The Hybrid Breast Augmentation – What is it? With Dr Marcus Sforza

Trish: Hello everybody out there in podcast land again. I’m really excited because I’m talking today with Professor Marcus Sforza, and he’s actually a aesthetic surgeon whose base in the UK. His specialty is orthopaedic surgery. He likes to specialise in the breath. We’re going to have a talk about the new Motiva Implants and some papers that’s been published … obviously anyways. Really exciting. I’m going to pass over to him. Thank you so much for joining us today.

Dr. Sforza: Thank you.

Trish: Now can you tell us, you’ve got the most experience with MBI and you’ve recently published a paper in the Aesthetic Plastic Surgery Journal around about 5,000 patients in this study. Can you tell us a little bit about that with the Motiva Implants?

Dr. Sforza: Yes. We did the first big study for Motiva. We started using Motiva Implants back in 2013. Some people still had questions about the long term use of the Motiva Implants so it was very important for us to do this study, where we follow up about 6,000 patients. We was the first time that they published such a large series with Motiva Implants and so low complication rates.

For you to have an idea, we basically almost reduced a 10 times fold, the number of complications of surgery with Motiva in relation to any other competitors in the market. Just by changing the implants, we managed to have 10 times less complications or revision rates. I think this was very reassuring for our patients. Today, in our practise, Motiva is implant of choice. In our practise today, there is no space for any other implants because we believe that patient safety is the most important thing for us. I want to believe that smooth implants, Motiva Implants will be ALCL free. That’s very important for me and my patients.

Trish: Because really before that, the implants that were around were actually … They’ve been around forever, haven’t they? Before the Motiva came out? It was time for a new implant really.

Dr. Sforza: Yeah, it’s not the fault of the companies because it’s not that any one is good or bad or they don’t want to upgrade. It is a very difficult system created by the FDA in a way because the cost for you to get a perspective study to get an implant approved to the American market … which is a big target because the American market is the largest market and more profitable market in the world. To get to that market, implant companies have to invest too much money. Motiva is now starting an IDE study, hopefully very soon, for the American market. These studies, they cost millions and millions of dollars.

After you get your implant approved by the FDA, everything that you change, you have to go through the same process again. It doesn’t encourage the companies to upgrade in a way because you forget that. It’s too hard.

Trish: It’s too hard, yes.

Dr. Sforza: That’s the advantage of Motiva because Motiva was not licensed by the FDA. They took a good number of years just to put as much innovation as they could before it starting this process. They really tried to become avant garde. Then, you start the FDA process and moving. Also, the first thing that really attracted me to Motiva is the amount of investment in research and development. That’s incredible. In less than 10 Motiva is going to his fifth generation of implants. Why? Because they keep pushing, pushing, pushing, pushing. If you think about the whole industry, the whole industry is not the fifth generation of implant. Motiva run through five different generations in less than 10 years.

Trish: It’s like they committed to continuous improvement really.

Dr. Sforza: They decided that they could do better. That they would be patient centric company. That was a very, very important thing because, before, the companies would get a group of surgeons, listen to their wishes, design devices, and then, create ruse so every surgeon could use that device in every patient. Motiva did it the other way around. They went to the patients not only to surgeons. They were patient centric, so they listened to the patients and what their patients wanted.

First, they wanted less complications, of course. Second, they wanted softness. They want implants that really could feel like breast, not too hard. Third, they want to go back to their own activities as quick, quick, quick as possible. All of this, you could only achieve with innovation and engineering. All the implants are engineered to give that to the patients. Then the surgeons are just there to put them in.

Trish: To put them in, yeah. I know that there’s a new classification coming from Europe as to how breast implants and their classification are classified. I think that’s maybe filter through, but, can you tell us a little bit about that? The breast implants classification.

Dr. Sforza: There is an ISO committee which decides the classifications and everything related to the implants. This ISO committee decided that it is going to be officially released but the consensus was made that the normal surfaces of Motiva Implants are actually a smooth silk surface. Basically what we’re trying to tell our patients and other surgeons is that this new silk surface … which is a smooth surface … actually is a surface that has the benefits of a textured implant and the benefits of a smooth implants in the same device. It will be qualified as a smooth implant.

Trish: Because some of the figures that were being bantered around … tell me if I’m right … three years data using textured implants and the re operation rate was about 8.5% over three years. That’s what it is captured or contracture or whatever. The same surgeons, with no changes of the techniques, but just changing the implant to Motiva nano surface, their re operation rate was one percent. Is that right?

Dr. Sforza: Or less than one percent.

Trish: Less than one percent. That’s huge.

Dr. Sforza: That’s a big difference, right?

Trish: Yeah. Yeah.

Dr. Sforza: That is only technology. The devices are not making better surgeons. It’s just that the devices are upgraded. Look, this is everywhere. You know that iPhone 8 is better than the 7. The 7’s better than the six. You know that the next model is going to be so much more upgraded and better. The same principles should apply to medical devices. As I say to my colleagues and my peers, plastic surgery is the only specialty that sometimes is still trapped on this. If you talk to an orthopaedic surgeon, they’re not doing knee replacements or hip replacements with 25 year old devices.

Trish: That’s true. It’s always changing. Always new stuff.

Dr. Sforza: Yes, we’re not putting heart valves 25 year old technology.

Trish: Makes sense.

Dr. Sforza: I understand tradition and I understand all of this, but we have to find a leeway so we can have all the necessary upgrades, skip, and keep the safety.

Trish: Moving with the times.

Dr. Sforza: That’s what Motiva is trying to do.

Trish: I want to ask you for the minimal scar techniques, like from a patient point of view. Can you tell us a little bit about the minimal scar techniques that

Dr. Sforza: Yes, of course. This is one of the things I focus my career on. The minimal scar I think is the future. Now that we have an implant that is much more elastic, that’s much softer … It’s not that better surgeons do smaller scars. It has nothing to do with the surgeon. Every surgeon can do a minimal scar. The problem is older devices, older implants are so hard that they physically don’t go through. Now with the use funnels and this ultra soft Motiva Implants, you can really systematically do a two point five centimetre scar or two centimetre scar on every single patient.

Eventually, I believe and that I see my practise and my Instagram, patients start to tell each other, “Look, why do I have a scar double than yours?” Then, I think this is not again, not because one surgeon is better, it’s just because we are now using a device and other surrounding devices … like Motiva created special retractors. Motiva has a funnel. Everything focused on making the scars smaller and smaller and smaller. I think women would appreciate if they have a scar that is two centimetres under your breast to put a large breast implant. It’s so much better and easier to hide than the larger scar. I think we’re moving and I want in the future that every surgeon will be able when they use this devices to do very small scars and give the patients better results.

Trish: One of the things that excites me the most or what I’ve really enjoyed hearing about today, is using what you call the hybrid technique, which is the implants in the fat. Which is, even for skinny girls as well … slim girls or someone that’s got something irregular. I think that’s going to be trend that’s going to be happening more. Can you tell us a little bit about what we call the hybrid technique?

Dr. Sforza: Yes, BBLs, Brazilian buttock lifts, are all over the place. All girls know about putting fat. The ladies, they know, you can take fat from somewhere and put it somewhere. It’s focused on the buttocks, but you can put anywhere. You can put on the face and of course you can put in the breast. What’s the benefit of using the fat on your breast? It’s because the surgeon will have the capacity to really sculpt the breast. Then you can give a better cleavage. You can give a nicer rounder, even softer breast to touch. Most important, you can reduce the implant size. I can give the patient a result of if they want a larger breast, of a D cup, with a C cup implant.

This will be much less complications, much quicker recovery time, and a much, much more natural sculpted breast. This is what I do all the time. We use 3D technology. We combine through technology to evaluate the volumes. We have a whole set of cannulas that Motiva developed. Then we have everything to give a very predictable … so the girls will have as long as they want with as small as possible implants with the plus of having some lipo wherever they

Trish: Bonus of getting skinny.

Dr. Sforza: Even the thinnest ladies, they have areas that they want to get rid of.

Trish: That’s true and like Dr. Marsovich was saying, even thin girls, you can usually get some fat off the inner thighs.

Dr. Sforza: Absolutely.

Trish: Awesome. I’m going to ask you one … Oh sorry, and talking about that, so if someone’s got a pigeon chest, you can actually fix that with that as well hey.

Dr. Sforza: You can improve something that implants only could not get. Or a pigeon chest or a pectus excavatum when it’s the other way around where the bone in the middle is really deep. You can also improve a lot of the shape using the fat in the middle. Fat is now a part of our way of doing surgery and then we are going to do more on. Today, every time I’m in the OR, every single list I’m having, I have at least one case that I’m doing hybrid augmentation. Every time. When two years ago, I would probably do one hybrid case every three, four months. Now, it’s every time I’m in the OR, I’m doing a hybrid case.

Trish: Wow. I’m going to ask you one last question. It’s about ALCL. The anaplastic lyph … Well, you say it for me.

Dr. Sforza: The anaplastic large-cell lymphoma.

Trish: That’s it. Can you tell what your beliefs are and are you worried about ALCL or biofilm with the implant that you’re using with the Motiva or has that made it a little bit less worrying for you?

Dr. Sforza: I think that there is no case ALCL with primary smooth implants. In that sense, the material behaviour is that with smooth, we discussed about the new classification. Motiva will have the benefits of the texture in terms of avoiding capsular contracture. I truly believe that it will behave as a smooth in relation to the ALCL. We don’t know exactly what’s behind the ALCL. I don’t see in my practise that any patients not doing surgery because they’re afraid of the ALCL. I think it’s something you discuss with the surgeon, you understand, and you are safe.

In my personal opinion, we are as safe as Motiva as we would be with a smooth implants. When there are other implants on the other side of the spectrum that have a much higher risk of developing ALCL. That’s a plus. Actually, my patients, the know that I use Motiva so they don’t ask about ALCL. I don’t discuss ALCL with my patients because the regulations where I live in the UK, they are very clear. You have an obligation to inform about ALCL if you’re using textured devices. Motiva is the smooth silk surface, so has only the benefits of the texture without being highly textured. I think the patients are really comfortable moving forward there.

Trish: Thank you so much for your time. It’s been really fantastic.

Dr. Sforza: Thank you.

Trish: Ladies if you want to learn all about the Motiva Implants, just go to the website just on the plastic surgery hub. In the search bar, just type in Motiva or drop us an email at [email protected]. We can let you know which surgeons in Australia, or anywhere else in the world, that are actually using Motiva Implants, so thank you so much.

Dr. Sforza: Thank you.

Trish: Okay. Ciao.

Dr. Sforza: Ciao.

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