Reply: Motiva Ergonomix Round SilkSurface Silicone Breast Implants: The Tale of Goldilocks: Never Be Afraid of Exploring Unknown Territory

Field: Medicine (Health Sciences)

Sir: We thank Dr. Sforza for his interest in our article “Motiva Ergonomix Round SilkSurface Silicone Breast Implants: Outcome Analysis of 100 Primary Breast Augmentations over 3 Years and Technical Considerations”1 and congratulate him and his team to their recent publication on Motiva implants.2 We would like to particularly applaud Sforza et al. for implementing these novel prostheses in their practice without suffering from a learning curve. In our hands, a technique modification was necessary to achieve stable results using Motiva Ergonomix SilkSurface implants. We feel that applying standard technique sufficient for implantation of textured shaped prostheses may jeopardize outcomes with Motiva Ergonomix SilkSurface devices. We faced a 7 percent revision rate over 3 years in our cohort, with implant dislocation being the most frequent complication. We completely agree with Sforza and colleagues that surgical technique for Motiva Ergonomix SilkSurface implants needs to involve a super tight pocket and a fixation of the inframammary fold. We therefore recommend advanced methods of inframammary fold fixation3 and intraoperative implant pocket assessment.4 Although we have evaluated the performance of Motiva Ergonomix in a smaller but rather homogeneous population of 100 primary breast augmentations with an inframammary approach and submuscular positioning, Sforza et al. have shared their experience with a larger and more heterogeneous cohort of primary augmentations, primary augmentations with mastopexy, secondary augmentations, and secondary augmentation with mastopexy, including different approaches and sites of implant placement. Interestingly, Sforza et al. do not report a difference in complication rates between these groups. Based on our experience, we feel that smoother implants such as Ergonomix should be used with caution when an additional mastopexy procedure is indicated. Textured implants promote early tissue ingrowth,5 facilitating stabilization of the implants within the pocket. The reduced interaction with native tissues of Motiva Ergonomix SilkSurface implants may limit the risk for capsular contracture and permit the implant to better adapt to the normal movement of the breast, but also allow for a degree of mobility, potentially problematic when dealing with a less firm soft-tissue envelope. Financial support from industry is common in breast implant studies.2 Therefore, it can be hard to determine whether study results are reported in an unbiased fashion. It is noteworthy that our study1 was entirely independent of any company’s input and that we achieved a 100 percent satisfaction rate with the postsurgical outcome among both patients and surgeons despite suffering from a learning curve. Although the tale of Goldilocks is typically interpreted today as a discovery of what is “just right,” it was understood differently in the past. It was viewed as a cautionary tale that imparts a lesson about the hazards of wandering off and exploring unknown territory.6 However, doing just that is of pivotal importance for us plastic surgeons. Innovation will be the key to our ongoing success and survival as a specialty. Unlike neurosurgery or cardiology, plastic surgery does not “own” any part of the human body, and our continued growth depends on the development of new solutions to unmet medical needs.7 Therefore, we should never be afraid of trying out new technologies, techniques, and devices. However, it is our responsibility to critically and independently evaluate any innovation no matter how exciting. DISCLOSURE None of the authors has a financial interest in any of the products or devices mentioned in this communication. Georg M. Huemer, M.D., M.Sc., M.B.A.Raphael Wenny, M.D.Section of Plastic and Reconstructive SurgeryKepler University Hospital LinzLinz, and Private practiceWels, Austria Matthias M. Aitzetmüller, M.DDepartment of Plastic and Hand SurgeryTechnical University MunichMunich, Germany Dominik Duscher, M.D.Section of Plastic and Reconstructive SurgeryKepler University Hospital LinzLinz, Private practiceWels, Austria, and Department of Plastic and Hand SurgeryTechnical University MunichMunich, Germany