Motiva Implant Questions - What Do Surgeons Think?

Question

Hi, I have been heavily researching into Motiva implants since there is so much buzz around them. I am interested in hearing what surgeons think: 1. Since the Motiva study which lead to it‘s FDA approval was only 3 years long, is it true that we can‘t completey eliminate the risk of BIA-ALCL which typically shows 7-10 years after textured implant insertion? 2. The study was mostly evaluated in UTM placement of the inplant. However, one of the surgeons I had a consultation with says the rate of capsular contracture is still low with subfascial placement, which she recommends. Is it true? 3. I recently saw a surgeon on YouTube speak out that subfascial placement of the implant is a marketing strategy and almost impossible to do (unless you do it carefully in a 3 hr surgery) and that revisions of patients who claimed their first sugery was done subfascially always ended up being subglandar. That is because the fascia is easily damaged. 4. My surgeon recommended the preserve technique done subfascially, because it preserves breast tissue and I will be able to breast feed in the future. However, I‘m reading that OTM placement compresses the milk ducts which will cause difficulty breastfeeding.

John L. Burns Jr., MD · Answer

Motiva is unique with its 4 micron implants surface and is more biocompatible and resists capsular contracture.  They've been around worldwide since 2010 with zero cases of BIA-ALCL with about 4.6 million devices over that time period.

Gerald Minniti, MD, FACS · Answer

I am one of the 22 surgeons in the US conducting the ongoing Motiva USA FDA Trials (year 6 of 10). Worldwide there are approximately 4.5 million women with Motiva implants going as far back as 2010. Benchtop research into the current surface of Motiva implants centered around fibroblast and white cell compatibility, which showed a propensity for a type of white cell that downregulates inflammation. Natrelle, in their quest to maintain dominance in the implant market has tried to duplicate the surface with their own 4 micron texture without similar results. Like smooth surfaced devices, it is unlikely there will ever be a case of BIA-ALCL with Motiva as the primary or only device. Capsular contraction rated are the lowest worldwide, regardless of implant placement, approximately 0.5%. I am also a Preserve surgeon and Motiva implants do very well in this position (above the pectoralis fascia). Moreover, this system is unique in the way the space is created, avoiding cutting or disrupting Cooper's ligaments, which run through the breast, and allowing a 'nesting' of the implant within the base of the breast tissue. There are no reports of inability to breast feed with OTM implants, Preserve or otherwise.

Donovan Rosas, MD · Answer

The presence of implants should not influence your decision to breast feed. You should be able to safely breast feed regardless of prior surgery and should consider doing so for the sake of the newborn. There is mountains of data regarding the immunologic benefits of breastfeeding. 
With regards to your specific questions:
1. We are waiting on long term data. The Motiva device early impressions are good with lower levels of contracture. Although, the BIA-ALCL phenomenon may have scared many a surgeon away from textured devices.
2. Early data suggests lower rates of capsular regardless of plane of dissection. That being said, whether or not an implant is truly subfascial is up for debate on a case by case basis.
3. There is a rise in subfascial popularity as of late. The claim is lower pain and faster recovery with equivalent rates of contracture. That being said, the fascial plain is a tenuous dissection with many subfascials becoming subglandular.
4. As stated above, generally speaking breastfeeding is possible (and encouraged) post augmentation.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

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