A Head-to-Head Meta-Analysis of 35,052 Smooth vs Textured Implants in Breast Reconstruction and Augmentation.

[BACKGROUND] Whether texturing confers clinical advantages over smooth breast implants remains questionable, especially in the wake of breast implant-associated anaplastic large-cell lymphoma concerns with textured implants.

[OBJECTIVES] The aim of this study was to compare complications, implant-specific events, and patient-reported outcomes between smooth and textured implants across augmentation and reconstruction.

[METHODS] Following PRISMA 2020, the authors synthesized head-to-head comparative studies through January 15, 2025. Random-effects models estimated risk ratios (RRs) for dichotomous outcomes and mean differences for BREAST-Q domains; heterogeneity ( ) guided prespecified subgroup and sensitivity analyses (eg, implant plane and exclusion of overlapping or historical cohorts). Review Manager v5.4 was used for statistical analysis.

[RESULTS] Thirty-three studies comprising 35,052 implants met inclusion criteria. In the initial pooled analysis, smooth implants showed higher capsular contracture (RR = 1.69, 95% CI, 1.36-2.11, < .00001; with significant heterogeneity, = 79%, < .00001); nonetheless, after stratifying by plane (subpectoral and prepectoral) and conducting sensitivity analyses that excluded overlapping/historical cohorts, the difference was no longer statistically significant (RR = 1.13, 95% CI, 0.82-1.56, = .46) with no subgroup differences ( = 0%, = .92). Infection was lower with smooth implants (RR = 0.51, 95% CI, 0.30-0.89, = .02). No differences were detected for seroma, hematoma, rippling, rupture, malposition/rotation, explantation, or BREAST-Q domains.

[CONCLUSIONS] In contemporary, plane-matched comparisons with appropriate sensitivity analyses, smooth implants did not demonstrate a higher capsular contracture risk and were associated with lower infection risk compared with textured implants. Other complications and patient-reported outcomes were similar among both groups.