Dr Liew is one of the most sought after and leading plastic surgeons in Australia. Today I speak with him about the Motiva Implants and why he loves them and chooses to use these next gen implants when performing breast augmentation.
Trish: Good Morning podcasters. Well, I’m here today with Dr. Steven Liew. And Dr. Steven Liew is one of Australia’s leading plastic surgeons, and today, he’s the Director of the Shape Clinic in Sydney. And today we’re going to have a talk about the Motiva implants. Our topic is the natural breast with the Motiva Ergonomics Implants. So, welcome, Dr. Liew.
Dr. Steven Liew: Thank you for having me, Trish.
Trish: Thank you so much for taking the time out of your busy day.
Dr. Steven Liew: You’re welcome.
Trish: So, look, I know Motiva seems to be taking Australia by storm at the moment. Could you tell us, first of all, what are the surgical areas and specialty that you do?
Dr. Steven Liew: As a cosmetic plastic surgeon, my main area of focus, is in the breast and face area.
Trish: Okay, great. Well, I know that you’re amazing on the face, because you’ve done some amazing things with my face. So, you do breast specialty as well.
Dr. Steven Liew: Yes
Trish: Great. So, I’m going to ask you a couple of questions if you don’t mind, just to answer some questions by readers, and people that are interested in Motiva Implants. So, I know that sometimes there are some likely complications with breast augmentation surgery, and how can the risk be controlled, or minimised?
Dr. Steven Liew: Like any form of surgery, including breast augmentation surgery, there’s always some potential risk. But the lucky thing is, with breast augmentation surgery, in most careful, professional specialist hands, it is very, very, very low. And most of the time, they are quite minor.
I think to answer your questions, to your readers, the main one, that as a surgeon that we want to stress will be to the risk of bleeding. Once again, those are low. They can be under meticulous known surgical technique, and also for the patient to avoid certain medication that potentially can increase the risk, such as any inflammatory medication like aspirin.
The other big one has been infection, together with what we call capsular contraction. That is scarring around the implant, that eventually cause distortion. And this, once again, can be avoided by adhering to a very specific technique. In Australia, we call it the 14 point recover technique.
Basically, essentially, it’s a no touch technique. We want to have a meticulous surgery, doing under vision, to what we call a shell technique, meticulous stopping any bleeding. And then, the surgeon, and the surgeon alone, is the person who will get the implant to be open from the sterile case, and then place it inside, or underneath the breast in the shortest period as possible to reduce “any exposure or contamination.”
And of course, the surgeon would change their gloves, and do want we call a non-touch or minimal touch technique. That has been proven, scientifically, to be very effective to reduce infections. More importantly, long term, to reduce thick capsular contraction formation.
Trish: Okay, so of course, that’s why women should really do their homework on the type of clinic and the surgeon that they are choosing to have their surgery with, isn’t it? Because you want to make sure all those boxes have ticked, and that you’re in less risk of anything, don’t you?
Dr. Steven Liew: That’s absolutely right, because, you know, breast augmentation surgery is a lot more than just putting an implant in and choosing the implant. There are multiple steps a specialist surgeon will consider before even going into that surgery. Patient skin has been cleansed, and there are various other manoeuvres we do before we even actually make that final incision.
Trish: Of course. And, so why do you chose to recommend Motiva Breast Implants to your breast augmentation patients? And are they … Is there a particular type of patient that they are best suited to?
Dr. Steven Liew: I was first attracted by Motiva Implant about two, two and a half years ago, from a conference. I was attracted to it, essentially, by the science behind Motiva Implants. That, to me, is the progress in breast surgery because if you think about breast implants, the concept of a breast implant, and the type of breast implant, has not changed for the last thirty years.
So, when I heard of this new, completely different approach to this breast implant, it automatically attracted my attention. It’s the science behind it. The science behind it, is to talk about why do we have to accept that women have implants, must have a capsule or scar formation around it? What can we do to actually make this a thing of the past?
By manipulating the surface of the implant, the so called, nano-texturing. That to me, is the major break through in the development of the breast implant, that attracts me. And of course, having that attraction, I do a lot more investigation, a lot more research in the science behind it, looking at literature.
And then, finally, I’ve used the implant for the last two years, and I’ve been an extremely happy by it. Not only by the result, but also by the feedback from the patients.
My greatest joy of using Motiva Implants, particularly the ergonomic range, is allowed me to create a breast that is not only natural, not excessively full look in the upper part of the breast. A more of a tear drop look, a more natural look. But it is also very soft to touch, soft to look, and it animates, that is, it moves with the patient. So, that to me is a basic requirement, for me as a breast surgeon, to have what I call a good or great cosmetic outcome from the breast implants.
Trish: Yeah. And you know what? I mean, I was impressed by the Motiva Implants when I found out the fact that they had a microchip in them because I remember when all that big PIP disaster was happening. People didn’t know what implants they had, whereas at least the microchipping is just an added bonus, as well, because you know where they’ve come from, and what number they are, and at any point in your life you can go to the doctor and know exactly what implants you’ve got in you, as well.
Dr. Steven Liew: Absolutely. They serve dual purposes. One, is for patient’s reassurance, if there’s any concerns in the future, they can get the “breast scan” without going through ringing up hospital what implant they have.
The second thing is, from surgeon’s perspective, it’s many times we can patient who had breast implant done, seven, eight, nine years ago, most of the time the medical record has already been destroyed, or they come from overseas.
And for our planning perspective, this was consultation perspective … Well, we took the patient … It’s actually much better to have a definitive idea what implant the patient had in their chest, and then, to be able to have a very precise consultation on what size to go next because we do have a reference point. Rather than, I think you have this, or maybe, this is this. We can change the conversation. You had this? Is this the size? This is the dimension, this is the width, this is reduction … I would suggest going… I think it’s a very, very convenient feature.
And it’s one thing, it’s called progress. Because as a plastic surgeon, there has not been any progress in breast implant for the last 30 years.
Trish: Yeah. It’s true. It was just the right thing at the right time, I think. I heard a story the other day, of a patient who actually did go overseas, and have some implants. She had them removed, to get them replaced here. And she actually had two totally different implant brands, two different sizes. One was smooth and one wasn’t. I was just like, “Whoa.” She didn’t even know what was in her body.
Dr. Steven Liew: Yeah. I think now is … I think, hopefully now, in this country, we will not see any of this thing done, and with the ability of the patient, having a chip implant, all of that should be more comfortable for them.
Trish: Yeah. Totally. So, what complications did the Motiva Ergonomix Implants avoid in comparison to traditional teardrop or anatomical implants?
Dr. Steven Liew: Well, I think when we talk about anatomical implants like may gel, all the anatomical implant we have in the market, they do need that degree of roughness, or texture, severe texturing, to the surface implant, so that it will stick and it won’t move. With anatomical implant, it would move, then, the shape of the breast, or be completely distorted and look quite odd. That’s one of the requirement.
With Motiva Ergonomix, with it’s nano texturing it allows movement. But more important, with the type of gel they have, which is, once again, cohesive or… but is a softer cup, or gel. It allows the distribution of the gel in the lower pole, simply from gravity. That itself, automatically creates a teardrop shape, hence, a very natural result when you look at the patient three months after surgery.
Because it is a round implant, it doesn’t really matter if it rotates. So, first of all, using Ergonomix, Motiva Ergonomix, you avoid the risk. You completely eliminate the risk of rotation from a classical teardrop, but get the benefit of a teardrop appearance.
Trish: Okay. So, the Motiva Ergonomix Implants are round. So, how do you get the teardrop shape then?
Dr. Steven Liew: The teardrop shape is because of the quality of the gel. The Ergonomix have a slightly different firmness, and quality, of the gel. When the patient stands upright, and the distribution of the gel itself were to create that shape.
Trish: Okay. Right. So, what technique do you use with the Motiva Ergonomix Implants to help to achieve that soft, natural look?
Dr. Steven Liew: So, the technique is almost the same as what we do with a classic operation. Because it is not a teardrop implant, it does allow me to have a little bit more of a leeway in terms of the exact fit of the implant.
So, with the Ergonomix Motiva, I can create a pocket that is just slightly larger than the implant to allow a little bit of movement, which simulates a natural breast, without the risk of any rotation.
Trish: Okay. I know we’ve had that talk lately about the complications, and the risk of cancer and all that, with … that implants can cause. So, can breast implants cause an increased risk of cancers, or other lymphoma? And if so, is there anything that we can do to reduce the risk there?
Dr. Steven Liew: I think this is a very good question, and a very current question. This is the most highly discussed phenomena in … among plastic surgeons that does a lot of breast surgery. There is a type of cancer, or lymphoma, specifically related to breast implant. Let me … not qualifying. This is not your breast cancer. That is, this is a type of lymphoma that arise from the capsule or the layer of scar surrounding the implant, as opposed to, the breast cancer that we’ve heard of that occurs within the breast tissue.
So, in effect, this is a misnomer. It is not a breast cancer. It is a type of cancer arising due to the breast implant, due to the scarring in under breast implant. The technical term is ALCL, or anaplastic large-cell lymphoma.
Interestingly, Australia is actually a pioneer in this area because there has been a large, high quality, publication. The incidence of ALCL is about 1 in 4000, to about 1 in 60,000. It basically depends upon the type of breast implant.
We now know that an implant with a rough, highly rough texturing, has a higher risk compared to those with a smoother type of implant. Put that in perspective, the incidence of female in Australia to have a lifetime risk of developing breast cancer, that is, cancer arising from the breast tissue, is about 1 in 8. So, we are talking about ALCL, associated breast implant in 1 in 4000, to 60,000. So, this is very, very, very low risk.
But, nevertheless, we as a surgeon, we want to eliminate that risk to as low as possible. So, hence, we have to be very meticulous in when we do the surgery to reduce any risk of infection or contamination. But more importantly, this is where Motiva has out shine itself. That’s not the reason why Motiva was developed, but it’s just that this become so topical.
There has not been any cases of Motiva associated ALCL reported. Motiva has been used over six, or close to about six to seven years now. So, even though it’s a fairly new type of implant, it has been around for six to seven or eight years, which is the average time where ALCL will occur. So, today there will nowhere in the literature, there has not been a case associated with ALCL, so that’s an extra bonus.
Trish: Mm-hmm (affirmative). And I guess that’s why women should know, or at least research, which brand of breast implants they’re choosing, as well.
Dr. Steven Liew: Right.
Trish: Yeah.
Dr. Steven Liew: I think now we should all be a lot more transparent. I normally tell the patient what implant I use, so that they know. I’ll get them to do some research about it, rather than just take my word for it.
Trish: Yeah. Of course. And I suppose you kind of answered this in a way, but how do you think the Motiva silk nano surface helps reduce complications with breast implant surgery?
Dr. Steven Liew: I think this is a very good question because I say this is the main reason I chose Motiva, is from the technology. Because it’s nano texture, it is still a rough implant, but when you look at it you wouldn’t have thought so. That’s because of the nanotechnology. It does regulate the cell involved in creating the capsule, which is a fibroblast. Fibroblast is the cell in our body that lay down collagen.
Now, there has been some histology, high grade histology, looking at the activity of the fibroblast. It’s been shown that with Motiva, because of the fine tune adjustment of the texturing, it actually put the fibroblast tissue at rest, and it is functioning, rather than sitting dominant. So, that’s one of the reasons why we see lack of capsular contracture in Motiva, from all the literature today.
Trish: Yeah. And, look, as a patient you really want to minimise the risk as much as you can on your side, just by picking the right implant, picking the right surgeon. Hey.
Dr. Steven Liew: Correct. Absolutely.
All right. So, why would you say that women thinking about breast surgery should come and talk to you?
Dr. Steven Liew: Well, I think the most important thing is, women come in different size and shape. Women’s breasts come in different size and shape. Apart from … Breast implant is a lot more than just putting the implant in.
I’ve always said, when you enhance a breast, everyone can put the biggest implant in, but I think choosing the right size for you, not only for your breast, but also complement the body. It’s the bit that most of us, most patients don’t even think about. You and I have same woman, beautiful breasts, but may not be suitable. Instead of enhancing the whole body shape, it sometimes makes them look a little bit too top heavy, or too plump. And I think that is probably the worst thing we can do to women in breast augmentation.
It is still our role to actually, perhaps, discuss this with the patient that a certain size suits them. When you go beyond a certain limit, it may be counterproductive. Rather than beautify them, I think it’s actually downgrading them. That’s what I think, what you’re selecting when patient comes into see me.
Trish: It’s very much an aesthetic science and art. There’s no doubt about it.
Dr. Steven Liew: Absolutely. So, apart from just thinking about the shape of the breast, cleavage, how full the upper pole, how much, et cetera, and all this stuff, one should also think of the body shape. Not just the chest but the whole, overall, body shape.
A typical example would be, someone who are very skinny and lanky, with a long chest, it does not make sense to give them a full round breast, because it simply doesn’t compliment. You might as well give them something that complements an elongated look, and choose an implant that will create more elongation, rather than just…
Trish: Yeah. And I suppose when someone has a consult with you, at least you can … because someone might come in saying, “Oh. This is what I want.” But once you explain to them how that’s going to sit on their body, they might think, “Oh. Okay. That’s not the look that I’m after, even though that’s what I thought that I wanted, this is what I want.”
Dr. Steven Liew: At the end of the day, it should be a two way street. This is a conversation between the patient and you. They will tell you what on their wish list, and if that match the surgeon aesthetics, then it’s a win-win situation. Otherwise, if it’s not, it is my responsibility to discuss this, so that they can end up with something that will look aesthetically pleasing.
Trish: Yeah. That’s so true. It’s all about the patient making an informed decision, isn’t it? Once they know all of the information, they can actually make the right decision for them, with the surgeon.
Dr. Steven Lieu: Correct.
Trish: So, tell me, just one last question. What are your patients saying about their results with the Motive Breast Implants?
Dr. Steven Liew: I think the commonest saying will be, “I love my breasts compared to what my friends has. I like mine better because it feels very natural. It looks natural.” And I think that’s the biggest difference I’ve heard in the last eighteen months, or so.
Trish: Yeah. They look fantastic. Like, I don’t even want breast implants, but I want them, the Motiva ones, that is.
Dr. Steven Liew: Yes.
Trish: That’s awesome. Well, thank you so much. That’s been really interesting today, and great to hear that it’s … I mean, we all know this, but it’s definitely a two way thing. You’ve got to discuss with your surgeon what’s right for you. It’s not just one implant for everyone, it’s whatever you want. There’s a different implant in the Motiva range that would actually work better for you. And of course, why not lessen your risk of anything going wrong, really?
Dr. Steven Liew: Yeah. Absolutely.
Trish: Awesome. Well, thank you so much for your time today, Dr. Lieu.
Dr. Steven Liew: Thank you for having me, Trish.
Trish: Pleasure. So, listen, if you would like to see Dr. Lieu, you can get in contact with him at Shape Clinic. Be warned, book well in advance because he’s very, very busy. So, if you look him up online, www.shapeclinic.com.au. Otherwise, drop us an email to info at plasticsurgery.com.au. Thanks so much, Dr. Lieu.
Dr. Steven Liew: No problem. Thank you so much. Bye-bye.
Trish: Bye-bye.