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Nothing Gets Cut: Preservé and the Preservation Era Comes for Breast Augmentation

Black and white editorial still life of delicate ivory lace lingerie folded on linen in soft light. Preservé breast augmentation editorial by Dr. Frank Agullo, MD, FACS.

Preservation is the most important word in plastic surgery right now. Preservation rhinoplasty keeps the nasal structures intact. The deep plane facelift respects the anatomy instead of fighting it; I have written the facelift version of this argument before. The whole idea is to preserve as many of the structures that are naturally there without dividing them or cutting them.

Breast augmentation just got its preservation moment, and I was in the room when it arrived in this country.

It is called the Motiva Preservé technique, and the name is literal. We’re not cutting any nerves, arteries, or breast tissue. Nothing gets cut. Let me walk you through what that actually means, because it changes almost every number patients care about.

A Pocket Without a Blade

A traditional augmentation and a Preservé share the basics: an implant, and a pocket to hold it. I use Exparel on all my patients either way, injected between the ribs to numb the breast for up to three days.

From there the two operations separate. The Preservé incision sits in the inframammary fold, but it is much smaller, about two and a half centimeters, an inch. The patient can be under light sedation. And there is no cutting involved in creating the pocket, and no electrocautery either. Instead, we create the pocket with a dilator and a balloon, precisely made above the muscle, behind the breast tissue.

Then the implant, a Motiva Ergonomix, the gummy bear type, goes in through a Keller funnel. The whole procedure takes thirty minutes or less.

The Ligaments Do the Work

Here is the part I find most elegant. Because nothing is divided, the natural breast ligaments survive intact, and they now act like a mesh that keeps the implant in the pocket.

Two things follow from that. By using these ligaments, we get a lot more of a lift from the breast with just the implants. And we obtain greater volumes in the end result using smaller implants. The breast is lighter, but we get more out of the implant in terms of size compared to a traditional augmentation. Smaller implant, bigger result, better support. That arithmetic does not exist in the standard operation.

No Muscle Release, and What That Buys You

The implant goes above the muscle, behind the breast gland, so the muscle does not need to be released as in a dual plane augmentation.

Long term, when patients exercise, flex their pectoralis muscles, or do upper body weights, the implant does not animate. There is no motion. It looks a lot more like a natural breast in that respect, and this technique prevents animation deformity altogether. Muscle function is not jeopardized, strength is not affected, and it is very athlete-friendly.

The short-term version is just as striking: patients notice immediately after surgery that they can raise their hands above their head without any discomfort or pain. Back to work the next day. Gym within two weeks. A traditional augmentation runs about a week to return to work and four weeks to exercise.

The Honest Limits

This is not the operation for everyone, and I would rather tell you that here than in a consultation you paid to attend.

The implant ceiling is 325cc. If a patient desires more than a two cup size increase, we need a traditional augmentation over the muscle, or dual plane. And significant breast ptosis is not solved by this procedure alone; those patients need a breast lift at the same time. The patients who seek out Preservé are chasing the natural result and the ultrafast recovery, and those it delivers.

The implant choice is also not negotiable. The Motiva Ergonomix is really the only implant that can work through such a small incision and tunnel; other implants would easily rupture. Its surface has been studied thoroughly and creates the least inflammatory reaction with the body compared to other implants, and the Motiva line carries a capsular contracture rate under 0.5 percent and a rupture rate under 0.5 percent, well ahead of its competitors.

Where I Fit In This Story

I was one of the very early adopters of this technology. I was in the select thirty-surgeon group that launched the procedure in the United States, chosen by Motiva, and trained in Costa Rica with the surgeons who developed and invented this technique.

I have now performed more than fifty Preservé procedures. I haven’t had to do any revisions, although it might be a little too soon to tell, and I say that out loud because honest data matters more than marketing. What I can say without hedging: my patients have been very happy, every one has returned to work the next day, and they have resumed exercise two weeks later.

The full technique details live on my Motiva Preserve technique page, and the implant background on the Motiva breast implants page.

Ready to Talk?

If a natural result and a next-day recovery sound like your version of an augmentation, come talk about Preservé. Call (915) 590-7900, text 1-866-814-0038, or book online. #StayBeautiful

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

Companion reads: the clinical candidate guide on agulloplasticsurgery.com, and the practice overview at swplasticsurgery.com.

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The Augmentation That Never Touches the Muscle: Why I Switched to Preserve

Black and white portrait study of a woman's profile, soft studio light. Preserve prepectoral breast augmentation commentary by Dr. Frank Agullo, MD, FACS.

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

Question Traditional Submuscular Preserve Prepectoral
Where the implant sits Behind the muscle In front of the muscle, behind the gland
Is the muscle cut Yes, partially released No, never touched
How the pocket is made Cutting and cautery Balloon dissection
What holds the implant Muscle and capsule Your own ligaments
Typical recovery Six to eight weeks Back to work in one to three days

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.