Adhesive textured implants and reduced capsular contracture
Between 2006 and 2018, Allergan textured implants using Biocell macrotextured surface technology experienced widespread popularity and became one of the leading implant choices in the global aesthetic market, including Vietnam. At that time, these implants were highly favored by plastic surgeons due to their "adhesive textured" properties, which were believed to provide stable implant positioning, reduce implant displacement during movement, and achieve a well-maintained breast contour, while also being thought to reduce capsular contracture.
However, subsequent medical evidence shifted this perception. In July 2019, after extensive long-term clinical studies, the U.S. Food and Drug Administration (FDA) and other global health authorities identified that the macrotextured surface of Allergan Biocell implants was associated with chronic immune stimulation around the implant capsule. This chronic inflammatory response was linked to a rare form of lymphoma known as BIA-ALCL (Breast Implant–Associated Anaplastic Large Cell Lymphoma).
As a result, on July 24, 2019, Allergan officially announced a global recall of all Biocell textured implants and permanently discontinued their production.
Currently, a significant number of patients in Vietnam and overseas Vietnamese communities who underwent breast augmentation during this period (2006–2018) still have Biocell textured implants in situ without removal. Given this situation, MD, MSc. Dr. Ho Cao Vu recommends that patients with older-generation macrotextured, highly cohesive adhesive implants (such as Allergan/McGhan, Eurosilicone, Polytech, etc.) should consider consulting qualified medical specialists for implant removal to minimize potential health risks, including malignancy-associated complications.
Differences between textured and smooth breast implants in the same patient
This is an extremely rare clinical case involving an overseas Vietnamese patient who underwent breast implant removal surgery. The patient, Ms. Lan Thanh, reported that she underwent breast augmentation on 09/11/2011 and believed that she had received identical smooth silicone implants from the Mentor brand (based on her implant card information).
However, an unexpected finding was revealed intraoperatively. During dissection and removal of the previous implants, the surgical team identified that the patient had actually received two different types of implants from two different manufacturers: a textured Allergan implant on the left side and a smooth Mentor implant on the right side.
This inadvertent mismatch over 14.5 years provided a unique clinical observation of how the body responds differently to two implant surface types within the same patient:
Left breast – Allergan textured implant pocket:
The implant pocket was markedly thickened, with irregular folds, wrinkling, and a rough, uneven surface. This was attributed to the macrotextured surface technology of Allergan implants, which promotes tissue adherence to the implant shell. These surface characteristics can stimulate a chronic inflammatory response, leading to continuous fibroblast activation and collagen deposition surrounding the implant. As a result, the pocket became progressively thickened and stiff, with areas of capsular tightening and visible implant rippling on clinical examination. The implant shell also showed signs of long-term aging with yellow discoloration after 14 years.
Right breast – Mentor smooth implant pocket:
In contrast, the smooth-surfaced Mentor implant demonstrated a completely different tissue response. After 14 years in situ, the continuous low-friction interaction between the smooth implant surface and surrounding tissue resulted in a more physiological capsule formation. Due to the minimal tissue adherence and lower inflammatory stimulation, the capsule remained thin, soft, and smooth. The implant shell and gel maintained structural integrity with no significant signs of degradation.
Smooth breast implants are not the cause of capsular contracture
Currently, many aesthetic practitioners advise patients to avoid smooth silicone implants under the claim that "softer gel increases the risk of capsular contracture." However, from a scientific perspective, this represents a misunderstanding or misrepresentation of implant biomechanics and tissue response.
Smooth implants typically induce the formation of a thin, pliable, and physiological fibrous capsule. The primary determinants of capsular contracture are not the implant surface itself, but surgical technique and, to a lesser extent, patient-related biological response factors. In contrast, macrotextured surfaces may induce persistent mechanical and inflammatory stimulation over time, which has been associated with progressive capsular thickening and contraction.
The regulatory actions in 2019 serve as a key reference point. While macrotextured implants such as Allergan Biocell were withdrawn from the market by regulatory authorities due to associations with chronic inflammatory complications and BIA-ALCL (Breast Implant–Associated Anaplastic Large Cell Lymphoma), smooth silicone implants from established manufacturers have maintained long-term regulatory approval and safety profiles endorsed by the FDA.
Painless breast implant removal
Many patients delay implant removal due to fear of pain, prolonged recovery, or concerns about antibiotic use. MD, MSc. Dr. Ho Cao Vu notes that implant removal surgery is performed using next-generation ultrasonic dissection technology combined with laryngeal mask airway anesthesia, allowing rapid recovery with minimal postoperative discomfort. Patients are typically discharged within 4 hours and do not require postoperative analgesics or antibiotics.
Recommendation for removal of macrotextured breast implants
Based on real-world clinical experience from nearly 2,000 implant removal cases (including macrotextured implants, salt-loss textured implants, smooth implants, and older-generation saline implants), MD, MSc. Dr. Ho Cao Vu has documented a range of significant complications that may develop silently within the implant pocket over time.
In particular, with textured breast implants, frequently observed abnormalities include: fluid-filled collections within the pocket, papillary tissue formation, erythematous inflammatory changes of the capsule lining, intermittent intrapocket bleeding/oozing, double capsule formation, severe capsular contracture (Baker Grade III–IV), and in some cases, calcified "stone-like" capsular hardening.
Given these potential risks, the surgeon recommends that patients with older-generation macrotextured implants classified under regulatory warning lists issued by the FDA should consider proactive implant removal to eliminate the potential risk of Breast Implant–Associated Anaplastic Large Cell Lymphoma (BIA-ALCL).
