Breast Implant Options at Kare Plastic Surgery

Choosing the Right Breast Implant — Allergan, Sientra, Mentor, and Motiva

Dr. Karamanoukian works with all four major FDA-approved breast implant manufacturers and selects the implant for each patient based on her anatomy, goals, activity level, and personal preferences rather than on brand loyalty or financial incentives. Every implant line has distinct clinical characteristics, surface technologies, shell architectures, and gel formulations that make certain implants better suited to certain patients. Understanding the differences between them is the foundation of an honest consultation at Kare Plastic Surgery.

Allergan Natrelle — The Most Widely Used Implant in Los Angeles

Allergan's Natrelle collection remains the most widely placed breast implant in the United States and the most recognizable name in breast augmentation. The Natrelle smooth round silicone gel implant has one of the longest safety records in modern breast surgery, with published core study data extending beyond ten years showing well-characterized rupture rates, capsular contracture rates, and patient satisfaction outcomes. For patients and surgeons who value a deep body of real-world evidence, Natrelle smooth round silicone implants represent the most extensively studied option available.

Allergan's Natrelle 410 is the flagship form-stable cohesive gel implant, commonly called the gummy bear implant. The 410 uses a highly cross-linked silicone gel that maintains its shape even when the shell is cut, resists gel migration, and provides a teardrop profile that mimics the natural slope of the breast from upper to lower pole. The 410 requires a textured shell to prevent rotation in the pocket, and Allergan's textured surface has been studied extensively. Surgeons and patients considering the 410 should discuss the device's specific textured surface and its long-term safety profile at consultation. Dr. Karamanoukian reviews the complete published literature on textured surfaces with every patient who is a candidate for shaped implants.

Sientra HSC and HSC+ — The Surgeons' Implant

Sientra implants are manufactured exclusively for board-certified plastic surgeons and are not sold to medspas, non-physician injectors, or aesthetic centers — a distribution policy that sets Sientra apart from the other major implant manufacturers and reflects the company's commitment to surgical quality standards. Sientra's High Strength Cohesive (HSC) and HSC+ silicone gel formulations use a proprietary cohesive gel that is firmer than conventional silicone, providing a more defined shape with less rippling and better projection retention over time. This makes Sientra implants particularly well-suited to patients who want a more defined, structured breast shape and to patients with thin overlying tissue where implant edge definition and rippling resistance matter most.

Sientra's core study published results extending to ten years show competitive capsular contracture rates with their smooth round implants and strong patient satisfaction data. The company also produces a line of shaped textured implants for patients seeking an anatomic profile. Dr. Karamanoukian finds Sientra's smooth round HSC and HSC+ particularly useful for patients who want more projection than a standard smooth silicone provides without moving to a shaped or textured device.

Mentor MemoryGel and MemoryShape — Predictable Softness and Reliable Data

Mentor's MemoryGel smooth round implants are known for producing one of the softest and most natural feeling results available in silicone gel augmentation. The MemoryGel formulation uses a responsive gel that returns to shape after compression, providing a feel that most patients and surgeons describe as very close to natural breast tissue. Mentor has published consistent long-term safety data across multiple cohort studies, and their smooth round implants have well-documented complication profiles that allow straightforward informed consent discussions.

Mentor's MemoryShape is the company's gummy bear equivalent, using a form-stable highly cohesive gel in a teardrop profile for patients seeking an anatomic shape. Like the Allergan 410, MemoryShape requires a textured shell. For patients who are good candidates for round smooth implants — which represents the majority of breast augmentation patients — Mentor MemoryGel is a consistently reliable choice with decades of published outcomes data that Dr. Karamanoukian reviews with patients at consultation.

Motiva SmoothSilk — The Newest FDA-Approved Option with Breakthrough Safety Data

Motiva received FDA approval on September 26, 2024, after completing the most rigorous premarket approval study ever conducted for a breast implant in the United States. The five-year results from the FDA pivotal trial of 451 primary augmentation patients showed a capsular contracture rate of 0.5% at five years — the lowest ever documented in a prospective U.S. FDA breast implant study. No cases of BIA-ALCL or BIA-SCC were reported across the entire study cohort. Patient and physician satisfaction exceeded 97%.

The clinical advantage of Motiva lies in its SmoothSilk nanotextured surface, which is engineered below 2 micrometers of surface roughness to reduce the macrophage and foreign body giant cell activation that drives capsular contracture formation. Published studies comparing Motiva to Mentor smooth round, Mentor MemoryGel, Allergan Microcell, and Allergan Biocell surfaces have documented significantly reduced immune activation with the Motiva surface. For patients for whom capsular contracture is the primary long-term concern — particularly those with a prior history of contracture or who are seeking revision — Motiva represents a meaningful clinical advance over the current standard of care.

Breast Implant Revision & Silicone Disease

Breast Implant Revision and Silicone Disease — A Complete Clinical Practice

Not every breast augmentation produces a result the patient is satisfied with over time. Implants can develop capsular contracture that causes hardening and distortion. They can shift from their original position. They can rupture. The patient's body can change through weight fluctuation, pregnancy, or aging in ways that make the original implant size or placement feel wrong. And a growing number of patients are experiencing symptoms that they attribute to breast implants and are seeking removal as part of addressing their overall health.

Breast Implant Revision Surgery in Los Angeles

Revision breast augmentation is significantly more complex than primary augmentation because the surgeon is working within the existing pocket anatomy that the first surgery created. The capsule that formed around the first implant has its own structural properties that affect where the new implant will sit. If the original implant was placed in the wrong pocket position, correcting it requires addressing the capsule itself, either releasing it, partially removing it, or using internal sutures to close off the old pocket and create a new one. Dr. Karamanoukian sees breast implant revision patients from across Los Angeles who are dissatisfied with the results of prior surgeries performed at other practices. His consultation process begins with a thorough analysis of what went wrong and a candid assessment of what can be improved and what the limits of revision are.

The most common problems that bring patients to Kare Plastic Surgery for breast revision include capsular contracture (Baker Grade III and IV), implant malposition or displacement, symmastia (implants meeting in the middle), bottoming out (implant descending below the fold), double bubble deformity, rippling and implant palpability, implant rupture, and dissatisfaction with the size or shape of the original result. Each of these requires a specific surgical strategy and Dr. Karamanoukian explains the recommended approach and the expected outcome for your specific situation at consultation.

Breast Implant Illness and Silicone Disease

Breast implant illness (BII) is a term used to describe a collection of systemic symptoms that some patients attribute to their breast implants, including fatigue, brain fog, joint pain, hair loss, dry eyes, and immune system changes. While BII does not have a single universally agreed clinical definition, the growing body of patient experience and emerging medical research make it clear that some patients experience meaningful improvement in these symptoms following implant removal. Dr. Karamanoukian approaches every patient who presents with BII concerns with the same thoroughness he brings to any clinical problem: a complete evaluation of the patient's symptoms, a review of the implant history including implant type, age, surface, and any documented complications, and an honest assessment of the evidence for and against implant-related causation in that individual patient's case.

Silicone disease, more formally described as silicone-related disorder or silicone lymphadenopathy, refers to the specific immune and inflammatory response that some patients develop to silicone that has escaped from implant shells into surrounding tissue or regional lymph nodes. This can occur with implant rupture, with gel bleed from intact implants over time, and with older generation implants that had less stable gel formulations. Dr. Karamanoukian's dual board certification in lymphatic surgery gives him a distinctive advantage in evaluating and managing patients with silicone lymphadenopathy, as the lymphatic anatomy of the axilla and chest wall that is affected in these cases is within his core surgical training.