracture remains genuinely debated.
Textured implants do show a clear advantage in one area: visible rippling. Patients with smooth implants report significantly more rippling, the visible wrinkling or folding of the implant that can show through the skin. This is partly because textured implants, especially anatomical ones, tend to be filled with firmer, more cohesive silicone gel that holds its shape better. Newer smooth implants with more cohesive gels may close this gap.
The Link to a Rare Cancer
Textured breast implants are associated with breast implant-associated anaplastic large cell lymphoma, or BIA-ALCL, a rare cancer of the immune system that develops in the scar tissue surrounding the implant. As of April 2022, 1,130 women worldwide had been diagnosed with BIA-ALCL, and at least 59 had died from it.
The risk varies dramatically depending on the type of texturing. One heavily macrotextured product line, Allergan’s Biocell implants, accounted for about 91% of worldwide cases where the manufacturer was known, despite representing only about 5% of implants sold in the U.S. before it was pulled from the market. Lifetime risk estimates for Biocell implants specifically may be as high as 1 in 100. For textured implants more broadly, risk estimates range from about 1 in 355 to 1 in 2,207, depending on the study and the specific product.
BIA-ALCL typically appears years after implant placement. The main warning signs are persistent swelling around the implant, a noticeable lump under the skin, or pain in the breast area that develops long after surgical healing is complete. Some patients also develop capsular contracture as a sign. When caught early and treated with implant removal and surrounding scar tissue removal, the prognosis is generally favorable.
The 2019 Allergan Recall
In July 2019, the FDA requested that Allergan voluntarily recall all Biocell textured breast implants and tissue expanders worldwide. The recall covered a wide range of products, including Natrelle saline implants, Natrelle 410 anatomical implants, Natrelle Inspira implants, round gel implants, and Natrelle 133 tissue expanders, among others. Healthcare providers were told to stop implanting new Biocell products immediately and return unused inventory.
Other textured implants from different manufacturers were not part of this recall and remain available. The FDA’s concern was specifically tied to the aggressive macrotexturing used in Allergan’s Biocell line, not to all textured surfaces.
If You Already Have Textured Implants
The FDA does not recommend preventive removal of textured implants in patients who have no symptoms. Because BIA-ALCL remains uncommon overall, the risks of unnecessary surgery may outweigh the benefits for someone who feels fine. That said, the decision is personal, and some women with Biocell implants in particular choose to have them removed or exchanged for smooth implants given the elevated risk profile of that specific product.
If you have textured implants of any brand, the key is knowing what to watch for. Swelling that develops months or years after surgery, a new lump near the implant, or unexplained pain or tightness around the breast all warrant evaluation. These symptoms don’t mean you have BIA-ALCL, but they should be assessed with imaging, and potentially fluid testing, to rule it out.