When choosing your breast implant, both you (the patient) and your surgeon need to take into account several different characteristics. This is beyond simple considerations such as the size of your breast implants in ccs. All implants are foreign bodies. Silicone is relatively inert in the human body and we know from many studies and reviews that on the whole it is safe, and very likely free from causing proven systemic problems. But there are always small numbers of cases where a silicone implant can cause problems, not least due to issues such as implant rupture, or capsular contraction, but also because of the way the implant might look, feel or move in the the breast. The surface characteristics of the implant can affect these things too and over the years there have been changes to the outer surface of the implant. This is called the implant shell. When the implant shell is totally smooth on the outside, the implant is simply referred to as a smooth implant. Smooth implants are recognised to be best placed under the pectoral muscle (dual plane) to reduce the capsular contraction that has a higher tendency to occur if they are placed in front. They do not adhere to the muscle or breast tissue. The implants will move and slide when the breast is pressed, particularly in a relatively empty breast prior to augmentation (typical of someone who has lost weight, or who breasts shrunk a lot after pregnancy). Conversely, a very textured implant or an implant with a very high surface area coating such as the Allergan Biocell texture or polyurethane coated type of implant will adhere to the surrounding tissue. This adherence can be a great advantage in some individuals, such as where there could be or actually already is (i.e. someone having implant exchange) a problem with implant movement. For example, excess movement could cause a tear-drop (anatomical shape) implant to rotate. Or if a round implant is used in someone who has had a lot of revisions and has a stretched implant pocket, the excess movement might feel or look odd, or even enable the implant to flip from front to back in the pocket. A strongly adherent implant can also help with the aesthetic result, enabling the surgeon control over where and how the implant imparts it’s shape. Texturing may also reduce the risk of capsular contraction, and there are reasonable studies to support this where the implants are placed sub glandular (in front of the muscle) but it is probably a fairly similar rate when they are dual plane. The adherence to the tissues might make the removal of a sub pectoral implant harder at a later date, if the surrounding capsule tissue needs to be removed too. Sometimes not all of the capsule can be removed without causing additional trauma to the ribs. But in addition, there is a potential issue with a rare type of cancer. This cancer is known to very occasionally arise in the scar tissue that forms around a breast implant. In other words it arises in the “peri-implant capsule”. It is a cancer of the white blood cells that are in the scar, and is therefore classified as a lymphoma. It is specific to breast implants and is better known as BIA-ALCL which stands for breast implant associated anaplastic large cell lymphoma. Its occurrence is rare, and it has been shown to be readily treatable by full removal of the implant and capsule when detected early. But importantly, it has also been linked to occur less if the implants are less textured, and it is thought to be extremely rare if just smooth implants have been used. There is even a lot of debate currently as to whether it has ever occurred with smooth implants, although I suspect it can occur, albeit far less commonly than with the most textured implants. So although you have over a 100 fold greater chance of getting other forms of cancer in your lifetime than of getting BIA-ALCL from a breast implant, it is important to always minimise risk to individuals and consider the pros and cons of the type of implant texture. Consider smooth or lesser textured implants with your surgeon.