Textured vs. Smooth Breast Implants: Safety, Recalls & BIA-ALCL: Textured implants were recalled over BIA-ALCL risk. Compare textured vs smooth shells, who still uses textured, and what to do if you have them.
Key Takeaways
- Allergan's macro-textured BIOCELL implants were recalled in 2019 due to a confirmed link to BIA-ALCL (a rare lymphoma).
- Not all texturing is the same: macro-texture (Allergan BIOCELL) carries significantly higher BIA-ALCL risk than micro-texture (Mentor Siltex).
- Smooth implants dominate the US market today and have no confirmed BIA-ALCL association.
- The FDA does not recommend preventive removal of textured implants in women without symptoms.
- Teardrop (anatomical) implants traditionally require texturing to prevent rotation — smooth teardrops are emerging but not yet widely used.
What Texturing Is and Why It Was Invented
Implant texturing refers to a roughened outer shell surface, created through various manufacturing processes. Texturing was introduced in the 1980s and 1990s for two purposes:
- Anti-rotation: Teardrop (anatomical) implants have an asymmetric shape — they need to stay oriented correctly. The textured surface grips the scar tissue capsule and prevents the implant from flipping.
- Capsular contracture reduction: Early studies suggested textured surfaces reduced the rate of capsular contracture by disrupting the organized scar tissue formation. This benefit has not been consistently replicated in large studies.
By the 2010s, textured implants had significant market share — particularly in Europe and Australia, where anatomical (teardrop) implants were very popular.
Smooth vs. Textured: Side-by-Side Comparison
Key differences between smooth-shell and textured-shell implants:
| Feature | Smooth | Textured |
|---|---|---|
| Shell surface | Polished, uniform | Roughened (micro or macro) |
| Movement in pocket | Moves freely ("massage" possible) | Adheres to capsule — less movement |
| BIA-ALCL risk | No confirmed association | Elevated — especially macro-texture |
| Capsular contracture | Rates vary; placement matters more | Some studies suggest lower rates — evidence mixed |
| Shape options | Round (standard) | Round or teardrop (anatomical) |
| US market share (2026) | ~90%+ | ~10% (mostly micro-texture) |
| Can rotate? | Yes, but round shape means rotation doesn't matter | Designed not to rotate — critical for teardrops |
The BIA-ALCL Link and the Allergan Recall
BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) is a rare cancer of the immune system — not breast cancer. It develops in the fluid or scar tissue surrounding a breast implant, and the vast majority of confirmed cases worldwide have involved textured implants.
In July 2019, the FDA requested Allergan to voluntarily recall its BIOCELL textured breast implants and tissue expanders after confirming that BIOCELL's macro-textured surface was associated with the majority of BIA-ALCL cases in the US.
Key facts about the recall:
- The recall applies only to Allergan BIOCELL textured products — not all Allergan implants and not smooth-shelled Natrelle implants.
- The FDA estimated BIA-ALCL lifetime risk for macro-textured implants at roughly 1 in 2,832 to 1 in 30,000, depending on methodology.
- When caught early, BIA-ALCL is highly treatable with implant removal and capsulectomy. Prognosis is excellent in early-stage cases.
For a full overview of this disease, see our BIA-ALCL guide →
Micro-Texture vs. Macro-Texture: Not All Texturing Is Equal
The BIA-ALCL risk differs dramatically by texturing method:
| Texturing Type | Brand Example | Manufacturing Process | BIA-ALCL Risk |
|---|---|---|---|
| Macro-texture (aggressive) | Allergan BIOCELL (recalled) | Salt-loss technique — deep, irregular pores | Highest confirmed risk |
| Micro-texture (fine) | Mentor Siltex | Imprint stamping — shallow, uniform texture | Very low; handful of reported cases worldwide |
| Nano-texture | Motiva SilkSurface | Nano-scale texturing | No confirmed BIA-ALCL cases to date |
| Smooth | All smooth-shell brands | No texturing | No confirmed association |
I Have Textured Implants — What Should I Do?
The FDA's current guidance for women with textured implants and no symptoms:
- Prophylactic removal is not recommended. The risk of surgery (anesthesia, infection, scarring) must be weighed against the very low absolute risk of BIA-ALCL, even with macro-textured implants.
- Routine monitoring is key. Report any new swelling, pain, lumps, or fluid collection around the implant — especially swelling that occurs more than 1 year after surgery.
- Discuss with your surgeon. If you have Allergan BIOCELL specifically, your surgeon can help you weigh the risk-benefit of removal vs. monitoring based on your individual health profile.
If you do develop symptoms, your surgeon will likely recommend ultrasound-guided aspiration of any fluid around the implant to test for BIA-ALCL. If confirmed, treatment is implant removal with total capsulectomy. Removal guide →
Do Teardrop Implants Still Require Texture?
Historically, yes — teardrop (anatomical) implants require texturing to prevent rotation, which would cause a visible deformity. This is why the Allergan recall impacted the teardrop implant market so heavily: the most popular textured teardrops were BIOCELL-surfaced.
Developments since the recall:
- Micro-textured teardrops (Mentor CPG with Siltex surface) remain available and are used by some surgeons.
- Smooth round implants have largely replaced teardrops in the US. High-profile round implants produce a similar upper-pole look without the rotation risk. Round vs. teardrop comparison →
- Smooth anatomical implants are in development by some manufacturers, but rotation remains a concern without texture. These are not yet mainstream in the US.
Frequently Asked Questions
References & Sources
- FDA Requests Allergan Voluntarily Recall Natrelle BIOCELL Textured Breast Implants. FDA Safety Communication (2019) . View source ↗
- Medical Device Reports of BIA-ALCL. FDA.gov (2024) . View source ↗
- How to Diagnose and Treat Breast Implant–Associated Anaplastic Large Cell Lymphoma. Plastic and Reconstructive Surgery (2018) . View source ↗
- Breast Implant Black Box Warning (2021). FDA.gov (2021) . View source ↗
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a board-certified plastic surgeon or qualified healthcare provider before making any medical decisions.