It is accepted universally that a textured implant surface decreases the prevalence of capsular contracture that requires surgical intervention. But what is the texture of the implant?There are two different types of implant textures, meaning the outer shell of the implant, whether the implant is saline or silicone. The implant bag or shell can be smooth or rough. In this picture, on the right is a smooth breast implant and on the left is a textured implant. Prior review studies have shown that a textured implant decreases the risk of capsular contracture significantly.But why is this? Let’s assume that this circle is a smooth round silicone implant. When this implant is placed in the breast, the body reacts to it like we discussed before, forming a capsule.Because the surface of the implant is smooth, when the fibroblasts or the cells that form the capsule orient themselves, they arrange themselves into a more parallel uniform orientation.When the cells contract the capsule, it squeezes the implant in a more forceful and homogenous vector. On the other hand, the textured implant reduces the fibroblasts’ proliferation and in a sense produces a random orientation of the cells and the collagen of the capsule, where the vector forces go in many directions, reducing the contractile properties of the capsule as a unit. It is known that the rate of capsular contracture is higher when implants have smooth surfaces, regardless of the filling material.Now, to make things a little more complicated, the implant surface property only applies when the implant is placed above the muscle. In other words, if you have a textured implant that is placed above the muscle, the rate of capsular contracture is significantly lower than for a smooth implant above the muscle. On the other hand, if the implants are placed under the muscle, the rates of capsular contracture are very similar without any statistical significance.