Abstract Background Whether texturing confers clinical advantages over smooth breast implants remains debated, especially in the wake of BIA-ALCL concerns with textured implants. Objectives To compare complications, implant-specific events, and patient-reported outcomes between smooth and textured implants across augmentation and reconstruction. Methods Following PRISMA 2020, we synthesized head-to-head comparative studies through January 15, 2025. Random-effects models estimated risk ratios for dichotomous outcomes and mean differences for BREAST-Q domains; heterogeneity (I²) guided prespecified subgroup and sensitivity analyses (e.g., implant plane; exclusion of overlapping or historical cohorts). Review Manager 5.4 was used for statistical analysis. Results Thirty-three studies comprising 35,052 implants met inclusion. In the initial pooled analysis, smooth implants showed higher capsular contracture (RR = 1.69, 95% CI 1.36–2.11, p 0.00001; with significant heterogeneity, I² = 79%, p 0.00001); 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, p = 0.46) with no subgroup differences (I² = 0%, p = 0.92). Infection was lower with smooth implants (RR = 0.51, 95% CI 0.30–0.89, p = 0.02). 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.
Abdel-Naby et al. (Wed,) studied this question.