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Abstract Some textured silicone breast implants with high average surface roughness (‘macrotextured’) have been associated with a rare cancer of the immune system, Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). Silicone elastomer wear debris may lead to chronic inflammation, a key step in the development of this cancer. Here, we model the generation and release of silicone wear debris in the case of a folded implant-implant (‘shell-shell’) sliding interface for three different types of implants, characterized by their surface roughness. The ‘smooth’ implant shell with the lowest average surface roughness tested (R a = 2.7 ± 0.6 μ m) resulted in average friction coefficients of μ avg = 0.46 ± 0.11 across 1,000 mm of sliding distance and generated 1,304 particles with an average particle diameter of D avg = 8.3 ± 13.1 μ m. The ‘microtextured’ implant shell (R a = 32 ± 7.0 μ m) exhibited μ avg = 1.20 ± 0.10 and generated 2,730 particles with D avg = 4.7 ± 9.1 μ m. The ‘macrotextured’ implant shell (R a = 80 ± 10 μ m) exhibited the highest friction coefficients, μ avg = 2.82 ± 0.15 and the greatest number of wear debris particles, 11,699, with an average particle size of D avg = 5.3 ± 3.3 μ m. Our data may provide guidance for the design of silicone breast implants with lower surface roughness, lower friction, and smaller quantities of wear debris.