Implant Surface · 2 of 4
Microtextured surface implants
Fine surface roughness designed to encourage tissue ingrowth without the BIA-ALCL risk of coarser macrotextured surfaces. Standard for anatomical implants in modern practice.
Clinical summary
Microtextured surfaces have fine surface roughness (~50-100 µm pores) that encourages tissue ingrowth without the elevated BIA-ALCL risk of macrotextured implants. Standard for modern anatomical implants (rotation immunity required). Lower capsular contracture rates than smooth in older data; modern data shows smaller difference. BIA-ALCL risk higher than smooth but substantially lower than macrotextured. Modern Motiva SilkSurface represents the finest end of microtextured.
The four surface categories
| Surface | Texture scale | BIA-ALCL risk profile | Best for |
|---|
| Smooth | Polished/glossy | Essentially undetectable | Round implants where rotation doesn't matter |
| Microtextured | Fine surface roughness (~50-100 µm) | Lower than macrotextured | Anatomical implants; modern standard |
| Macrotextured | Coarser pores (~200-700 µm) | Higher (BIOCELL-pattern recalled 2019) | Largely withdrawn from market |
| Polyurethane-coated | Foam-like coating | Very low | Specialty — strong tissue adherence, low rotation |
The surface decision is one of the most clinically meaningful in implant selection. Surface affects rotation risk (anatomical implants need texture; round don't), capsular contracture rates (debated but historically textured had lower rates), and BIA-ALCL risk (specifically associated with macrotextured surfaces).
Microtextured geometry
The microtextured surface is created by manufacturing techniques that produce fine surface roughness:
- Salt-loss texturing — surface dipped in salt particles, then washed; salt particles leave fine pores.
- Imprinting — surface molded with fine texture pattern (Mentor Siltex method).
- 3D imprinting — finer-grained imprinting (Motiva SilkSurface).
The resulting pore size is approximately 50-100 microns — smaller than macrotextured (200-700 microns) but larger than smooth (effectively zero pore size). The clinical purpose: tissue ingrowth without the larger pores associated with elevated BIA-ALCL risk.
BIA-ALCL risk hierarchy
| Surface | BIA-ALCL risk (estimated lifetime) | Notes |
|---|
| Smooth | Essentially undetectable | Lowest documented risk |
| Microtextured (Siltex, SilkSurface) | ~1 in 30,000-100,000 | Lower than macrotextured |
| Macrotextured (BIOCELL) | ~1 in 2,000-3,000 | RECALLED 2019 |
| Polyurethane-coated | Very low | Different mechanism |
For BIA-ALCL minimisation, smooth is the lowest-risk choice. Microtextured represents a substantial improvement over macrotextured but not equal to smooth. For patients with anatomical implants where smooth is not appropriate, microtextured is the appropriate choice.
The anatomical implant requirement
Anatomical (teardrop) implants effectively require microtextured surface in modern practice:
- Smooth anatomical implants have unacceptably high rotation rates (over 10-15% in older data).
- Macrotextured anatomical implants are essentially withdrawn (2019 recall).
- Microtextured anatomical implants have rotation rates of approximately 1-3% — clinically acceptable.
- Polyurethane-coated anatomical implants exist as specialty alternative with very low rotation but limited availability.
The choice between microtextured and polyurethane for anatomical implants depends on brand availability and surgeon preference; microtextured is more widely available globally.
Modern microtextured products
| Brand | Microtextured product | Texture characteristic |
|---|
| Mentor | Siltex | Salt-loss texturing; established microtextured |
| Motiva | SmoothSilk / SilkSurface | 3D imprinting; finer end of microtextured |
| Polytech | POLYtxt | European-standard microtexturing |
| Sebbin | Microtextured variants | European microtexturing |
| Nagor | Microtextured variants | UK-developed |
Frequently asked questions
What is the difference between microtextured and macrotextured?
The difference is in pore size of the surface texture. Microtextured surfaces have fine roughness — pores typically 50-100 microns (slightly larger than the diameter of a human hair). Macrotextured surfaces have coarser pores — typically 200-700 microns (visible as a deliberate textured appearance). The pore size difference is clinically meaningful: macrotextured surfaces (specifically Allergan BIOCELL pattern) had elevated BIA-ALCL risk and were withdrawn 2019, while microtextured surfaces have lower BIA-ALCL risk and remain widely used.
Are microtextured implants safe regarding BIA-ALCL?
Lower risk than macrotextured but not zero. Current evidence suggests microtextured surfaces have approximately 10-20x lower BIA-ALCL risk than macrotextured. Specific microtextured variants from major manufacturers (Mentor Siltex, Motiva SilkSurface) have very low documented risk. The absolute BIA-ALCL risk with microtextured surfaces remains low (estimated 1 in 30,000-100,000 lifetime risk depending on specific texture and population). For patients with BIA-ALCL concern, smooth surface has the lowest risk; microtextured is acceptable for most patients.
Why are anatomical implants always microtextured?
Anatomical (teardrop) implants need surface texture to encourage tissue ingrowth and prevent rotation within the pocket. The microtextured surface allows tissue to grip the implant, holding it in correct orientation. Without texture, anatomical implants would frequently rotate, creating visible asymmetry. Modern microtextured anatomical implants have rotation rates of approximately 1-3% — far below historical smooth anatomical rates. Microtextured surface is essentially mandatory for clinical use of anatomical implants.
How is Motiva SilkSurface different from other microtextured surfaces?
Motiva SilkSurface (sometimes called 'nanotextured') is at the smooth end of the microtextured spectrum — finer surface roughness than traditional Siltex (Mentor) or other microtextured surfaces. Motiva markets SilkSurface as having BIA-ALCL risk closer to smooth surface than to traditional microtextured. The clinical evidence is still developing but suggests SilkSurface may represent a meaningful refinement of the microtextured concept.
Do microtextured implants have lower capsular contracture rates than smooth?
Historical data suggested yes — approximately 2-5% with microtextured vs 3-6% with smooth. Modern data shows the difference is smaller than historical data indicated. The mechanism (tissue ingrowth into texture pores creates a more regular capsule) is real but the absolute clinical impact has narrowed with improvements in modern shell technology and surgical technique. The modern difference is approximately 1-2 percentage points — meaningful but not dramatic.
Are microtextured implants available across all brands?
Yes — all major brands offer microtextured options. Mentor Siltex (the dominant microtextured surface), Motiva SilkSurface, Polytech POLYtxt, Sebbin microtextured, Nagor microtextured. Specific manufacturing differs between brands (Siltex uses negative imprinting, SilkSurface uses 3D imprinting), but the clinical category (microtextured surface) is consistent.
Related references