DR. EPSTEIN’S COMPREHENSIVE Breast Augmentation Guide

Anesthesia – General, Sedation or Local?

How Motiva Implants Are Different from Allergan Natrelle, Mentor and Sientra Implants

Does a Motiva Breast Implant Look and Feel Different than Allergan Natrelle, Mentor and Sientra Breast Implants?

The first question to ask is "IS there a difference between Motiva breast implants and Allergan Natrelle, Mentor and Sientra breast implants?"

Strictly from the patient's point of view, this is probably the single most important question one could ask. There is, without question, a very big difference in the feel of the Motiva breast implants, both Motiva Round® and Motiva Ergonomix® versus that of ANY of the breast implants made by Allergan Natrelle, Mentor and Sientra.

I have used implants from Allergan Natrelle, Mentor and Sientra, and the breasts that have these implants are all wonderful, but breasts augmented with Motiva breast implants are even MORE wonderful. How do I know this to be so?

From a qualitative point of view, and by that I mean just your own observations when you see and feel breasts with all of these implants, there are differences. I am one of the few surgeons that can actually make these statements, because as of the date of the FDA approval of Motiva breast implants, 9/26/2024, I have implanted approximately 140 Motiva breast implants, both round and Ergonomix, in women who participated in the US Motiva FDA Clinical Trial.

My observations are that breasts augmented with Motiva implants feel softer, maintain better upper breast fullness, have less inferior migration of the inframammary fold (less dropping of the lower breast crease), AND the results are so stable, that from one year to six years I do not see any significant changes in the shape of the breasts. They look just as amazing at six years as they do at one year. I have seen my study patients yearly during the study and took photographs, obtained three dimensional computer images and made measurements of the breasts, so I have the data to make these statements!!!

Why Does a Motiva Breast Implant Look and Feel Different than Allergan Natrelle, Mentor and Sientra Breast Implants?

The next question to ask is "WHY is there a difference between Motiva breast implants and Allergan Natrelle, Mentor and Sientra breast implants?"

To do this, we need to see what is different about he Silicone shell (the bag) that contains the silicone gel, what is different about the silicone gel itself and lastly what is different about how the silicone shell and the silicone gel inside relate to one another. As one who majored in BioMedical engineering at Northwestern University more years ago than I care to mention (Hint: 1970's), I find this the most interesting aspect of the Motiva implants, and one that most all of my fellow colleagues have not yet embraced. It's really not about putting the different implants on a table and seeing which one feels more natural. It is about understanding on a higher level why this is so, which will result in a greater appreciation of the technology behind the implant, and of course, the implant itself! That said, I will explain this for all of you to know, understand and appreciate!

Silicone Breast Implant Rheology for Dummies

Rheology is the science of how a gel flows and behaves. This is important for the both the engineer designing the implant and for the surgeon to know as well. All silicone gels are different and behave differently.

The most important two characteristics are softness and ability to maintain shape.

The five characteristics that are used to describe a silicone gel are:

Rheology for Dummies
  1. Elasticity % - Think of a spring. If you compress it the spring is shorter and when you release the force, it goes back to its original length. But what if it did not go back to its original length? If you compress and release a silicone gel and it does NOT go back to its original length or shape, then that gel will be perceived as softer. So here, we want a low Elasticity % for a breast implant.
  2. Stiffness - This is pretty self explanatory. Compare modeling clay (not stiff) to a rock (very stiff). The ideal breast implant should have minimal stiffness.
  3. Elastic deformation - think of a rubber band. As you apply a force and stretch it, the rubber band lengthens; release the tension and it comes back to its original length. This is similar but different from the spring analogy. Here we want a high elasticity for our ideal breast implant silicone gel.
  4. Energy absorption - As a force is applied to a gel, it is dissipated as heat. You may not notice the temperature go up, but it does a tiny bit. The ideal gel will allow a force to compress it and rather than resist that compression, it translates that energy to heat. Again, this is a quality we want because it contributes to softness.
  5. Viscoelastic deformation - This is a fancy term for a very simple thing. If a substance is elastic, it stretches when you apply a force, but when you stop at a certain amount of force, it does not stretch anymore. If a material has a viscoelastic property, when you apply a force, it will stretch (or compress), but when you stop at a certain amount of force, the material continues to stretch (or compress) even more, even though the force is not changing. The material is acting like a spring and a thick liquid at the same time. This is what happens when you sink into a gel mattress. This gives perhaps the greatest perception of softness as you comfortably sink into the mattress. Such a mattress is shown below. Close your eyes and imagine after a hard day at work, lying down on this mattress, appreciating how amazingly soft it feels as you sink into it! That's viscoelasticity!
Viscoelastic mattress

So we have now identified five parameters that are used to characterize silicone gels. We know which characteristics we want to be high and which we want to be low for our ideal soft silicone gel with preservation of shape:

Elasticity % - Low

Stiffness - Low

Elastic Deformation - High

Energy Absorption - High

Viscoelastic Deformation - High

The next step is to look at how the Allergan, Mentor, Sientra and Motiva gels all compare against one another....

Radar graph different implants

AGN - Allergan Natrelle: Truform 3 is the Highly Cohesive Gel Implant

AGN - Allergan Natrelle: Truform 3 is the Soft Touch Gel Implant

J&J - Mentor: Memory Gel Implant

SIL - Sientra: High-Strength Cohesive Implant

EL - Establishment Labs: ProgressiveGel® Plus (Motiva Round Implant)

EL - Establishment Labs: ProgressiveGel® Ultima (Motiva Ergonomix Implant)

So What Can We Conclude from the Above Data?

It appears that the Allergan, Mentor and Sientra implant gels rank highly in the characteristics that we want to be low, and low on the characteristics we want to be high. The Motiva Gels are just the opposite - they rank highest where we want high and lowest where we want low. It is like the Motiva implant gels are a mirror image of the Allergan, Mentor and Sientra implant gels!

So when my patients and colleagues ask me "what is so different about the Motiva breast implants?", you can easily see that it is in the science of the silicones!

How Else is a Motiva Implant Different from the Allergan, Mentor and Sientra Implants?

Another really important difference between Motiva and the Allergan, Mentor and Sientra breast implants is the silicone shell itself. The amount of times the mandrel (mold) is dipped into the silicone gel to create a Motiva Round implant shell is greater than that of the Motiva Ergonomix implant shell. This gives the Motiva Ergonomix shell a little more elasticity to go along with the greater elasticity of the ProgressiveGel® Ultima than that of the Motiva Round implant which uses the ProgressiveGel® Plus silicone gel inside.

Now the elasticity of the shell and silicone gel inside match, which allows the implant to move as a complete unit, rather than having the silicone gel sloshing around inside as it does in the Allergan, Mentor and Sientra breast implants. This is what Establishment Labs refers to as the TrueMonoBloc®. This is the secret to creating an implant that is extremely soft yet it maintains its shape so beautifully! One other benefit to all of this is that if the gel is not moving around inside the gel, and the shell is filled 100% to capacity as only the Motiva Round and Ergonomix implants are, then there is less folding and wrinkling of the implant, less chance of visible rippling of the breast and lastly less chance of the implant folding back and forth and cracking, which is called fold fatigue. No mechanical device, including breast implants last forever, but with these characteristics, you can be certain to get the longest possible life out of your breast implants!

I explain all of this in my video below:

Will I Continue to Use Non-Motiva Breast Implants?

The answer is yes. While I believe Motiva breast implants to be superior to all other available breast implant options, there are some women who do prefer the non-Motiva implants. All breast implants available in the United States - Motiva, Allergan, Mentor and Sientra, in the hands of an experienced and skilled surgeon will produce beautiful breasts.

I believe that aesthetic surgery is all about presenting options and giving patients choices, so in this regard I will continue to offer other implant options for the foreseeable future.

In Conclusion

Motiva implants will not prevent a surgeon who selects the wrong implant or improperly creates an implant pocket in the breast for a given patient from creating a problem. In my plastic surgery journey which is now in its fourth decade, I have learned how important both experience and expertise are. They are not synonymous, but they do go hand in hand. Thousands of surgeries later, I am in a wonderful place - being able to offer my patients the very best in surgical decision making and the ability to carry out that surgical plan in the operating room with the greatest chance of success and the lowest risk of untoward events.

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