Surgical Planning

Breast Implant Types: Shape, Surface, Fill, Profile

UNE Plastic Surgery · Dr. Kim Uigeon, board-certified plastic surgeon · Published 2026-09-23 · Updated 2026-09-23

1. The four axes an implant is classified on

Shape. A round implant has equal upper and lower volume, spreads naturally to the side when lying down, and carries little rotation worry. A teardrop gives a natural upper slope and emphasised lower pole, but if it turns the shape turns with it. Because teardrops were paired with rough textured shells and that texture retreated over BIA-ALCL, teardrops receded too; round is rising again internationally.

Surface reads clearest in five steps: smooth (fully smooth, Mentor’s mainstay); nano texture (~4µm micro-relief, Motiva SmoothSilk, classified as smooth under ISO 14607); micro texture (Mentor Siltex); macro texture (rough — good tissue adherence but linked to BIA-ALCL, now much reduced); and polyurethane coating (well-fixated, capsular contracture reported at 1–2%, but the rough surface carries BIA-ALCL concern). The rougher the surface, the better it adheres and the lower the contracture tends to be — but the higher the BIA-ALCL risk. That trade-off is exactly why the standard settled on smooth and nano.

Fill. Cohesive gel holds together as one mass, so little leaks even if the shell is damaged; current implants use a highly cohesive fifth-generation gel. Saline collapses immediately on rupture (easy to notice) but feels like a water bag and ripples, so it is rarely used here. Profile is the side-view height: at the same volume, a higher profile projects forward and a lower one spreads wide. Higher cohesivity holds shape and cuts rippling but feels firmer.

2. Smooth versus textured and capsular contracture: what the evidence says

Rough texture is now largely avoided because of BIA-ALCL, but the question still comes up. Older work reported more contracture with smooth than textured (Hakelius & Ohlsén, Plast Reconstr Surg, 1997 — ~4× at five years),^[3] and a 2025 meta-analysis of 17,407 patients found textured had about 2.8× less contracture (Haas et al., 2025).^[2] But those figures do not separate the implant plane, so they need care.

A study that held technique constant is more informative: 253 patients, 506 implants, all placed through an inframammary incision, compared at 1 and 2 years (Filiciani et al., Plast Reconstr Surg, 2022).^[1] Overall at one year, contracture was smooth 6.1% versus textured 2.7% — not statistically different. Split by plane, the picture changes:

• Subfascial: smooth 12.5% vs textured 3.1% — about 4.4× (p=0.002).
• Submuscular: smooth 1.6% vs textured 2.0% — no difference.

The overall “no difference” came from the subfascial gap being cancelled out against the similar submuscular numbers. Two more points: by two years even the subfascial difference was no longer significant — pass the first year without a complication and later contracture risk converges. And more important, when a complication (hematoma, seroma, infection) occurred, contracture risk rose about 7× — up to 33× for smooth, about 6.4× for textured. So: under the muscle, surface choice matters little for contracture; for subfascial, weigh surface with tissue thickness; and with either surface, intraoperative hemostasis and recovery care move contracture more than the surface does. This means textured is favourable on this one measure — not that textured is recommended. Rough macrotexture is not used clinically today; the choices are smooth and nano.

3. Brands actually used in Korea

Two brands are in active consultation and surgery here — Motiva and Mentor. Sebbin’s situation changed and is covered separately below.

Motiva Ergonomix

Made by Establishment Labs (Costa Rica). Three features: a ~4µm nano-texture SmoothSilk surface; ProgressiveGel Ultima that projects lower when standing and spreads to the side when lying; and a contactless Q-Inside serial chip, plus a BluSeal barrier. Only the Ergonomix line launched in Korea — Round, Ergonomix2, and MinimalScar seen abroad are not options here. Data: a retrospective analysis of 5,813 patients followed a mean ~23 months reported overall complications 0.76% and, for primary augmentation, zero capsular contracture (Sforza, 2018).^[4] A meta-analysis of 13 studies, 4,784 patients, reported contracture 0.54% and no BIA-ALCL (Aitzetmüller-Klietz et al., 2023).^[5] Good numbers — but mostly under 5–10 years of follow-up, some studies manufacturer-funded, and no 20–30-year data yet. Ergonomix is often chosen because its profile and volume line-up is finely divided, which helps pair different combinations left and right for asymmetry; rippling is relatively low too — “low,” not “none.” No implant is rippling-free.

Mentor Classic, Xtra, Boost

Mentor (Johnson & Johnson) is one of the longest-used silicone lines. Three lines are used in consultation here: Classic Smooth (softest, feel-first), MemoryGel Xtra Smooth (higher fill, less empty space between shell and gel — shape retention and less rippling), and MemoryGel BOOST (shape retention and upper-pole volume). Xtra’s first published trial is GLOW — a trial name, not a product. A U.S. multicentre study followed 287 patients for three years; among 151 primary augmentations, infection, rupture, malposition, and rippling were all 0%, contracture 1.5%, and BIA-ALCL zero (Alderman et al., 2023).^[6] 95% were smooth and 88% submuscular. One thing to note: BREAST-Q breast satisfaction rose from 35 to 78.5, but physical well-being fell from 100 to 78 — because 88% were submuscular, with early muscle pain and activity limits; the paper itself notes recovery can take over six months. This study is manufacturer-funded.

Sebbin, and why it is not recommended now

Sebbin (France) held European CE Class III certification; its distinctive option was a micro-polyurethane-coated shell — well-fixated, contracture reported at 1–2%, suited to those with a wider chest or revising for contracture, but the rough surface carried BIA-ALCL concern. The decisive change: the maker, Groupe Sebbin, entered liquidation in March 2025, halting production and supply. So it is not recommended for new patients. Those who already have Sebbin implants do not need immediate replacement — track rupture and contracture on regular screening, and if revision becomes necessary, switch to a current line such as Motiva or Mentor after checking warranty terms.

4. Size and profile: what is measured

Size is set from diameter first, not volume (cc). If one breast is 12 cm wide, an implant diameter over 12 cm is generally not safe; diameter is fixed first, then profile and volume within it. The items measured are the five in Tebbetts and Adams’ High Five (Plast Reconstr Surg, 2005):^[7] breast base width (usually 10–13 cm, the upper limit of implant diameter), skin stretch, nipple-to-fold distance, the pinch test (skin and gland thickness — if thin, a plane where muscle covers the implant), and chest width.

At the same volume, profile changes the impression greatly. Motiva Ergonomix keeps surface and gel the same and divides by side-view height: Mini (lowest — narrow chest, thin breast, natural volume), Demi (medium-low, balance), Full (medium-high, upper-pole volume and a defined line), Corsé (highest, rarely used here). Read the size chart in one order: find the diameter row for your base width, then choose a profile — volume follows. Choose volume first and you end up with a diameter that exceeds your base width. The same 12 cm diameter across profiles:

The diameter is the same, so side spread is identical across all four; only projection and volume change. So “keep the width, add volume” is answered by raising the profile one step, not by widening the implant.

5. The four things looked at before the brand

Many ask whether Motiva or Mentor is better first, but the brand comes last. At UNE, four things are looked at first: tissue thickness (pinch test — if thin, options narrow sharply), breast base width (the real range an implant can occupy), desired upper-pole volume (a defined line, or a natural flow), and feel preference (softness first, or shape retention first). Once these are set, which line fits narrows on its own, and the brand is chosen within that. Feel read on a page differs from feel in the hand — handling an actual implant helps.

Summary

• Four axes, one standard. Shape, surface, fill, and profile/cohesivity describe any implant; the Korean standard is cohesive gel + smooth or nano + round.
• Surface and contracture depend on the plane. Under the muscle, surface barely changes contracture; subfascial shows a smooth-textured gap that fades by two years. Complications raise contracture far more than surface does. Textured is favourable on this one measure but not recommended — macrotexture is retired for BIA-ALCL.
• Brand comes last, diameter comes first. Motiva and Mentor are the lines used here; Sebbin is discontinued (2025). Size is set from base width, then profile, then volume.

References

1. Filiciani S, Siemienczuk GF, Etcheverry MG. Smooth versus textured implants and their association with the frequency of capsular contracture in primary breast augmentation. Plast Reconstr Surg. 2022;149(2):373–382. doi:10.1097/PRS.0000000000008717.
2. Haas E, Christodoulou N, Secanho M, et al. Capsular contracture after breast augmentation: a systematic review and meta-analysis. Aesthet Surg J Open Forum. 2025;7:ojaf003. doi:10.1093/asjof/ojaf003.
3. Hakelius L, Ohlsén L. Tendency to capsular contracture around smooth and textured gel-filled silicone mammary implants: a five-year follow-up. Plast Reconstr Surg. 1997;100(6):1566–1569. doi:10.1097/00006534-199711000-00030.
4. Sforza M, Zaccheddu R, Alleruzzo A, et al. Preliminary 3-year evaluation of Motiva silicone breast implants: a single-center experience with 5813 consecutive breast augmentation cases. Aesthet Surg J. 2018;38(suppl_2):S62–S73. doi:10.1093/asj/sjx150.
5. Aitzetmüller-Klietz ML, Yang S, Wiebringhaus P, et al. Complication rates after breast surgery with the Motiva Smooth Silk surface silicone gel implants: a systematic review and meta-analysis. J Clin Med. 2023;12(5):1881. doi:10.3390/jcm12051881.
6. Alderman A, Caplin D, Hammond DC, et al. Clinical results of Mentor MemoryGel Xtra breast implants from the GLOW clinical trial. Aesthet Surg J. 2023;43(12):NP1021–NP1032. doi:10.1093/asj/sjad272.
7. Tebbetts JB, Adams WP. Five critical decisions in breast augmentation using five measurements in 5 minutes: the high five decision support process. Plast Reconstr Surg. 2005;116(7):2005–2016. doi:10.1097/01.prs.0000191163.19379.63.