Breast augmentation is a deeply personal decision that involves more than just choosing a size. At Baumholtz Plastic Surgery in San Antonio, TX, board-certified Plastic Surgeon Dr. Michael Baumholtz walks patients through every step of the journey, starting with one of the most critical questions: Should you choose smooth or textured breast implants?
This isn't a minor detail. It impacts your safety, long-term outcomes, and peace of mind. Understanding the surface of your implant is just as important as selecting the right size, shape, and placement. This page aims to break down the facts in clear, practical terms so you can move forward with confidence.
In today's age of information overload, patients are bombarded with mixed messages, influencer opinions, and outdated studies. Our goal is to cut through that noise and offer clear, medically sound guidance. You deserve answers grounded in science and delivered with compassion.
Why Implant Texture Matters
It’s Not Just A Surface Detail
When we talk about implant texture, we're referring to the outer shell of the implant. While this might sound like a small technical distinction, it can significantly affect how the implant interacts with your body.
Smooth implants have a slick surface that allows them to move more freely within the breast pocket. Textured implants, on the other hand, have a roughened surface that grips the surrounding tissue, preventing the implant from shifting or rotating.
This interaction with the surrounding tissue impacts both aesthetics and the body’s inflammatory response. While the primary goal is to enhance shape and symmetry, understanding how these implants settle, move, and age within the body can make all the difference in achieving long-term satisfaction.
Real Concerns, Real Decisions
Choosing the right implant texture isn't just about aesthetics - it's about minimizing risk and ensuring your long-term safety. At Dr. Baumholtz's San Antonio practice, many patients come in after reading conflicting advice online. His role is to translate the medical evidence into clear, patient-friendly guidance tailored to your unique situation.
These are not choices to rush. Dr. Baumholtz believes in providing every patient the time and information needed to feel confident, not overwhelmed. This is about your body, your health, and your future.
What Are Smooth Implants?
The Basics
Smooth breast implants are the most commonly used implant type in the United States. Their soft shell and mobility within the breast pocket allow them to settle naturally over time. They come in a variety of profiles, widths, and projections to match different body types and preferences.
They are often praised for their natural look and feel, making them a frequent choice for women who want fullness without the feeling of stiffness or artificiality. They also adapt more easily to natural movement, which can contribute to a softer breast appearance over time.
Why Dr. Baumholtz Often Recommends Them
Dr. Michael Baumholtz often recommends smooth implants for the following reasons:
Smooth implants are not only versatile but align with Dr. Baumholtz’s preference for results that age well and pose fewer complications. He’s seen firsthand how patients benefit from this implant type, especially when combined with meticulous surgical technique and personalized planning. For women seeking long-term peace of mind and a soft, natural look, smooth implants offer a compelling, low-risk option.
What Are Textured Implants?
Designed To Stay In Place
Textured implants have a rough shell designed to hold the implant in place. They are often paired with teardrop-shaped (anatomical) implants to prevent rotation within the breast pocket.
These implants were originally created to reduce the risk of capsular contracture and to help maintain a specific breast shape. In some patients, especially those undergoing reconstructive surgery, they may still have limited use.
However, in primary cosmetic breast augmentation, especially in Dr. Baumholtz's practice, their role is minimal. New techniques and technologies have reduced the need for texture-based stability, allowing smooth implants to do the job with fewer risks.
Why They Come With More Risk
While textured implants may offer certain advantages, they also carry additional risks, including:
There is no denying the scientific link between macro-textured implants and BIA-ALCL. Patients need to be aware that this is not a theoretical concern - it is a documented risk. Moreover, the adhesion of these implants to surrounding tissues makes revision surgery more challenging. Scar tissue may develop more aggressively, increasing both surgical complexity and recovery time. For these reasons, Dr. Baumholtz does not use macro-textured implants in any cosmetic case and has shifted entirely toward safer, evidence-backed alternatives.
The Safety Conversation: What The Science Tells Us
Smooth = Safer (In Most Cases)
Clinical studies and real-world outcomes support the use of smooth implants in most primary augmentations. Major plastic surgery organizations in the U.S., including the American Society of Plastic Surgeons, have acknowledged the association between textured implants and BIA-ALCL.
Dr. Baumholtz relies on devices from trusted manufacturers like Allergan and Motiva - brands with strong track records and FDA oversight.
Years of post-market surveillance, global recalls of certain textured models, and independent studies all point to one conclusion: when safety is your priority, smooth implants are a smarter, lower-risk choice. Patients in San Antonio deserve care built on current research and best practices - not trends or outdated preferences.
Why This Isn’t A One-Size-Fits-All Topic
Every woman has a unique body and set of goals. While smooth implants are the default recommendation, there may be rare instances where a textured or nano-textured option is appropriate. The key is individualized evaluation and open, honest communication between patient and surgeon.
Some patients present with unique anatomy or surgical histories that warrant considering all available tools. What matters is that no decision is made in isolation - Dr. Baumholtz builds each surgical plan collaboratively, focusing on mutual understanding and transparency.
Personalizing The Choice: What Dr. Baumholtz Considers
Body Type And Skin Thickness
Women with thin skin or low body fat may experience visible rippling with some implant types. In these cases, Dr. Baumholtz may:
These anatomical details can change the game. In patients with minimal tissue coverage, he adjusts the implant fill, placement, and adjunctive support materials to maximize outcomes. Every adjustment is made with a clear focus on balancing aesthetic goals with long-term health.
Desired Aesthetic Outcome
Some women want fullness, others prefer subtlety. Dr. Baumholtz doesn’t just ask what size you want - he wants to understand what look you’re going for, how your body moves, and how implants will feel over time. That’s why 3D planning and a careful exam are essential parts of his approach.
Previous Surgeries Or Complications
In revision cases - a specialty of Dr. Baumholtz’s San Antonio practice - smooth implants are often easier to work with and reposition. They allow for cleaner surgical corrections and reduced risk of further complications.
Women seeking revision surgery deserve clarity and hope. Whether correcting rippling, capsular contracture, or implant displacement, Dr. Baumholtz uses smooth implants to support long-term, stable results in complex cases.
Understanding BIA-ALCL: The Real Story
What It Is (And Isn’t)
BIA-ALCL is not breast cancer. It is a rare type of lymphoma that occurs in the scar tissue and fluid near the implant - almost exclusively in patients with textured implants.
Symptoms can include swelling, a fluid mass, or asymmetry years after surgery. While rare, the condition is serious and should be addressed promptly with evaluation and, if necessary, implant removal.
The disease has understandably generated concern. But fear should never replace facts. Dr. Baumholtz takes the time to explain this condition in context - calmly, clearly, and with respect for your need to understand the full picture.
Why Smooth Implants Avoid This Risk
Smooth implants are not associated with BIA-ALCL. This fact is a driving force behind Dr. Baumholtz's decision to avoid textured implants in his practice, and one that reassures many of his patients.
When you walk into a consultation with Dr. Baumholtz, you’re stepping into a space where evidence guides every recommendation. This safety-first mindset has helped hundreds of San Antonio women feel confident about their choice.
The Role Of Implant Placement In Reducing Risk
Submuscular Placement = Added Safety
Implants placed beneath the chest muscle are less likely to develop visible rippling and are associated with lower capsular contracture rates.
Muscle coverage not only improves aesthetics - it adds a protective layer that benefits patients in both the short and long term. This is the standard in Dr. Baumholtz’s San Antonio practice, where optimal outcomes are built into the surgical foundation.
Part Of A Bigger Surgical Strategy
Dr. Baumholtz combines several risk-reduction techniques:
Every surgical detail matters. From no-touch insertion to optimized incision location, his method reflects best-in-class protocols that prioritize healing, minimize scarring, and reduce post-op complications. The Keller Funnel and Betadine prep are just part of a larger commitment to excellence.
Motiva: A New Option Worth Discussing
Nano-Textured, Not Traditional Textured
Motiva offers an innovative alternative. Their implants feature a nano-textured shell - classified as smooth in the U.S. - designed to reduce inflammation without the risks associated with traditional texturing.
These newer implants are designed with patient safety in mind. They include RFID-based tracking, softer gel consistency, and advanced shell technology. For certain patients, especially those with reconstruction needs or anatomical preferences, Motiva offers exciting potential. Dr. Baumholtz evaluates each case to ensure this choice aligns with his gold-standard safety metrics.
The Emotional Weight Of Safety Decisions
Patients Want Peace Of Mind
Breast augmentation isn’t just about body image. It’s about confidence, comfort, and reclaiming your sense of self. That emotional investment deserves a surgical plan rooted in safety.
Dr. Baumholtz understands that fear, hope, and excitement often coexist in the decision-making process. His role is to ensure you feel supported - both emotionally and medically - every step of the way.
Why The Surgeon-Patient Relationship Matters
This is a journey you take together. Dr. Baumholtz believes in collaboration, not prescription. His consultations focus on your goals, your concerns, and your values - not just your measurements. In his San Antonio office, you’ll never feel rushed or pressured.
That trust doesn’t end after surgery. Follow-up care, long-term check-ins, and ongoing communication are all part of his standard of care. It’s what sets Baumholtz Plastic Surgery apart in the San Antonio community.
Local Insight: Why San Antonio Patients Choose Dr. Baumholtz
Revision And Complex Case Expertise
Dr. Baumholtz has a well-established reputation across Texas for handling revision cases, particularly involving implant removals and corrections from other practices. This makes his office a destination for patients looking to fix or improve prior results.
When other surgeons say, “This can’t be done,” patients often find renewed hope at Baumholtz Plastic Surgery. His experience with challenging cases has made him a trusted name in San Antonio and beyond.
Commitment To Safety And Honesty
From initial consults to post-operative care, the message remains consistent: You’ll always get the truth here. Whether it’s about what an implant can realistically achieve or the small risks worth discussing, honesty is the core of Dr. Baumholtz’s care philosophy.
Making The Right Choice For You
You Deserve Clarity, Not Confusion
The internet is filled with fear, bias, and misinformation. At Baumholtz Plastic Surgery in San Antonio, TX, the focus is on facts and patient-centered planning.
No two patients are the same, which is why no consultation is ever rushed. Dr. Baumholtz invests in your understanding as much as your outcome, helping you feel empowered, not overwhelmed.
Shared Decision-Making Is Key
Dr. Michael Baumholtz always reminds patients: “What you want + what I can deliver = our shared goal.”
That equation only works if both sides feel heard and respected. At Baumholtz Plastic Surgery, your voice is central to the planning process. You’ll be educated, not sold.
FAQs About Smooth Or Textured Implants
What happens if I already have textured implants but no symptoms?
- Dr. Baumholtz typically recommends regular monitoring, including imaging and follow-up exams. There is no need for automatic removal unless complications arise, but it’s important to stay informed and check in regularly.
Is it true that all shaped implants must be textured?
- Most teardrop-shaped implants are textured to prevent rotation, but Dr. Baumholtz rarely recommends these due to associated risks. He often achieves a natural slope using round, smooth implants and precise surgical placement.
Do smooth implants move around too much inside the breast?
- When placed correctly, especially under the muscle, smooth implants settle naturally but stay well-positioned. Proper pocket creation and muscle support minimize unwanted shifting.
Can you switch from textured to smooth implants in a revision surgery?
- Yes, and Dr. Baumholtz often performs this type of revision. He carefully removes the old implant and adjusts the pocket if necessary to fit the new smooth implant securely.
Are there lifestyle factors that affect which implant texture is better?
- Your level of physical activity, skin elasticity, and personal goals all matter. For active individuals, smooth implants often provide more natural movement without added risk.
How do you know if you’re a candidate for Motiva implants?
- Dr. Baumholtz evaluates candidacy based on anatomy, prior surgery, and desired outcomes. Motiva implants are discussed when they align with patient needs and meet his high safety standards.
Is textured implant risk only about BIA-ALCL, or are there other concerns?
- BIA-ALCL is the most discussed issue, but textured implants can also lead to more aggressive scar tissue and complex revision surgeries. Smooth implants generally allow for more predictable outcomes over time.
Next Steps: Let’s Talk About What’s Right For You
Thinking about breast augmentation? Have questions about implant texture or safety?
Dr. Michael Baumholtz, board-certified Plastic Surgeon in San Antonio, TX, invites you to book a private consultation. It’s a chance to ask questions, explore options, and find a plan that fits your body, your life, and your goals.
At Baumholtz Plastic Surgery, you’ll find a supportive team, a thoughtful approach, and a surgeon who genuinely puts your safety first. Your confidence is earned - not assumed - and your result will be as unique as you are.
Further Reading
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Medical References
- Implant surface selection in primary cosmetic breast augmentation
https://www.sciencedirect.com/science/article/pii/S2352587825001044 - Perception of Risk and the Choice Between Smooth and Textured Implants
https://pmc.ncbi.nlm.nih.gov/articles/PMC12278739/ - Recognizing and Managing Breast Implant Complications: A Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC12067747/ - Comparative Characteristic of Complications in Smooth and Textured Implants
https://journals.sagepub.com/doi/abs/10.1177/07488068241253470?ai=2b4&mi=ehikzz&af=R - Comparison of revision surgery after implant-based breast reconstruction by implant surface
https://academic.oup.com/bjs/article/112/5/znaf082/8134046 - Smooth vs. Textured Implant Breast Reconstruction
https://pmc.ncbi.nlm.nih.gov/articles/PMC9237832/ - What to Know About Breast Implants - FDA
https://www.fda.gov/consumers/consumer-updates/what-know-about-breast-implants
