Smooth or Textured Implants: What’s Safer and Why It Matters
Smooth or Textured Implants: What’s Safer and Why It Matters
Textured implants carry a higher risk of a rare lymphoma called BIA-ALCL than smooth implants do. The FDA describes an individual’s risk as low, and does not recommend removing textured implants from people without symptoms. Certain Allergan BIOCELL implants were recalled in 2019, and most US surgeons now use smooth implants for routine augmentation.
Key takeaways
- The association is with the surface, not with silicone or saline fill.
- BIA-ALCL is not breast cancer. It is a lymphoma arising in the capsule around the implant.
- The FDA does not recommend removal for people without symptoms.
- Knowing the symptoms matters more than knowing the statistics.
Why Texturing Existed in the First Place
Textured surfaces were not a gimmick. They were developed to solve real problems.
A roughened surface encourages tissue to adhere to the implant, which was intended to reduce capsular contracture — the hardening of scar tissue around an implant — and to stop anatomically shaped implants from rotating out of position.
For years that was a reasonable trade-off, because the risk we now know about had not been identified.
What Changed: BIA-ALCL
BIA-ALCL stands for breast implant-associated anaplastic large cell lymphoma. Two things about the name matter.
It is not breast cancer. It is a lymphoma — a cancer of the immune system — that develops in the scar capsule the body forms around an implant.
It is associated with textured surfaces. The FDA states that textured implants carry a higher risk than smooth ones, and that implant fill does not appear to be a risk factor based on current data.
That last point is worth repeating, because it is widely misunderstood: this is about the outside of the implant, not what is inside it.
The Numbers
Risk estimates vary by manufacturer and texturing type, which is why you will see very different figures quoted.
| Population | Estimated risk |
|---|---|
| Overall US risk, averaged across textured implants | About 1 in 30,000 |
| Allergan BIOCELL textured implants | About 1 in 443 to 1 in 3,345 |
These figures are from the American Society of Plastic Surgeons. The lower BIOCELL estimate reflects a median follow-up of around seven years.
A 2017 study cited by ASPS found BIOCELL implants roughly six times more likely to be associated with BIA-ALCL than other textured implants — which is why one manufacturer’s product was recalled rather than the whole category.
The FDA notes that the exact number of cases is difficult to determine, and describes an individual’s risk as low. Both things are true at once: the association is real, and the absolute numbers are small.
The 2019 Recall
On 24 July 2019 the FDA requested a voluntary recall of certain Allergan BIOCELL textured breast implants and tissue expanders. Clinicians were told to stop implanting the listed products and return existing inventory.
On 12 September 2019 the FDA designated it a Class I recall — its most serious category.
Since then, most surgeons in the United States have used smooth implants for routine breast augmentation.
If You Already Have Textured Implants
This is the question most people arrive with, so here is the FDA’s position stated plainly.
The FDA does not recommend removing textured implants in people who have no symptoms — including the recalled BIOCELL implants.
What it does recommend:
- Know the warning symptoms (below)
- Monitor the area around your implants for changes
- See your provider if symptoms or changes appear
A decision about your own implants belongs in a conversation with your surgeon, not with an article. If you are worried, that conversation is worth having.
Symptoms to Know
BIA-ALCL typically appears years after surgery, long after the incision has healed.
The most common sign is fluid collection and swelling around the implant. Others reported include:
- A lump in the breast or armpit
- Persistent breast pain
- A rash
- Capsular contracture, or a breast becoming lumpy or misshapen
All of these have other causes — rupture and trauma among them. They warrant evaluation, not alarm.
When BIA-ALCL is diagnosed, treatment involves removing the implant, the complete capsule, any associated mass and a margin of surrounding tissue.
What Has Emerged Since
The picture has continued to develop, and any article on this topic written before 2023 is incomplete.
On 8 September 2022 the FDA issued a safety communication regarding squamous cell carcinoma and various lymphomas found in the capsule around breast implants. It issued an update on 8 March 2023.
These are reported as rare, and they are distinct from BIA-ALCL. If you have implants of any surface type and have concerns, the FDA’s breast implant pages carry its current guidance, and your surgeon can discuss what it means for you.
This is a moving area. Anything you read about implant safety — including this page — should be checked against current FDA guidance rather than assumed to be up to date.
What This Means If You Are Choosing Implants Now
For most people considering augmentation today, this is a settled question rather than a live decision. Smooth implants are what the great majority of US surgeons use for routine augmentation.
Texturing retains a role in certain reconstructive and specialised situations, where a surgeon weighs it case by case.
Two questions worth asking at consultation:
- What surface do you use, and why?
- Have you used macrotextured implants in the past, and what do you tell those patients now?
A surgeon who answers both directly is telling you something useful about how they handle safety information generally.
How to Find Out What You Have
If you do not know your implant type, you can find out — and that is more useful than worrying about an unknown.
- Your implant card, given at the time of surgery
- Your operative report
- The surgeon who placed them
- The facility where surgery took place, which keeps records
You are looking for the manufacturer, the model and the surface type.
A Note on Rupture Screening
Separate from the surface question, silicone implants can rupture without obvious signs.
The FDA states that MRI is the most effective method for detecting silent rupture, and that ultrasound is an acceptable alternative for screening asymptomatic patients.
The recommended timing and interval are specified in implant labeling and have been revised over the years. Ask your surgeon what applies to your specific device rather than relying on a figure from an article.
Saline rupture is usually obvious, because the implant visibly deflates.
Have questions about your implants? Dr. Michael Baumholtz is double board-certified in plastic surgery and general surgery, with more than two decades of experience in San Antonio. If you are unsure what you have or have noticed a change, a consultation is the right place to start.
Breast implant revision · Virtual consultation · Request an appointment
Frequently Asked Questions
Are textured breast implants safe?
Textured implants carry a higher risk of BIA-ALCL, a rare lymphoma, than smooth implants. The FDA describes an individual’s risk as low. Certain Allergan BIOCELL textured implants were recalled in 2019, and most surgeons in the United States now use smooth implants for routine augmentation.
What is BIA-ALCL?
BIA-ALCL is breast implant-associated anaplastic large cell lymphoma, a rare cancer of the immune system that develops in the scar capsule around an implant. It is not breast cancer. It is associated with textured implant surfaces, and implant fill does not appear to be a risk factor.
What is the risk of BIA-ALCL with textured implants?
ASPS cites an overall United States risk of roughly 1 in 30,000, averaged across textured implants. For Allergan BIOCELL implants specifically, estimates range from about 1 in 443 to 1 in 3,345. A 2017 study found BIOCELL around six times more likely to be associated with BIA-ALCL than other textured implants.
Should I have my textured implants removed?
The FDA does not recommend removing textured implants in people who have no symptoms, including the recalled BIOCELL implants. The guidance is to know the warning symptoms, monitor for changes, and see your provider if anything changes. Decisions about your own implants belong with your surgeon.
What are the symptoms of BIA-ALCL?
The most common sign is fluid collection and swelling around the implant, often appearing years after surgery. Other reported signs include a lump in the breast or armpit, persistent pain, a rash, or capsular contracture. These symptoms have other causes too, so they warrant evaluation rather than alarm.
Which textured implants were recalled?
The FDA requested a voluntary recall of certain Allergan BIOCELL textured breast implants and tissue expanders on 24 July 2019, and designated it a Class I recall on 12 September 2019. Clinicians were told to stop implanting the listed products and return existing inventory.
How do I find out whether my implants are textured?
Your implant card, your operative report, or the surgeon who placed them will have the manufacturer, model and surface. If you cannot locate these, the facility where your surgery took place keeps records. Knowing what you have is the useful first step rather than assuming.
Is silicone or saline fill a risk factor for BIA-ALCL?
Based on current data, implant fill does not appear to be a risk factor. The association is with the implant surface rather than what is inside it. The FDA notes this has not been tested in a large epidemiologic study.
Has the FDA found other cancers associated with breast implants?
The FDA issued a safety communication on 8 September 2022 regarding squamous cell carcinoma and various lymphomas in the capsule around breast implants, and an update on 8 March 2023. These are reported as rare. Discuss any concerns with your surgeon and review the current FDA guidance.
The Short Answer
Smooth implants are what most US surgeons use for routine augmentation now, and the reason is BIA-ALCL.
If you already have textured implants, the FDA does not recommend removing them without symptoms — but knowing the symptoms and watching for changes does matter.
If you do not know what you have, find out. It is a phone call, and it is more useful than wondering.
Sources
- FDA — Questions and Answers about Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
- American Society of Plastic Surgeons — BIA-ALCL Frequently Asked Questions
- FDA — Breast Implants
- FDA — Risks and Complications of Breast Implants
Guidance in this area is revised periodically. Check the FDA pages above for current recommendations. This article is general information and is not a substitute for advice from your own surgeon. Last reviewed October 2026.
