Now is probably the best time ever to consider breast augmentation. Almost everyone nowadays is choosing silicone gel filled breast implants over the older saline filled breast implants, for a much more natural look and feel. Our Long Island practice offers all the latest options in silicone gel implants.
From the start of my practice in 1994 up until May 2018, I preferred the Natrelle® brand of implants, made by Allergan. They are of the excellent quality, and the manufacturer stands by their products.
In May, 2018 I was selected as one of just 22 Principal Investigators in the US FDA Motiva clinical trial. This meant that I could place these breast implants into patients under strict FDA study guidelines. More about the clinical trial can be found here. These implants were far from new, just new to the United States. At the time of the study, several million of them have already been used in over 70 countries. What I discovered is that while I liked the Allergan Natrelle implants a lot, I loved the Motiva implants even more! In fact, when I performed a revision of my wife Amy's 25 year old implants, I used Motiva! Unfortunately, after the study enrollment of patients was filled, I could no longer use the Motiva implants until they obtained FDA approval in September, 2024.
People tend to think of silicone gel implants as if they are all the same. I guess we could do the same with automobiles. All cars will get you from point A to point B. However, the quality and comfort of the ride will vary. All breast implants will enlarge the size of the breast. As already discussed, breast implants vary in terms of shape (round vs teardrop), surface (smooth vs textured), profile (low, moderate, moderate plus, high and extra high), how soft the gel itself is, form stability – how well the implant will retain its shape vs collapsing, how strong the implant shell (bag) is, how elastic the shell is, what percentage filled the shell is (think of a ziploc quart size bag with 1/2 gt, 3/4 qt and 1 qt of liquid contents – how each will vary in appearance and feel). Each implant will have its own unique characteristics.
This is why options matter. Not every implant is ideal for every breast. The more implant options a surgeon has to chose from, the better the surgeon can select the best implant for a given breast, taking into account the desires and goals, as well as the tissue characteristics of the specific patient.
Breast Implant Options
Why are there so many options? This is a good thing. This is what gives a woman choices. This allows you to select the implant that best suits your personal preferences as a patient. Currently, only smooth surface devices are available (Allergan), so all implants are round (at least in my practice!). However, there are still some very nice options available.
Silicone Gel Implants – Firmness and Shape - (Before Motiva)
Is firmness a good thing? Well, the firmer the gel, the more it holds its shape. The softer the gel, the less it holds its shape. The caveat here is that the softer the gel, the more it will resemble the “feel” of natural breast tissue. So a more cohesive implant will feel firmer and hold its shape better, whereas a less cohesive implant will feel softer, better resembling the feel of a natural breast but will not hold its shape as well as a more cohesive silicone gel implant. So as you increase cohesiveness, you get better preservation of shape, but at the expense of softness. And if you decrease cohesiveness, you get less preservation of shape, but increase the softness of the implant. It’s a trade-off that you balance based upon your personal preferences. There is no wrong decision here. You will achieve great results with any of the silicone gel implants, but you can optimize that result for your own personal preference now with the different options currently available to you.
Silicone Gel Implants – Firmness and Shape - (After Motiva)
With the Allergan Natrelle, my mantra was shape (form stability) and softness, you can have one but not both.
With the Motiva, I have changed that mantra. These implants are by way of their uniquely formulated silicone gel very soft and in my opinion, best match the feel of a human breast better than any other device I have used. The design of the shell, how it's elasticity is matched to the gel contained within and the 100% fill of the shell with gel provides incredible form stability.
So now, you have have your cake and eat it too! Softness and shape, in one implant!
What are the current silicone implant options?
The firmer silicone gel implants are also known as “Gummy Bear implants” by their resemblance to gummy bear candy if you were to theoretically take a bite out of the implant (but don’t do so – they won’t taste as good as the candy!). These implants are not new – they have been available in other countries around the world for several years. I also indicate below when they became available in the United States. Teardrop Gummy Bear implants are no longer available in the United States as of July, 2019. Note: The below discussion is for Allergan Natrelle brand implants. I am not discussing Mentor nor Sientra brand devices. I am not a fan of the term "Gummy Bear" because it has led to more patient confusion than any other term! It really serves no purpose, but I use it just for completeness.
- Inspira® Responsive Non-Gummy (2006)
- Inspira® Cohesive Gummy (2016)
- Inspira® SoftTouch Gummy (2017)
- Motiva® Round (2024)
- Motiva® Ergonomix (2024)
Allergan Natrelle Implant Options
Inspira® Responsive Non-Gummy
The Inspira® Responsive Non Gummy Breast Implant is an excellent implant. The gel is the least cohesive among the Inspira® implant family, which makes it the softest. On the other hand, it does not hold its shape as well as the other “Gummy” (form-stable) implants. This implant works well when there is adequate breast tissue of good or better quality, yielding a very soft, nicely shaped breast. In young women with small breasts with a tight soft tissue envelope, this is my “go-to” implant. While rippling is far less frequent with silicone gel implants than saline ones, with this implant, there is the potential for a little more rippling than seen with the Gummy options in women with thin or stretched breast tissue. For this reason, I do not recommend this implant for women with very thin, stretched out, compromised breast tissue.
Click here to see before and after photos with the Inspira Responsive Non-Gummy Implant.
Inspira® Highly Cohesive Gummy
This type of implant is the most cohesive of all the Inspira® implants, making it the most “form-stable” which allows it to retain its shape. This implant will yield the greatest degree of upper breast (upper “pole”) fullness and the least amount of downward migration of silicone gel, or bottoming out. This implant is excellent when there is very compromised, thin tissue as shape is best preserved with the least amount of rippling. I also use this implant for women who wish to maximize the amount of upper breast fullness, as this implant is the most form stable and best retains the maximum upper breast fullness.
Inspira® SoftTouch Gummy
The Inspira® SoftTouch Breast Implant is the most recent and newly introduced implant released in April 2017. This implant is still cohesive enough to be considered a “gummy”, but its cohesiveness and firmness lie in-between the Inspira® Responsive Non-Gummy and the Inspira® Cohesive Gummy implants. It is an excellent compromise between softness and firmness and suitable for most situations. It is a favorite among many of my patients.
Click here to see before and after photos with “Soft-Touch” and “Highly Cohesive” Gummy implants.
Motiva Breast Implants - The Latest Innovation!
With the then available choices of breast implants in the United States, there is a trade-off. There are two important characteristics that patients in particular pay attention to. The first is softness and the second is shape. The ability for an implant to hold its shape when placed in the vertical position (which is the position the implant will be when you are upright) is called “form stability." Softer implants tend to possess less form stability, and those implants with greater form stability tend to be firmer. With three choices of gels, you can have one that is very soft but with poor form stability, one that is firm but has excellent form stability, or one in-between. There is no “best” implant here. There are times that I have preferred one of these over the other two. Sometimes I feel a patient will do best with one of the three choices, and sometimes I believe that any of the three will give great results. It all depends upon the patients preferences and their tissues and breast architecture.
In September 2024, the Motiva breast implants manufactured by Establishment Labs obtained FDA approval and became available in the United States. This is a sixth generation breast implant with technology far superior to all the previous implants. The implant is available in a round and a teardrop shape. What makes the teardrop shape (called the "Ergonomix") unique is that the implant looks round when lying flat on a table, but when the implant is upright, as it is within the breast of a woman when standing, the implant will then change shape on its own and take on a teardrop shape. As the implant rotates within the breast. the implant continually adjusts its shape automatically, maintaining the teardrop shape. There is no longer a need for a macro textured surface to secure the implant to the chest wall and breast, and no longer any issues with malrotation causing shape changes in the breast. The Motiva implants are the most natural feeling, natural looking implants that I have ever used. As one of only 22 "Principal Investigators" in the Motive US FDA Clinical Trial, I have experience with this implant since 2018 and have seen my study patients yearly. The stability of the results are absolutely amazing! Lastly, the safety data (rupture rate, capsule contracture rate, reoperation rate) on this implant is far superior to that of the other implants. Motiva implants have the lowest rate of device related complications. You can learn more about Motiva breast implants here.
Motiva is my current first choice for both primary (first time) breast augmentation as well as revision of breast augmentation in all women. My wife Amy had saline breast implants and I replaced them with Motiva implants.
What are Motiva Implants?
Motiva Implants Options
It’s All About Choices…
Now there are several excellent options available to give you the look and feel that you so desire and deserve. I will be happy to discuss these options with you and help you to select the one that will give your breasts the look and feel you have always wanted.
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Topics - What Implant Type Do I Need
Sections – Five Key Decisions You Need To Make
Chapters – Breast Augmentation Guide
- Intro to Breast Augmentation
- Motiva Breast Implants
- Five key decisions you need to make
- One-Day Recovery Breast Augmentation
- Anesthesia – General, Sedation or Local?
- Breast Lift (Mastopexy) with/without Implants or Fat
- What else should I know about breast augmentation?
- Important Things to Consider When You Decide to Move Forward With Breast Augmentation
- Revision of breast augmentation
- ALCL and Breast Implant Illness
