Implant Surface · 1 of 4
Smooth surface implants
Polished, untextured implant surfaces. Lowest BIA-ALCL risk among current options. Modern shell technology has narrowed historical capsular contracture concerns. Standard choice for round implants in modern practice.
Clinical summary
Smooth-surface implants have polished, glossy outer shells without surface texture. Their primary advantages: lowest BIA-ALCL risk (essentially undetectable in current data), no rotation complications (designed to move within pocket — relevant only for round implants where rotation doesn't matter), and modern shell technology has narrowed historical capsular contracture difference vs textured. Modern practice in 2026 has shifted substantially toward smooth surfaces for round implants. Not appropriate for anatomical implants where shape orientation matters.
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| Macrotextured | Coarser pores (~200-700 µm) | Higher (BIOCELL-pattern recalled 2019) | Largely withdrawn from market |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).
Modern resurgence of smooth implants
The 2019 BIA-ALCL recall of Allergan BIOCELL macrotextured implants triggered a market shift toward smooth surfaces. Several factors converged:
- BIA-ALCL risk minimisation — smooth has lowest documented risk.
- Improved shell technology — modern smooth shells have lower capsular contracture rates than older smooth implants.
- Patient preference — natural feel slightly favoured.
- Surgeon shift — many surgeons trained when textured was standard now prefer smooth for round implants.
In 2026, modern practice uses smooth surface in approximately 60-70% of round implant placements globally — a meaningful increase from the textured-dominant era of 2010-2018.
Where smooth is appropriate
| Implant decision | Smooth fit |
|---|
| Round implant (any profile) | Standard appropriate choice |
| Anatomical (teardrop) implant | NOT appropriate — rotation risk too high |
| Patient prioritising BIA-ALCL minimisation | Lowest-risk choice |
| Patient prioritising natural feel | Slightly preferred |
| Patient with history of capsular contracture | Modern smooth shell acceptable; texture sometimes considered |
| Combined with mastopexy | Smooth or textured both work |
The capsular contracture debate
Historical data (1990s-2000s) suggested textured implants had lower capsular contracture rates — approximately 1-3% with textured vs 5-8% with smooth. This drove the textured-dominant era of 2010-2018.
Modern data (2018-2026) shows the difference is smaller than previously thought:
- Modern smooth shells have technological improvements reducing contracture vs older smooth.
- Surgical technique improvements (sterile field, minimal handling, antimicrobial irrigation) reduce contracture with all surfaces.
- The historical difference partly reflected outcomes from older technique and devices that no longer represent modern practice.
Current data shows modern smooth implants have capsular contracture rates of approximately 3-6% over 10 years; modern microtextured rates approximately 2-5%. The difference is smaller and the trade-off vs BIA-ALCL risk now favours smooth in many patient profiles.
Brand availability
All major brands offer smooth-surface round implants. Smooth surface is available across:
- Mentor MemoryGel Smooth
- Allergan/Natrelle Inspira SmoothPlus
- Motiva SmoothSilk surface
- Polytech smooth lines
- Sebbin smooth variants
- Nagor smooth lines
Frequently asked questions
Are smooth implants safer than textured?
For BIA-ALCL specifically — yes. Smooth-surface implants have essentially undetectable BIA-ALCL incidence in current data, while macrotextured implants (specifically Allergan BIOCELL pattern) showed elevated risk leading to 2019 worldwide recall. Microtextured and polyurethane-coated surfaces have intermediate risk profiles. For other complications (capsular contracture, rupture, malposition), the surface comparison is more nuanced — historical data suggested textured surfaces had lower contracture rates but recent data shows the difference is smaller than previously thought.
Why are smooth implants making a comeback?
Three converging factors. (1) BIA-ALCL — the 2019 recall of Allergan BIOCELL macrotextured implants and subsequent FDA warnings shifted patient and surgeon preference toward smooth surfaces with lower BIA-ALCL risk. (2) Modern shell technology — improved shell materials reduce capsular contracture rates with smooth implants closer to historical textured rates. (3) Patient preference — smooth implants ripple slightly less in some patients and have a more 'natural' feel. Modern practice in 2026 has shifted substantially toward smooth surfaces for round implants.
Can smooth implants rotate within the pocket?
Smooth implants are designed to move within their pocket — this is intentional, not a complication. The smooth surface allows the implant to sit naturally without tissue adherence. For round implants, rotation is irrelevant (round looks round in any position). For anatomical (teardrop) implants, smooth surface would cause rotation problems — which is why anatomical implants are essentially never smooth. Smooth surface is appropriate for round implants where rotation doesn't matter.
Do smooth implants have higher capsular contracture rates?
Historically yes — older data showed smooth implants had higher capsular contracture rates than textured. However, modern data is more mixed. Recent studies suggest the difference is smaller than historical data indicated, and modern surgical technique (proper pocket dissection, sterile field, low blood loss, antimicrobial irrigation, minimal handling) reduces contracture rates with both surfaces. Modern smooth implants in expert hands have contracture rates in the same range as modern textured implants.
Are smooth implants the FDA-recommended choice?
The FDA does not specifically recommend one surface over another, but in 2019 issued a worldwide recall of Allergan BIOCELL macrotextured implants due to BIA-ALCL risk. The FDA continues to monitor the situation and considers smooth, microtextured, and (some) macrotextured implants acceptable for use with patient-specific informed consent. For BIA-ALCL risk minimisation specifically, smooth surface has the lowest documented risk.
Should I choose smooth surface to avoid BIA-ALCL?
If BIA-ALCL is your primary concern — yes, smooth surface is the lowest-risk choice. Current data shows essentially undetectable BIA-ALCL with smooth implants. However, the absolute BIA-ALCL risk with any surface is low (estimated 1 in 2,000-30,000 with macrotextured; lower for microtextured; essentially zero for smooth). For most patients, surface should be selected based on the implant shape (smooth for round, textured for anatomical) and other priorities (rotation immunity, contracture risk, feel) rather than BIA-ALCL avoidance alone.
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