Is it worth exchanging silicone for Motiva ergonomix to improve rippling?

Question

I have had saline implants previously (Mentor) and swapped them out for Silicone (Natrelle style 15) in 2011 due to rippling and I heard silicone would feel softer. I did not notice a difference, and still developed rippling. I had a consult yesterday, quotes are pretty high ($13-16k) to do an exchange and possible mesh/internal bra. I am just not sure if it will be a noticeable difference to justify the surgery and cost. (I a lean and prone to rippling, 5'4" and 107lbs, work out regularly; implants are 410cc)

Mehmet Ozdemir, MD · Answer

As an ER doc, you know that the "mechanical" properties of the materials matter, but so does the "patient's anatomy." At 5'4" and 107 lbs, your primary challenge is a lack of soft tissue coverage (the "padding" over the implant). While Motiva Ergonomix is a fantastic, highly cohesive gel designed to mimic natural movement and reduce rippling, switching to them alone may not provide the "fix" you're looking for, especially since your current 410cc silicone implants are already a significant volume for your frame. The reality is that for someone with a lean physique, the implant's edge is almost always palpable or visible unless we increase the tissue thickness. To truly justify that $13–16k investment, you would likely need to combine the exchange with fat grafting (lipofilling) to the upper and medial poles to "camouflage" the ripples, or the internal bra/mesh your surgeon mentioned to provide better structural support. Without adding that layer of your own tissue via fat transfer, you might find yourself in the same position you were after the 2011 swap&mdash;frustrated that a high-tech material couldn't overcome the physical reality of thin skin coverage.

Robert M. Lowen, MD · Answer

Dear FitMamaERdoc,
   It is probably worth it because Motiva implants do not show rippling as much as Natrelle.  They have more cohesive gel, are 100% filled and are a "mono block" construction meaning the gel is adherent to the inner lining.  These are characteristics different enough from Natrelle that make them worth trying and inherently less ripply.
  There are a number of other factors related to rippling that your post did not inform us about.  For example, are the implants under the muscle  Placing them under may help, but not always.  Is your soft tissue coverage in the upper pole 2 cm or less?  If partial subpectoral, how high up was the medial pectorals released? Do you have much subcutaneous fat?  Would you like to be evaluated for soft tissue padding with your own fat or alloClae adipose tissue replacement?

Daniel Barrett, MD · Answer

Dear FitMamaERdoc,

it is hard to tell for sure without an examination. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Vasileios Vasilakis, MD, FACS · Answer

Hello,
Thank you for the question. Switching your implants to Motiva should improve the rippling, as wells as the overall feel of your breasts, especially since your current implants are 15 years old.
I wish you the best.
Vasileios Vasilakis, MD, FACSDouble Board Certified Plastic SurgeonHouston, TX.

Frank Agullo, MD · Answer

Honest answer: yes, switching to Motiva Ergonomix will reduce your rippling, but it won't eliminate it. The Ergonomix gel and SilkSurface shell move as one piece and fold less than older silicone. The bigger issue is that at 5'4" and 107 lbs, you simply don't have much soft tissue covering the implant, and that is what really drives whether ripples show.
If your only goal is the absolute least rippling, the Motiva Round actually wins out. It is firmer and holds its shape more, so it ripples less, but you give up some of the natural softness and movement that make Ergonomix so popular. There is also a newer Ergonomix 2 available internationally that ripples substantially less, but it is not in the U.S. yet.
For someone with your build, I would add a GalaFlex Lite mesh to support the lower pole, plus fat grafting over the cleavage to camouflage. That combination of the right implant, mesh, and fat tends to deliver the most durable result. Your $13K to $16K estimate is in line with that scope of revision.

#StayBeautiful,
@RealDrWorldWide

Jacob Carlson, MD · Answer

There are several factors to consider when it comes to managing visible rippling - amount of native breast tissue, implant placement, and implant firmness.
Obviously, if a patient has more native breast tissue, they will be able to conceal their respective implant more easily. If there is only a minor amount of rippling present, alternatives to changing out the implants would be autologous fat transfer or using donor fat like AlloClae.
If an implant is placed underneath the pectoralis muscle, then the implant (or at least a majority of the implant) is covered by that extra layer, which makes visible rippling less likely. Similar to comment regarding native breast tissue, some patients have thicker pectoralis muscles than others. Those patients with thicker pectoralis muscles tend to to conceal implant rippling better than others.
Anecdotally, Motiva's implants do tend to ripple less than other implants. The Ergonomix option is a little more "natural" in appearance, as it will assume slightly more of a teardrop shape when you are in the upright position. Motiva's Round implant, on the other hand, is going to maintain more fullness in the upper pole regardless of the position you are in. Because of this, the Motiva Round implants tend to create more of augmented appearance to the breasts, but it also makes them a little bit better as reducing visible rippling compared to the Ergonomix implants.
As you suggested, using mesh / internal bra might be recommended depending on a particular case. The mesh helps hold the implants in the appropriate position, but as you mentioned, can increase the cost of the procedure by a decent amount.
Hope this was helpful. Have a great weekend!

Harry T. Haramis, MD, FACS · Answer

Those Motiva implants should ripple less, although cannot guarantee 100% especially if thin skin and minimal breast tissue over them.

Mesh can help hide rippling by giving an extra, thicker layer to shield the new implants.

This should give noticeable results, to be confirmed with your/a plastic surgeon.

Is it worth exchanging silicone for Motiva ergonomix to improve rippling?

Answers (7)

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