Over the last year I have rapidly grown to love the Motiva Breast Implants from Establishment Labs. They were FDA approved for use in the United States in the Fall of 2024 and I began to use them in November of 2024. Since then I have quickly been able to see why surgeons around the world have loved these devices for the last 15 years. I was eager to start using them as surgeons in the pre-approval studies were recognized trusted leaders in the field of breast augmentation and their results were exciting. Opinions and data driven results from colleagues around the world pushed me to want to be able to offer these to my patients. Frankly I had been eagerly waiting for the green light approval from the FDA. Last week I did my 300th case of Motiva Breast Implants and after having placed over 600 of these implants I have several thoughts:
- Patients satisfaction: Patients love them! Overwhelmingly they come back at 6 weeks telling me how soft they feel and how happy they are with the way they look. Compared to previous generations of implants that I used from Mentor, Allergan and Sientra I like the early natural softness that they deliver. While my patients have been happy for years I have noticed quicker recoveries and high patient satisfaction!
- Capsular Contracture: These rates with Motiva are indeed lower in my practice. The truth is I have followed Dr Adam’s 14-Point plan for years and have had low capsular contracture rates with all implant companies. Surgical techniques have led to lower capsular contracture rates with all available breast implants on the market. It is more the surgeon that minimizes your capsular contracture risk than the device. That being said I would still occasionally have patients who would develop capsular contracture. With Motiva I have not had one significant capsular contracture in my series of 300 patients that has required reoperation. Ultimately someone will develop capsular contracture but I do believe the risk is lowered.
- Implant Displacement: There was much talk about potential breast implant displacement due to the lack of capsule that these implants create. In the pre-approval studies this was a problem that was noted. I have always reinforced my closure for extra support and have seen no increase in implant malposition with Motiva Implants even without adding extra support with products like mesh.
- SmoothSilk® Shell: Establishment Labs claims that their unique nano-textured shell is more biocompatible with the human body and decreases capsular contracture rate due to less of an inflammatory response. Due to the history of textured breast implants and breast implant associated Lymphoma BIA-ALCL textured implants have a bad reputation. As a surgeon who tries to be as safe and responsible as possible my research has shown that with over 4 million of these implants used worldwide in the last 15 years there has not been a reported case of lymphoma associated with these implants. I certainly would not even consider using these implants if I believed that there was more than a meaningful BIA-ALCL risk. The FDA even authorized these devices as a different shell class from previous textured implants. Of course only time can prove that there is zero risk. I believe that the tradeoff for lower capsular contracture rates and a muscle preserving technique outweigh the theoretical potential unknown risk. Patients have been very accepting to this discussion in consultation and decision making.
- Muscle Preserving Breast Augmentation: This is a reality with the newer technology of 6th generation implants. While for years I had mostly placed implants in the submuscular location I am now placing most implants in the subfascial location. The recovery is quicker in terms of both pain and swelling resolution. Patients can return to any and all exercises once they are healed. There are still good indications for submuscular or dual plane augmentations but each augmentation can be customized to the individual.
- Round versus Ergonomic: After 300 cases I can state that I prefer the round implants more than the ergonomic devices. While the ergonomics may move more like natural tissue due to the thinner gel on lean patients they can ripple more. There is a tradeoff for the more natural shape in terms of rippling and I would prefer a slightly more augmented result to a ripple.
- Profiles of the implants: I like the Demi profile the most. The Full profile implant is a very high profile implant and gives more of a fake, highly projected result than implants of previous generations. This may be due to a combination of me placing more of them subfascial or perhaps it is because of the thickness of the gel. Regardless the full profile implant is a very high profile result so she needs to be certain that this is her goal. The Mini profile implant has become more popular in the last year with patients who have embraced the “Ballerina Breast” or “Yoga Breast” aesthetic. It is a much more subtle augmentation which is exactly what some patients are asking for. Patients looking for a slightly fuller breast to just fill out their clothes but not change their size to a large degree love the Mini Profile Motiva breast implant.
I hope that these thoughts are useful for patients considering breast augmentation! I was told by my representative at Establishment Labs/Motiva that I am one of the top 5 surgeon/users of these implants in the United States and so my thoughts on these implants are based on a unique perspective. In my 22 years of practice I have used every brand available and have found that sixth generation Motiva Breast implant technology is uniquely different and helps me to deliver a beautiful result. If you have any questions feel free to contact my office!