For patients seeking breast augmentation, today’s technology offers more advanced and refined options than ever before. At the forefront of this innovation are Motiva® breast implants, which are sixth generation cohesive silicone gel implants (gummy bear implants). Motiva silicone breast implants are known for their excellent safety profile, natural look and feel, and significantly reduced risk of capsular contracture. When paired with biosynthetic internal bras, especially in certain clinical scenarios, these implants can help deliver long-term, beautiful results.
What Is Capsular Contracture—and Why Does Motiva Matter?
After any breast implant surgery, the body naturally forms a layer of scar tissue around the implant. This is called the capsule, and it’s part of the body’s normal healing response. In some cases, however, the capsule can become too thick or tight, causing the implant to feel firm, appear distorted, or even become painful—a condition known as capsular contracture.
One of the standout benefits of Motiva® implants is their extremely low rate of capsular contracture. This is largely due to their scientifically engineered nano-textured surface. Unlike traditional textured implants (macrotextured)—which have larger, more irregular surface topographies—Motiva’s implants are uniquely designed with 4-micron uniform nano-texturing. This specific surface architecture helps modulate the body’s immune response and reduces excessive inflammation, which is a key factor in capsule formation.
Several studies suggest that this nano-surface promotes more favorable integration with surrounding tissue, thereby decreasing the likelihood of the body forming a problematic capsule. In practice, this means fewer complications (specifically capsular contracture and rupture), fewer reoperations, and longer-lasting results for patients.
The Trade-Off: Malposition Risk
While Motiva’s smooth nano-texture provides a significant advantage when it comes to capsular contracture, it also brings one important consideration: malposition. Because these implants don’t “stick” to surrounding tissue in the same way that more heavily textured or smooth implants do, they can be more mobile within the pocket—especially in the early post-operative period or in patients with thinner tissue coverage.
Implant malposition can include a variety of issues:
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Bottoming out – when the implant drops too low
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Lateral displacement – when the implant shifts too far to the sides
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Symmastia – when implants drift too close to the midline
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High-riding implants – when implants sit unnaturally high on the chest
To mitigate this risk and create better long-term support, many surgeons—including myself—are increasingly turning to the use of biosynthetic meshes, often referred to as internal bras.
What Is an Internal Bra?
An internal bra is a supportive scaffold placed within the breast pocket during surgery. It acts like an invisible hammock, reinforcing the lower pole of the breast and helping maintain optimal implant position over time. This is especially important in patients who choose larger implants, have weaker tissue support, or are undergoing subfascial augmentation, where the implant sits just under the breast fascia rather than under the pectoral muscle.
Internal bras are no longer reserved for complex revisions—they’re now commonly used in primary breast augmentations when added support is needed.
Biosynthetic Meshes: TIGR® vs. GalaFLEX®
Two of the most widely used biosynthetic meshes are TIGR® Matrix and GalaFLEX®, each with their own distinct properties:
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TIGR® Matrix is a long-term resorbable mesh made of synthetic polymers that gradually dissolve over about 3 years. It provides initial strength and support, while slowly transferring the mechanical load to the body’s natural tissues as they regenerate and remodel.
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GalaFLEX® is a scaffold made from poly-4-hydroxybutyrate (P4HB), a naturally derived biopolymer. It’s absorbed over a longer timeframe—18 to 24 months—and encourages robust collagen production. GalaFLEX is particularly helpful in patients with thin tissues, previous surgeries, or implants placed above the muscle.
Both meshes have excellent track records and can be selected based on the patient’s anatomy, surgical goals, and the surgeon’s clinical judgment. I tend to use internal bras more often in cases where larger implants are placed, or where subfascial augmentation is performed—because in those settings, the tissue support is often not enough to prevent long-term implant descent.
Choosing the Right Implant: Ergonomix™ vs. Round
Motiva® implants come in two popular styles: Ergonomix™ and Round.
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Motiva Ergonomix™ implants are designed to behave like natural breast tissue. They shift shape slightly depending on the patient’s position—more teardrop-shaped when standing, rounder when lying down. These are great for patients who want a softer, more subtle look and a highly natural feel.
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Motiva Round implants offer more upper pole fullness and are ideal for patients who want a bolder, more augmented appearance while still benefiting from the safety of the nano-textured surface.
When combined with the appropriate mesh-based internal bra, either implant can produce stunning, long-lasting results—even in challenging cases.
The Bottom Line
Motiva implants represent one of the most exciting advancements in breast augmentation in the last decade. With their ultra-low capsular contracture rates, natural aesthetics, and innovative nano-texturing, they offer patients a safer, more predictable experience. However, to optimize long-term outcomes—especially in patients with larger implants, thin tissues, or subfascial placements—the strategic use of an internal bra with TIGR® or GalaFLEX® mesh can be a game-changer.
As with all surgical choices, the best approach is highly individualized. In my practice, I take pride in tailoring each procedure based on a detailed understanding of anatomy, patient goals, and the latest in surgical science—whether that means selecting the right Motiva implant, reinforcing results with mesh, or combining both for the ultimate support and aesthetic outcome.
