The 45-year-old patient, identified as Hong Thanh, received breast augmentation in Vietnam in 2011. According to her implant records, she had been fitted with smooth silicone gel implants in both breasts.

More than a decade later, she developed age- breast changes, including increased firmness and reduced softness. While visiting Ho Chi Minh City in late May, she sought medical advice and was recommended for implant removal.

During the procedure, Dr. Ho Cao Vu and his team at Nam Sai Gon International General Hospital discovered that the patient actually had two different implant types: a textured implant on one side and a smooth silicone gel implant on the other.

According to the surgical team, the capsule surrounding the textured implant had become significantly thicker, with multiple folds, wrinkles, and an uneven surface.

Dr. Vu said textured implants can trigger prolonged inflammatory responses in some patients, causing continuous tissue changes and gradual thickening of the fibrous capsule. Over time, this may contribute to breast firmness, loss of natural softness, and visible implant rippling or wrinkling. The implant shell also showed signs of aging, including yellow discoloration.

In contrast, the capsule around the smooth implant remained thin and soft, with minimal signs of inflammation. Both the implant shell and silicone gel appeared intact, without clear evidence of material deterioration.

The surgeon emphasized that smooth implants do not directly cause capsular contracture. Instead, the condition occurs when the body’s natural fibrous capsule around the implant becomes thicker and tightens, potentially leading to firmness or changes in breast shape. Factors such as surgical technique, implant pocket creation, and prolonged tissue irritation may play a greater role.

Textured implants under increased scrutiny

Textured breast implants were widely used in previous years because they were thought to lower the risk of capsular contracture.

However, in 2019, the U.S. Food and Drug Administration (FDA) and other health authorities reported a link between certain macro-textured breast implants and Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare type of lymphoma associated with breast implants. Several macro-textured implant products were subsequently removed from the market.

Dr. Vu said many patients who underwent augmentation during that period no longer remember the type of implant they received or have lost their implant records. Some only return for medical evaluation after experiencing symptoms such as breast hardness, pain, or deformity, meaning potential problems may go unnoticed for years.

Based on nearly 2,000 breast implant removal procedures, the doctor said his team has treated various complications to older-generation implants, including severe capsular contracture, double capsule formation, fluid buildup, inflammatory reactions, bleeding inside the implant pocket, and heavily calcified capsules.

Patients with long-term breast implants, especially those with older-generation macro-textured devices, should receive regular medical checkups and imaging at qualified facilities, he advised.

Routine monitoring can help identify implant aging, capsule thickening, and other complications before they progress or cause more serious symptoms.

The surgeon added that improvements in surgical methods have made implant removal procedures faster and more comfortable.

The combination of ultrasonic dissection technology and laryngeal mask airway anesthesia allows many patients to recover quickly, experience less postoperative discomfort, and leave the hospital within hours after surgery.