Smooth or Textured? Decoding Implant Choice in Cosmetic Breast Augmentation
- jessilyntanhy9
- 11 minutes ago
- 4 min read
Breast augmentation remains one of the most commonly performed cosmetic procedures worldwide, with an estimated 1.5 million surgeries annually. In the United Kingdom alone, approximately 7,000 cosmetic breast augmentations were reported in 2022, highlighting its continued relevance in aesthetic practice. Despite advances in implant technology—such as gel cohesiveness, anatomical shaping, and surface texturing—consensus on optimal implant selection remains elusive.
A recent national cross-sectional study by Jordan et al. (2025) surveyed UK consultant plastic surgeons to examine implant surface preferences (smooth vs textured) in primary cosmetic breast augmentation and the factors guiding these decisions. The findings provide valuable insight into contemporary UK practice, regional trends, and decision-making considerations relevant to surgeons navigating this nuanced area.
Implant Surface Preferences: Smooth vs Textured
The survey, completed by 75 consultant plastic surgeons across the UK, revealed that textured implants remain the predominant choice, reported by 82.7% of respondents, while 17.3% preferred smooth implants.
Interestingly, surgeon case volume influenced implant preference. High-volume surgeons performing more than 50 augmentations per year were significantly more likely to favour smooth implants (χ²(5) = 11.79, p = 0.038). This suggests that greater surgical experience, exposure to emerging safety data, and evolving patient expectations may drive the gradual adoption of smooth implants among more experienced operators.
Brand Preferences and Surface Selection
Brand selection mirrored surface preference trends:
Mentor: Preferred by 53.3% of surgeons, primarily associated with textured implants.
Motiva: Chosen by 24% of surgeons, often in conjunction with smooth or nano-textured implants.
Other brands (Nagor, GCA, Polytech, Sebbin) accounted for smaller proportions.
The study found a significant association between implant surface and brand preference (χ²(5) = 58.3, p = 0.011), reflecting how surgeon familiarity, training exposure, and institutional availability influence implant choice.
Surgical Techniques: Incision and Pocket Choice
All surveyed surgeons preferred the inframammary incision, consistent with global trends. This approach provides direct visualization, easier pocket creation, and a discreet scar.
Implant pocket selection varied:
Subglandular: 54.7%
Dual-plane: 36%
Subpectoral: 9.3%
No significant correlation was observed between implant surface and pocket choice (χ²(2) = 1.40, p = 0.50).
However, qualitative responses highlighted practical considerations:
Subglandular placement may reduce operative time and postoperative discomfort but carries higher capsular contracture risk with smooth implants.
Dual-plane techniques, increasingly popular, combine the benefits of subpectoral coverage with better upper-pole contour but may risk animation deformity.
Subpectoral and subfascial options offer lower contracture risk and better soft-tissue coverage, particularly in thin patients.
Factors Influencing Implant Selection
Surgeons ranked six key factors influencing implant choice:
Factor | Mean Ranking (1=Most Important) |
Patient preference | 2.04 ± 1.28 |
Cosmetic outcome | 2.45 ± 1.22 |
Risk of capsular contracture | 2.73 ± 1.29 |
Risk of BIA-ALCL | 3.67 ± 1.15 |
Advice from medical indemnity providers | 4.56 ± 1.08 |
Cost | 4.61 ± 1.03 |
Key insights:
Patient involvement is central; surgeons often guide patients but respect their informed preferences.
Cosmetic outcome and capsular contracture remain top clinical priorities.
BIA-ALCL risk, while acknowledged, is not the primary driver in decision-making, reflecting its low absolute risk in the UK (~1 in 24,000 implants).
Non-clinical factors such as cost and indemnity advice are less influential but can shape choices in certain institutional contexts.
Qualitative Insights: Nuances Behind the Numbers
Free-text responses highlighted several themes that add context to the quantitative findings:
Patient Awareness: Many patients arrive with pre-formed opinions, often influenced by media coverage and online forums. Surgeons emphasize evidence-based counselling while respecting patient concerns.
Safety Considerations: Surgeons balance perceived benefits of textured implants (upper-pole control, malposition prevention) with risks including capsular contracture and rare BIA-ALCL.
Institutional Policy: Hospital procurement and indemnity guidance sometimes limit implant choice, particularly for textured devices.
Aesthetic and Technical Considerations: Textured implants remain preferred in complex or borderline cases where positioning and shape control are critical.
Regional Trends
Textured implants dominated across all UK regions. Smooth implants were more commonly reported in:
North-East (n=4)
Scotland (n=3)
London (n=2)
Other regions (Yorkshire, Northern Ireland, South-East, South-West: n=1 each)
No statistically significant regional differences were observed (χ²(8) = 12.02, p = 0.25), indicating that personal surgeon preference, patient expectations, and institutional factors outweigh geographic influence.
Implications for Practice
Several practical lessons emerge from this study:
Engage Patients: Given the top-ranked importance of patient preference, preoperative counselling should integrate patient concerns, expectations, and safety awareness.
Tailor Implant Choice: Consider patient anatomy, tissue characteristics, and desired aesthetic outcomes when choosing between smooth and textured implants.
Stay Updated on Safety Data: Emerging evidence and regulatory guidance on BIA-ALCL and implant technologies may influence implant selection trends, particularly for high-volume surgeons.
Consider Institutional Constraints: Hospital policies, procurement limitations, and indemnity advice may affect implant availability and choice.
Leverage Evidence-Based Practice: The Breast and Cosmetic Implant Registry (BCIR) offers valuable data for longitudinal monitoring and supports informed decision-making.
Conclusion
Jordan et al.’s national survey provides the first UK-specific overview of implant surface selection in primary cosmetic breast augmentation. While textured implants remain the predominant choice, there is a clear trend toward smooth implants among high-volume surgeons, reflecting evolving evidence, patient awareness, and safety considerations.
Decision-making in implant selection is multifactorial, combining patient preference, aesthetic goals, and complication risk, with BIA-ALCL awareness forming part of a broader decision-making framework rather than a sole determinant. These insights can inform evidence-based guidelines, enhance patient counselling, and support optimal surgical outcomes in cosmetic breast augmentation.
Reference:
Jordan, C., Sosnowski, K., Shah, R., & Malata, C. (2025). Implant surface selection in primary cosmetic breast augmentation: A national cross-sectional study of UK plastic surgeons. JPRAS Open, 45, 212–224. https://doi.org/10.1016/j.jpra.2025.06.004
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