It is January 1st of 2026 and we just finished the first entire year of Motiva Breast Implants in the USA. I believe that I used my first set of Motiva breast implants in November of 2024 shortly after they achieved FDA approval. I placed my 400th set yesterday which gives me a nice experience with these devices. To my knowledge there is no other surgeon in the United States that has used as many of these implants this year so these opinions reflect a pretty strong experience.
Why did I want to use them? As a breast implant surgeon I want to use the best for my patients. Stories from surgeons around the world who told of how advanced this implant was compared to the older generation breast implants that I had been using from Allergan, Sientra and Mentor certainly were my biggest inspiration. Safety data not only from the USA FDA approval studies but from 14 years of worldwide safety data gave me the confidence to try them. The biggest fear of course is the history of BIA-ALCL from Macrotextured breast implants. Science has shown that ALCL is a macrotextured phenomenon. Those were very different devices than the specific 4 nanometer shell of Motiva’s breast implant. Call them SmoothSilk or Nanotextured or whatever you want but they are not the same. To date there has not been a known BIA-ALCL attributed to these implants.
What did I find? I found them to be quickly accepted by patients. Many patients have heard about Motiva on social media and have actively sought out surgeons who are using them. After surgery the results have been phenomenal. They are soft, natural looking/feeling and patients love them! Social media is powerful and helps potential patients become educated. Unfortunately many patients walk into some offices and just use whatever implant the surgeon always uses. They often don’t have an option between brands. In fact many hospitals have accounts with one specific manufacturer and every patient is going to receive an implant from that brand, whether or not it is the best option. I have access to all brands and am happy to use whichever is best suited to each patient. I show them implants from all of the manufacturers and indeed used implants from all of the companies this year. They need to understand the pros and cons about what is being placed in their body and I strongly feel they should have the chance to be educated about all available implants (even saline) and then make a decision with their surgeon.
What are the advantages? The innovative SmoothSilk nanotextured surface was specifically designed to be more biocompatible. The quoted capsular contracture rate is 1%. I am happy to report that in my early series of 400 sets I have not had one grade 3 or grade 4 capsular contracture. Some surgeons will claim that this is more due to surgeon technique improvements over the years and that all implants have lower rates of capsular contracture than previously reported. I agree we have improved over time surgically. We have things like Keller Funnels and understand many ways to lower capsular contracture risks. That being said when using mostly Allergan and Sientra for the last few years every year there were always a few patients that developed Capsular Contracture. It is surely to happen to me with Motiva at some point but at least in my experience this lower capsular contracture claim has been reality.
What about bottoming out? This was a big concern starting with these devices. Representatives from the other manufacturers grabbed onto this supposed concern and used it to try to downplay the devices. I can say that I very specifically have reinforced the closure at the base of the breast and have had only one patient where I believe one of her implants has settled a little low. She was a revision patient with a leak and capsular contracture so she was complicated to begin with. Her previous capsule had to be removed and thus her tissue was quite thin. I will still this as one patient when I self critique my results but statistically this concern about inferior malposition or bottoming out has not been a reality. I find it interesting that I have now seen ads from two of the other manufacturers touting their “good capsules” that support the implant. I have to say that these marketing ploys are a bit comical. Sure a little bit of capsule is fine but tell the patient with capsular contracture that capsule is good and she will likely be quite annoyed.
What does Motiva allow me to do that I couldn’t before? With smooth shelled breast implants from other manufacturers the biggest problem that would develop is capsular contracture. I would rarely do muscle sparing surgery because of this. In body builders I would sometimes place implants subfascial but there was a higher risk of capsular contracture. With Motiva’s shell I can go subfascial without a significant concern for capsular contracture. Because of this in any patient who likes to work out I now go subfascial. Patient recovery is significantly quicker and I allow my patients to go back to any and all chest exercise once they are healed. Animation deformity is a thing of the past. Subfascial muscle sparing breast augmentation has become my go to pocket location for most patients. This is an incredible change in my practice based on the biohacking technology of these implants.
Which Motiva implant do I like more? I prefer the round to the ergonomic breast implant. My opinion is that the round implant gives a much nicer result. Yes the ergonomic is touted to give a more natural shape but it also ripples more. In thinner patients I have found in a few patients that this can be quite bothersome. I believe that you trade a slightly more natural movement and shape for more rippling and that is something I currently warn patients about. This is a major tradeoff in thin patients. Ergo 2 is available in other parts of the world and Ergo 2 is an improvement on the Ergo we have in the USA. When we have the best Ergo 2 available here I am told this will address the rippling issue. Currently the USA does not have the most advanced Ergo. What I have learned with experience is that patients need to be educated about this. Unfortunately nobody speaks about this so surgeons starting out with these devices can’t warn patients about something they don’t know about. I also prefer the Demi profile to the Full profile breast implant. The Demi profile performs like moderate plus profiles of other companies and the Full profile does not look like a High profile implant but rather an Ultra High Profile implant. This is fine if the goal is a very high profile appearance or she wants a significant amount of volume but for most patients the Demi looks beautiful! The Mini profile has a surprisingly unique appeal to a larger and larger group of patients looking for a very minimal augmentation.
Moving forward: I have been told that I have done more Motiva Breast Implants in the last year than any other single surgeon in the United States. My experience with them has been phenomenal results and very low complication rates. Establishment Labs (Motiva) provides tremendous customer support and continues to innovate. They genuinely seem to care about patients and innovation. You will be hearing more and more about their “Preserve” technique over the next few weeks and months. I am also starting to enroll patients in their Post Approval Study as I believe good long term follow up data is important for good patient care. In summary after 400 sets of Motiva Breast Implants I am very pleased with the results that this sixth generation implant delivers with beautiful results and very low complication rates.