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Should I Get Motiva Breast Implants? What’s the difference?

If you’re considering breast augmentation, you now have more choices than ever. In late 2024, the FDA approved Motiva SmoothSilk Round and Motiva Ergonomix silicone gel-filled breast implants, adding to the lineup of available options. This brings the total number of FDA-approved silicone gel implant manufacturers in the United States to four: Motiva, Allergan, Sientra, and Mentor.

So, what makes Motiva implants different? And who might be a good candidate for Motiva implants? The company markets Motiva breast implants as “cutting-edge technology” and patients say they feel “natural”—but what do plastic surgeons have to say? This article is a quick dive into Motiva breast implants from a plastic surgeon’s perspective.

Breast implant, woman with hands towards breasts, for Marquis Plastic Surgery, Miami, FL.

What Sets Motiva Silicone Implants Apart?

Virtually no capsule is formed around Motiva implants.1 This is different than implants from Mentor, Allergan, and Sientra. This is a big marketing point from the company, Establishment Labs Holdings which is based in Costa Rica. But what exactly does ‘no capsule’ mean?
Classically, when silicone gel breast implants are inserted into the body, the body forms a capsule around the implant. The capsule is made of your body’s own fibrous tissue and it is the natural reaction to any foreign body, such as a breast implant. In contrast, Motiva silicone gel implants form virtually no capsule in most patients – likely because they don’t trigger a robust inflammatory / foreign body response.2 Any capsule around a Motiva implant tends to be so thin and flexible that it’s almost invisible.

Capsule or No Capsule? Which is Better?

It depends. Keep reading.

What Are the Benefits of Motiva – Low Risk of Capsular Contracture

Not everyone forms an ideal (soft, thin) capsule around Mentor, Sientra, or Allergan implants. In some cases, individuals develop a hard firm/painful capsule. This is called a Baker Grade III / IV capsular contracture. A severe capsular contracture can be painful and distort the breast’s appearance. Because Motiva implants are designed to form minimal to no capsule around the implant, the risk of developing capsular contracture appears to be lower.

For this reason, Motiva implants may be particularly beneficial for:

  • Patients with a history of severe capsular contracture. If you’ve experienced hard, painful capsules around implants in the past, Motiva’s design may help minimize inflammation and reduce the likelihood of recurrence.
  • Individuals prone to keloid-like scars. Patients with a history of forming thick, raised scars may be at an increased risk of developing a severe capsular contracture. In these cases, Motiva implants may offer protection against formation of a severe capsular contraction.
One Risk to Consider: Silicone Ruptures Are Not Contained

While avoiding a hard capsule (capsular contraction) is important, there’s benefit to having a well-formed soft/thin capsule. Namely, an ideal capsule acts as a protective barrier.

If a silicone breast implant ruptures, a capsule helps contain the silicone, making removal and replacement of the implant a more straightforward process. When the silicone remains within the capsule, it minimizes the risk of silicone spreading into the surrounding tissue, which can lead to other complications. Thus, having a well-formed capsule may offer some protection and contribute to the long-term safety of the implant.

How Does Motiva’s Complication Rate Compare to Allergan, Mentor, and Sientra?
The initial data on Motiva is promising – especially for patients with a unique risk for capsular contraction. However, the longer-term data on Motiva is still being gathered. In the FDA trial, patients were monitored for 4 years, and during that time, the rates of rupture and capsular contracture were very low.3,4,5 For comparison, companies like Mentor, Allergan, and Sientra have published 10-year surveillance studies, which provide a clearer picture of how their implants perform over time. Based on published averages from these 10-year surveillance studies, the risk of capsular contracture and rupture increase with time; there’s a notable rupture risk inflection point between 6–10 years.6 Thus, while the initial results for Motiva are encouraging, we look forward to seeing how the implant continues to perform as more long-term data becomes available.

Do Motiva Implants Require a Modified Surgical Approach?

Relative to some implant types, a modified surgical approach may be indicated.

While a soft, pliable capsule offers benefits from some patients, a capsule that’s too flexible—or even nonexistent—can create its own set of cosmetic challenges. Without enough support from the capsule, the implant may move more than desired, leading to issues such as:

  • Implant Roving: The implant shifts from its intended position, causing asymmetry or distortion.
  • Dropping or Bottoming Out: The implant moves downward through the inframammary fold (IMF), resulting in a breast that appears lower than intended.
  • Lateralization: The implant drifts to the side, affecting symmetry and overall aesthetics.

How Do Plastic Surgeons Address These Challenges?

Fortunately, these potential issues can generally be managed by adapting the surgical technique when using Motiva implants to maintain the best possible outcomes. Key adjustments include:

  • Avoiding Overly Large Pockets: Creating a pocket that’s too large can lead to excessive implant movement. To help mitigate this risk, limited and precise pocket dissection is used to optimized implant position. A snug and secure implant pocket and reduces the potential of displacement.7
  • Reinforcing the Inframammary Fold (IMF): Stabilizing the IMF prevents the implant from dropping or bottoming out, preserving the desired breast shape. In some patients, particularly in revision or reconstructive patients, this may include suturing in an acellular dermal matrix to help support the implant.
  • Releasing the Pectoralis Muscle: Releasing the pectoralis muscle attachments helps prevents muscle contraction from pushing the implant sideways.

By carefully adjusting these aspects of the surgical approach, surgeons can minimize the likelihood of implant shifting. Of note, many of the above techniques are already performed by most US-based plastic surgeons. This is because smooth-gel implants are the predominant breast implants placed in the US at this time. However, most of the published data on Movita implants is from outside of the US where textured-gel implant usage is more popular and these techniques are not always indicated.

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[1] Morris Ritz, Frederik W Fried, Motiva: Virtually No Capsule, Aesthetic Surgery Journal, Volume 43, Issue 4, April 2023, Pages NP308–NP309, https://doi.org/10.1093/asj/sjac348

[2] Doloff  JC, Veiseh  O, de Mezerville  R, et al.  The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans. Nat Biomed Eng. 2021;5(10):1115–1130. doi: 10.1038/s41551-021-00739-4.r

[3] Establishment Labs, Press Release, Establishment Labs Notes Presentation of 4-Year Results from Motiva U.S. IDE Study at The Aesthetic Meeting 2024, https://investors.establishmentlabs.com/press-releases/press-releases-details/2024/Establishment-Labs-Notes-Presentation-of-4-Year-Results-from-Motiva-U.S.-IDE-Study-at-The-Aesthetic-Meeting-2024/default.aspx.

[4] Glicksman C, Wolfe A, McGuire P. The Study of the Safety and Effectiveness of Motiva SmoothSilk Silicone Gel-Filled Breast Implants in Patients Undergoing Primary and Revisional Breast Augmentation: Three-Year Clinical Data. Aesthet Surg J. 2024 Nov 15;44(12):1273-1285. doi: 10.1093/asj/sjae134. PMID: 39331509; PMCID: PMC11565863.

[5] Aitzetmüller-Klietz ML, Yang S, Wiebringhaus P, Wellenbrock S, Öztürk M, Kückelhaus M, Hirsch T, Aitzetmüller-Klietz MM. Complication Rates after Breast Surgery with the Motiva Smooth Silk Surface Silicone Gel Implants-A Systematic Review and Meta-Analysis. J Clin Med. 2023 Feb 27;12(5):1881. doi: 10.3390/jcm12051881. PMID: 36902667; PMCID: PMC10004118.

[6] Mentor 10-year Core Study, https://pmc.ncbi.nlm.nih.gov/articles/PMC7899226/; Allergan 10-year Core Study, https://pmc.ncbi.nlm.nih.gov/articles/PMC4819531/; Sientra 10-year Core Study, https://journals.lww.com/plasreconsurg/fulltext/2018/04001/ten_year_core_study_data_for_sientra_s_food_and.4.aspx

[7] Sforza M., Hammond D.C., Botti G., Hedén P., Chacón Quirós M., Munhoz A.M., Kinney B.M., Corduff N. Expert consensus on the use of a new bioengineered, cell-friendly, smooth surface breast implant. Aesthetic Surg. J. 2019;39:S95–S102. doi: 10.1093/asj/sjz054.