Dr. WorldWide | Frank Agullo, MD

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A woman sat in my consult room last week, pulled up a photo of herself at twenty-five, and said the line I hear several times a week. She wanted the fullness she used to have, and she wanted to know why she should drive past three closer surgeons to see me.

Here is the honest answer. For most augmentations I do now, I never touch the muscle. Not minimally. Not partially. Not at all.

That is a bigger deal than it sounds, and it is the reason recovery looks nothing like what your mother or your older sister went through.

What the Preserve Actually Is

The Preserve augmentation is prepectoral. The implant sits in front of the pectoralis muscle and behind your breast gland, above the muscle but below the gland. I do not cut the muscle, release it, or go under it.

That distinction is everything. A traditional submuscular augmentation goes behind the pectoralis and partially releases it off the chest wall. That release is the source of the long, sore, six-to-eight-week recovery patients remember. Preserve never goes there, so that whole chapter disappears.

I make the pocket by balloon dissection. No cutting, no electrocautery. The tissues are pushed outward, and the pocket is defined by your breast’s own ligaments. Those ligaments hold the implant in position, which is why I do not need mesh to support it.

That also means the nerves and arteries stay where they belong. You keep a higher likelihood of preserving sensation and breast function, because I am not dividing the structures that supply them.

Preserve Versus Traditional, Side by Side

How I Pick Your Size

Cup size is a starting point, not a measurement. I work from your dimensions and a Chrysalix 3D simulation, not from a letter on a bra tag.

Almost everyone has some asymmetry, and that is normal. Breasts are sisters, not twins. So I will often choose slightly different volumes on each side to get you closer to even.

There is a quieter advantage to placing above the muscle. I can put the implant precisely where your breast needs the most volume instead of filling the whole breast uniformly. A smaller implant can give a larger apparent size and a little lift. Lighter breast, same result you wanted.

The Implants I Use, and the Ten-Year Myth

I use Motiva Ergonomix. The old rule about swapping implants every ten years does not apply to these. The rupture rate is under half a percent, and they carry a lifetime guarantee.

The surface matters too. These use a nano-surface called SmoothSilk, which produces the lowest inflammatory response of any implant on the market and an extremely low capsular contracture risk. They are soft, the gummy bear type, and they take on a natural teardrop shape when you stand. Ergonomix implants move with the body, so you do not get that fixed, stuck-on look.

What Recovery Honestly Looks Like

This is the part that surprises people, so I will be specific.

I do it under light conscious sedation. You breathe on your own, and you will not remember much. I place Exparel, a long-acting local, between the ribs so the breast stays numb for about the first three days. The incision is two and a half to three centimeters in the fold under the breast, hidden where you will not see it.

The implant placement takes about thirty minutes. Patients are usually awake, pain-free, and able to raise their arms overhead before they leave, often within an hour. Many go back to work the next day, and the gym is reasonable at about two weeks if augmentation is the only thing we did. Add a lift or liposuction and the timeline shifts, and I will tell you that up front.

Why I Was One of the First to Do This

Being an early adopter of Preserve was a deliberate choice. Motiva trained me directly as one of roughly twenty highly selected surgeons in the United States, and I traveled to Costa Rica twice for that training. There are still fewer than forty surgeons in the country doing this.

I am a double board-certified plastic surgeon, certified by the American Board of Plastic Surgery and the American Board of Surgery. I completed my plastic surgery fellowship at the Mayo Clinic and I teach as a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. I committed to preserving your own anatomy because it recovers faster and ages better than cutting through muscle ever did.

The Animation Problem You Avoid

Here is a detail patients rarely hear about until it bothers them. With a traditional submuscular implant, every time you contract your chest, the muscle squeezes the implant and the breast moves or distorts. Surgeons call it animation deformity, and it is a direct consequence of putting the implant under a muscle that is built to move.

Preserve sidesteps it entirely, because the implant never goes under the muscle. You can do a push-up, a plank, or a heavy press without watching your breast jump. For an athlete, a CrossFit patient, or anyone who lifts, that is not a small thing, and it is one of the quieter reasons I prefer this plane.

One Honest Caveat

Preserve is not for absolutely everyone. Very thin patients with almost no breast tissue sometimes need a different plan, and I will say so in the room rather than force the technique. If a standard augmentation or a fat-based approach fits you better, that is the conversation we have.

Read the Patient-Facing Versions

For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com. For the practice overview, see the version on swplasticsurgery.com.

Ready to Talk?

The honest answer to what size and which implant is right for you needs an exam and a 3D simulation. Come see me.

Call the office at (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

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Compared to five years ago, we weren’t doing any of these procedures. Since then, the procedures have increased in demand exponentially, to where we’re probably doing twenty to thirty procedures per month, since around 2024. We’ve actually seen a lot of patients traveling for these procedures from other states and around the country.

I want to talk about it the way I would with a colleague, because the demand is telling us something. So here is the candid version.

Who Is the Typical Patient

The typical patient is actually anything you can imagine. There are really no stereotypes in terms of who’s seeking these procedures. There’s a wide range of ages and a wide range of races. You would think that a lot of men would consider themselves small, and that’s why they’re obtaining these procedures, but actually, a lot of men are already well-endowed, and they’re just looking for enhancements. I can see that the age between thirty and fifty is the most common, but again, we see all types of patients.

What They Are Asking For

They’re asking for several different kinds of procedures. The most common is size enhancement, which is usually done with fillers. The most common fillers, which give the most volume in the penis, are Voluma and VoluX. These fillers are going to increase girth and can increase length up to half an inch, but that’s not the main objective or how it physically works.

Men who want to enhance sensation or who have erectile dysfunction are getting the P-Shot, which is essentially PRP, platelet-rich plasma derived from your own blood, which is injected into the cavernous bodies of the penis and the crown to increase sensation, libido, and erection strength.

Recently, we’ve seen an increased demand for Bocox, which is botulinum toxin injected into the cavernous bodies of the penis. This creates vasodilation, which creates a larger erection. It usually increases length by half an inch to one inch, creates a stronger erection, and is used in normal patients as well as for erectile dysfunction.

Some men are looking for a descended testicle look, where the testicles hang more pronounced, and smoother scrotal skin, and to avoid the scrotal shrinkage that we sometimes see with changes in temperature. These men are good candidates for Scrotox, which is Botox injections into the dartos muscle and the scrotal skin.

The Part I Make Sure Everyone Hears

It is very important to know that Scrotox can cause sterility, because really, those muscles we have are for temperature control of the testicles and the spermatic cord. A patient who would not be a candidate for Scrotox is one who would still want to have a family, as the procedure can make a male sterile.

It’s also important to understand that all of these treatments are off-label. Even though the products are FDA-approved, we are using them in an off-label nature, with the patient’s consent and understanding of the risks and complications.

What Is Really Driving It

I think, essentially, it’s increased self-esteem in sexual encounters and increased performance. Some of the procedures are more about appearance, such as the Scrotox for smoother skin and more descended testicles. Some men actually come for injections to increase the testicle or scrotal size, so that’s more about appearance. I think length and girth are a combination of appearance and sexual confidence. And I think erectile strength is more about sexual confidence and performance.

The Misconceptions Men Walk In With

One of the biggest misconceptions men have when considering these procedures is that the procedure will considerably lengthen the penis. As I’ve discussed before, these procedures really don’t create a lot of length. If anything, it’s half an inch maximum, or one inch. But they do seem to create a lengthening effect at rest, when the penis is not erect, and they mostly create an increase in girth.

The other misconception is that these results are permanent, where, for example, fillers can last one to two years, and Botox usually lasts three to six months.

And then I think the biggest misconception of them all is that bigger is always better, and that’s not necessarily the case. Sometimes the quality of the erection is more important than the size.

Where the Risk Lives

There are many risks and complications. It’s extremely important that you go to a board-certified physician to obtain these enhancement procedures, that the facility is using FDA-approved botulinum toxin and fillers, and that these procedures are performed in sterile environments. This is certainly not a procedure where you would want to bargain or look for the least expensive provider, if that means cutting back on safety and quality products.

The main risks, especially with the penile fillers, would be some areas of contour deformities, which can always be touched up later. Sometimes there could be nodules that are palpable, which can also be dissolved if necessary. It’s very important that the product be injected in the right plane. If it’s injected too superficially, then the nodules and irregularities will be more apparent. They can even create edema in non-circumcised men, which can interfere with intercourse and even regular voiding. The most dangerous complication would be an infection in this area, which is avoidable with the right sterile technique and postoperative care.

The Bigger Picture

I think this is part of a broader male aesthetics trend. We are seeing men more frequently in our clinics for cosmetic procedures, hair restoration, hormone replacement, weight loss therapies, peptides, and wellness IV drips. I think men are getting more comfortable with these treatments. I think a lot of it has to do with finding the right provider that they’re comfortable with and that they can trust.

So many men are curious but embarrassed to ask about these treatments. A lot of them do research online. We even have a chatbot that can talk to them, and at least they seem to think it’s a little bit more private. But what I would say is that these are actually very common procedures that most men know about and have even researched for themselves, that we just don’t talk about. Clinics that perform this on a regular basis understand the needs of men and usually cater to them in a very respectful and private way, where they’ll feel understood and not judged.

The Credential Behind the Opinion

I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, an American College of Surgeons Fellow, Mayo Clinic plastic surgery fellowship trained, and a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Castle Connolly Top Doctor for thirteen consecutive years. I write about this candidly because the field is growing faster than the honest conversation around it.

Ready to Talk?

If you are a man weighing any of this, or a colleague trying to build this part of a practice the right way, the principles are the same: honesty up front, sterile technique, FDA-approved products, and realistic expectations.

For the patient-facing clinical guide, see the companion post on agulloplasticsurgery.com. For the MedSpa and men’s wellness side, see the version on swplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful.

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.