Cohesivity of Motiva Silicone Gel Implants

Some basic concepts about silicone gel

Forget the concept of “cohesiveness” as some breast implant manufacturers portray it – I searched some definitions online and Collins dictionary gives it as follows: Something that is cohesive consists of parts that fit together well and form a united whole. Water is non-cohesive – spill it on the floor and it scatters. Hardly a united whole. Silicone gel – drop it on the floor and it stays together. That is a united whole. Cohesivity is not an analog parameter, it is a digital (binary) one. It’s black and white. A substance either is, or is NOT cohesive.

That said, now consider viscosity. Viscosity is a state of being thick, sticky, and semifluid in consistency, due to the internal friction of its molecules. Internal friction is the variable, not “cohesivity.” Viscosity is an analog parameter – it varies in gradation. As viscosity increases, there is greater resistance to a change in shape. If the viscosity is increased, the gel will ultimately resemble a solid. So, think about gels as being available in a varying spectrum of viscosities ranging from soft and deformable to firm and solid, rather than looking at gel and solid as two discretely separate things.

Shape and firmness, are they mutually exclusive?

Now let’s consider the concept of shape and firmness. Consider the case of the Natrelle 410 anatomical implant, which is a wonderful device that I have used it numerous times and still do. The reason this device holds its anatomic (teardrop) shape is because of its gel. It is called a “form stable” device. If you strip away the shell of the device, the gel will still hold the anatomic shape. That is why it has sometimes been referred to as a “Gummy Bear” implant. The gel is very firm. For this to be true, the gel needs to have a very high viscosity. The firmer the implant, the higher the viscosity and the more the implant will maintain its shape, but at the sacrifice of softness, a characteristic which all women want for their breasts.

410 Anatomical Breast Implant Long Island NY

Anatomical Implant (textured surface)

With conventional silicone gel implants, there is a “give and take” here. One must realize that the more you want to control (maintain shape), you will do so at the cost of softness. On the other side of the spectrum from the Natrelle 410 anatomical implant is the Natrelle “Responsive” implant, a “non-gummy” round smooth silicone gel implant that I also love. It has one of the lowest viscosities of the silicone gel implants which makes it super soft. The only problem is that it does not hold its shape well at all. If you look at this device upright, you will see that the gel just falls to the bottom of the implant shell. As not all breasts have the same size, tissue quality and shape characteristics, and patient desires vary as well, there are times when one or the other implant, or an implant with in-between characteristics are best suited for a particular patient.

Responsive Breast Implant Long Island NY

Round Implant (smooth surface)

At first, we might think that the Motiva Ergonomix implant would be a very firm implant because we think that if it is anatomic in shape, then it must be similar to the Natrelle 410 implant, which is the firmest implant in the Natrelle line (assuming the gel is the same or similar to the “Natrelle Highly Cohesive” round implant). We already saw that the firmness is not because of the shape, it is because of the viscosity of the gel. So, for the Natrelle 410 implant, in order to achieve an anatomical (teardrop) shape, the gel must be very firm. So what is so different about the Ergonomix implant?

Why an Ergonomix implant can be soft, yet maintain an anatomic shape:

I am going to introduce another new concept. Unlike viscosity which is the ability of a gel to resist a change in shape, elasticity is the ability of a material to resume its normal shape after being stretched or compressed. This can be thought of as the opposite of viscosity, well, sort of. The reason that the Ergonomix implant can emulate an anatomic shape when vertical is not because of its inherent shape, which is round, but rather because the reduced viscosity (softer) gel AND an implant shell whose elasticity matches the elasticity of the silicone gel inside it. Motiva calls this True Monoblock® technology – the implant gel and its shell are matched to move together as a unit. This now permits the implant to change shape under the influence of gravity, without bottoming out excessively as softer traditional implants such as the Natrelle Responsive implants do. This allows you to “have your cake and eat it too”, that is, a soft implant and a natural, teardrop shape. The manufacturer refers to the softer, cohesive, lower viscosity, high elasticity gel inside the Ergonomix implant as “Progressive Gel™ Ultima.”

So, is the Ergonomix implant a round implant or an anatomic shaped implant?

The answer is, this is a round implant. However, when it lies in a vertical position in the body, it assumes a teardrop shape because of the way the filling gel inside and the implant shell outside react to the forces of gravity. The Motiva TrueTissue Dynamics™ Technology allows this round implant to behave as an anatomical implant without some of the drawbacks associated with these devices (such as rotation). This implant demonstrates the most change in shape, decreased upper pole deformation and increased point of maximum projection. The final result is an implant that when subjected to gravity shifts from the horizontal to the vertical position, provided with a configuration to shift at its maximum point of projection when subjected to gravity to provide a more natural look and feel. See the video below:

Viscosity of Motiva Gel Implants

Is this the only option for Motiva implants?

The Round Plus is a round implant, however, unlike the Ergonomix implant, it is filled with a different gel called “Progressive Gel™  Plus.” Both the Progressive Gel™  Plus and Progressive Gel™ Ultima gels are highly cohesive. However, the difference is that the Progressive Gel™  Plus has a high viscosity and elasticity that provides this implant with the properties to maintain its maximum projection point independently of the position or action taken by the patient. In other words, gravity does not cause this implant to change from a round to an anatomical shape as does the Ergonomix implant, which is filled with the lower viscosity, Progressive Gel™ Ultima gel. The Round Plus implant is firmer than the Ergonomix implant, giving it more upper pole fullness and a rounder look that the Ergonomix implant. It’s all about personal preference!

Round Plus and Ergonomix® Ultima® in vertical positionRound Plus and Ergonomix® Ultima® in vertical position

The Round Plus implant on the left has a higher point of maximal projection than the Ergonomix implant on the right. The Ergonomix implant has more of an anatomical shape when placed vertical. Remember, both of these implants are round implants when they are placed flat.

Implant Maximum ProjectionPoint of Maximum Projection (PMP) with an Ergonomix® breast implant in horizontal and vertical positions.       

As the Ergonomix implant is moved from a horizontal to a vertical position, the implant assumes a more anatomical shape. However, I would not call it conventional, this due to the technologies that come with the implant, initiating with the shell the same True Monoblock® technology that was designed for the Ergonomix implant. This provides for enhanced mechanical performance and links all components of the implant to the same tensile strength, thus providing movement and ease of implant insertion. A controlled surface, SmoothSilk®, uniquely made to provide the most biocompatible behavior to reduce the risk of capsule contracture. The BluSeal® technology gives the implants the guaranty of a barrier layer in 100% surface implant.

What makes motiva Breast Implants different?

Motiva Implants™ are considered “Next Generation Breast Implants” due to their innovative technology including theTrue Monobloc® shell, the BluSeal™ barrier layer, and the SmoothSilk® Surface. Motiva Implants also include their Q Inside Safety Technology™ which provides a secure micro-transponder giving patients access to implant-specific data from outside of the body. This information includes information such as the serial number, manufacturer name, date of manufacture, lot number, and more. The best part about this? Q Inside Safety Technology™ cannot be lost or stolen as traditional warranty cards could.

True Monobloc® Technology

The True Monobloc® Technology is a flexible, multilayer system that links all components of the implant shell to create a single structure. This design allows enhanced mechanical performance, natural movement, and ease of implant insertion. By using this technology, the shell of the implant is able to act as a whole structure, not only making insertion easier for the surgeon but also improving the implants qualities under stress.

Motiva Implants™ TrueMonobloc® exceeds the industry standards for implant shell mechanical properties. By implementing a multilayer shell structure, Motiva Implants™ allow flexibility without losing their response to gravity. The shell of Motiva implants is composed of 5 layers (Ergonomix® Shell) or 6 layers (Round Plus Shell) of the same silicone elastomer with a uniquely pigmented barrier layer called BluSeal™.

BluSeal™

Motiva’s BluSeal™ Technology is a used to show the presence of a barrier layer in 100% of the shell of the Implant. The blue pigment allows easy inspection of this key element which prevents the diffusion of silicone towards the breast tissue. A barrier layer is necessary in breast implants to minimize silicone gel diffusion into the body, a feature that has been a standard in the industry for more than 20 years, in order to significantly reduce the risk of capsular contracture in all Motiva Implants™. This safety feature is only present in Motiva Implants™ as other breast implants on the market are colorless making the barrier layer difficult to visualize. The BluSeal™ indicator finally allows surgeons to verify the presence of this important safety component surrounding the entire implant with 100% assurance. The BluSeal™ indicator has complied with the most rigorous quality and safety standards of the American Society of Testing and Materials and ISO.

SmoothSilk® (SilkSurface™)

Although there are many surfaces on the market that portray themselves as “smooth” surfaces, the Motiva SmoothSilk® (SilkSurface™) is unlike any other. SmoothSilk® (SilkSurface™) is a controlled, smooth breast implant surface with small dimensional features in its surface including low roughness, low surface area, high density of peaks and less friction. This surface has no evidence of deep cavities, pore`s ruptures or silicone debris which differentiate Motiva Implants™ from the traditional breast implant surfaces available. Due to this, the SmoothSilk® (SilkSurface™) may reduce the inflammatory response post-op which minimizes the risk of inflammation, fibrosis, capsular contracture and other complications significantly.

SmoothSilk®/SilkSurface™ has a high density of peaks, unmatched by other surfaces, which means fewer valleys or low areas for cells to pile up and create ridges. The peaks act as contact points for the surrounding tissue which results in an improved arrangement of the collagen fibers in regards to the surface. Because of this, the risk of capsular contracture is greatly reduced. The combination of a low roughness with a high density of peaks is unique for the Motiva Implants® and allows for a better bodily response to the implanted device.

Motiva Implants® Post Market Surveillance Report (Q4-2017), shows data related to all the adverse events reported back to the manufacturer in over 386,284 devices placed on the market since October 2010 to December 2017. Complaints due to capsular contracture represent less than the 1% of the implanted devices, and there were no reports of double capsules, late seromas or ALCL.

To learn more about the Motiva Implants® clinical trial in the United States from Establishment Labs, click here.

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