Can One Breast Implant Be Safer Than the Others?
As a plastic surgeon and with extensive knowledge of breast implant design, manufacture and experience in breast augmentation for over three decades, I have been asked this question many times. I am going to dispel some myths and provide some new information.
Many patients think saline implants are safer than silicone because they contain saline. The truth of the matter is that ALL breast implants have a shell (the “bag”) that is made of silicone. The bag can be filled with either saline or silicone gel. The body is exposed to silicone either way. Recent scientific data demonstrates that silicone does not cause cancer, autoimmune disease nor is there any biologic basis for “breast implant illness.” Implants filled with silicone gel are just as safe as saline implants, are far more natural in feel, having far less rippling than implants filled with saline. I would not allow my spouse and daughters to get silicone gel implants if I had even the slightest concern about their long term safety. I will also note that macrotextured breast implants, both silicone gel and saline, have been removed from the market because the macrotextured implant was associated in very rare cases with health issues.
Motiva vs. Other Silicone Implants
Motiva is a silicone gel implant, but several design features distinguish it from traditional silicone breast implants:
| Feature | Motiva Implants | Traditional Silicone Implants |
| Implant Fill | Cohesive silicone gel | Cohesive silicone gel |
| Implant Shell | SmoothSilk®/SilkSurface® technology designed with a very fine surface structure | Smooth silicone shell; design varies by manufacturer |
| Feel | Designed for a soft, natural feel | Feel varies depending on implant brand and gel cohesivity |
| Movement | Ergonomix® is designed to adapt its shape with body position and movement | Shape and movement depend on the specific implant design |
| Shape Options | Includes designs intended to provide natural-looking breast shape and movement | Multiple profiles and gel options are available depending on the manufacturer |
| Safety Data | FDA clinical trial data currently provides shorter-term U.S. follow-up | Several established brands have longer-term U.S. clinical data |
| Choosing an Implant | Selection depends on anatomy, tissue characteristics, goals, and the specific Motiva implant | Selection also depends on anatomy, tissue characteristics, goals, and implant design |
Safety Considerations
So what implant choices are available and how do they match up in safety? Prior to September 2024, there were three manufacturers that were cleared by the FDA to sell breast implants in this country: Allergan, Mentor and Sientra. I have used primarily Allergan but also have experience with the other two. In September, 2024 a fourth manufacturer obtained FDA clearance to sell Motiva implants in the United States.
It is important to note from the outset that every one of these implants is safe. So what makes one implant “more safe” than the others? Here are the “safety parameters” that I would use when making a decision about one device (implant) over another one:
Rupture Rate
Breast implants are mechanical devices and as such, will not last forever. That said, there is no set time period (ie “ten years”) that implants need to be removed/replaced.
Capsule Contracture
This is where the thin, fibrous tissue sac that forms around all foreign bodies implanted (including breast implants) become thick, hard, and contract, making the breast feel hard and sometimes displacing the implant upwards.
Reoperation Rate
This is how frequently another surgery is performed. This metric is a little harder to interpret, as many of the reasons for reoperation have nothing at all to do with the implant. That said, reasons for reoperation due to the implant would relate to rupture, capsule contracture formation, and lower breast stretching and malposition that is attributed to the device itself. Some of the latter is attributable to the implant, some is not and it is hard to distinguish how much for each.
Based upon the data submitted to the FDA by each implant manufacturer, for round, smooth silicone gel implants (Mentor, Allergan and Sientra at 10 years, Motiva at 5 years)
| Motiva | ||||
|---|---|---|---|---|
| Rupture | 9% | 2% | 3% | .6% |
| Capsule Contracture | 16% | 10% | 12% | .5% |
| Reoperation | 30% | 25% | 24% | 8.8% |
Motiva clearly has the best safety profile of all four manufacturers of breast implants. Although the Motiva data is only reported at year 5 of the ongoing ten year study, the data has been the same since year 2!
In my practice, I have shifted towards Motiva implants, however. I offer my patients a choice, It is my opinion Motiva offers the most natural feeling breast (my spouse Amy has them for five years!), and the safety data is the strongest, I believe that the Motiva implants will not only offer the best results but also be far more cost-effective in the end.
Frequently Asked Questions
Do Breast Implants Need to Be Replaced Every 10 Years?
No. Breast implants are not lifetime devices, but there is no set rule that they must be replaced every 10 years. Replacement or removal may become necessary if an implant ruptures, capsular contracture develops, or another concern requires revision surgery. My current recommendation is to have an ultrasound 5 or 6 years after initial implantation and then every 3 years or so afterwards to monitor the implants to make sure that they're still intact. This is often done at the same time as annual breast screening for cancer. If you get a prescription for an ultrasound with your breast screening, please make sure that the physician notes on the prescription to specifically check the integrity of the breast implants
What Happens if a Silicone Breast Implant Ruptures?
A rupture means the implant shell has developed a tear or opening. Because silicone gel implants do not simply deflate like saline implants, a rupture may require evaluation and, when appropriate, surgery to remove or replace the affected implant.
How Can I Tell if a Silicone Breast Implant Has Ruptured?
A silicone implant rupture may not always cause an obvious change in the breast. If you're concerned about an implant's condition, further evaluation usually first with an ultrasound. Occasionally an MRI is needed to determine whether a rupture has occurred and whether treatment is needed.
Why Does Capsular Contracture Matter When Comparing Breast Implants?
A thin layer of fibrous tissue naturally forms around a breast implant. Capsular contracture occurs when that tissue becomes thick, firm, and contracts around the implant, potentially making the breast feel hard or shifting the implant upward. Because it can lead to additional treatment or surgery, capsular contracture rates are one factor to consider when comparing implants.
Can I Replace My Current Allergan, Mentor, or Sientra Implants With Motiva?
Changing implant brands may be an option during breast implant revision, but the appropriate choice depends on your current implants, breast tissue, anatomy, and reason for revision. Dr. Epstein can evaluate your existing implants and discuss whether Motiva fits your goals. In the vast majority of cases Motiva can replace any of the other implants.
How Should I Compare Breast Implant Safety Data From Different Manufacturers?
Rupture, capsular contracture, and reoperation rates are useful factors to consider when comparing breast implants. It is also important to consider how long patients were followed in each study because rates reported at different time points cannot be compared as though the follow-up periods were identical.
Why Are Motiva’s Five-Year Results Compared With 10-Year Data From Other Implant Brands?
The available manufacturer data represent different follow-up periods. The Allergan, Mentor, and Sientra figures cited are 10-year results, while the Motiva figures are from five years of an ongoing 10-year study. Keep that difference in follow-up time in mind when reviewing the reported rates. The currently reported Motiva data is extremely encouraging. For the Motiva implants the rupture rate is approximately 0.5% at 5 years. The other implants are 10% or more at 10 years.
Disclosure: Dr. Epstein is a paid investigator in the Motiva U.S. FDA clinical trial and is compensated by Establishment Labs to train surgeons on the Preservé technique. Dr. Epstein owns stock in Establishment Labs.
Sections - Motiva Breast Implants
- What is the Motiva Breast Implant?
- Are Motiva Implants Safe? FDA Data Explained by a Trial Investigator
- Motiva Ergonomix vs. Round: A Surgeon's Guide to Choosing
- Ergonomix vs Round: Breast Shape and Movement
- Dr. Epstein’s Eight Year Motiva Experience
- What Makes the Motiva Implant Different?
- Motiva – Is it Smooth or Textured?
- Motiva vs Other Implants
- How Motiva Implants Are Different from Allergan Natrelle, Mentor and Sientra Implants
- MOTIVA Warranty Information
- MOTIVA US Clinical FDA Trial
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Chapters – Breast Augmentation Guide
- Intro to Breast Augmentation
- Preservation Breast Augmentation – A New Era!
- Motiva Implants – What You Need to Know
- 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
