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

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.

June 4, 2026

The Title She Defended Three Months After Surgery: Stephanie Han, Motiva Preservé, and the Recovery Her Coach Never Noticed

WBA lightweight champion and El Paso police officer Stephanie Han, a Motiva Preserve breast augmentation patient of Dr. Frank Agullo, MD, FACS, at Southwest Plastic Surgery in El Paso, Texas.

Saturday night, Stephanie Han defended her WBA lightweight world title against Holly Holm at the El Paso County Coliseum, live on ESPN, and won by decision. She is 13-0. About four months earlier, she was on my operating table for a breast augmentation, and nobody in her camp knew.

We sat down together to talk through how that was possible. Our conversation is below, in her words and mine.

Your Body Is Your Livelihood. Why Did You Decide to Do This?

Stephanie: “It’s something I’ve wanted to do for a very long time, and I always held back because of the stigma, that you shouldn’t do it because it’s going to affect your performance as a professional fighter. But I did my own research and realized I can still perform at an elite level. Most importantly, I’m doing it for myself. I don’t ask for a lot of things in life. This is personal.”

You’re a Mom of Two Who Breastfed Both. How Did That Factor In?

Stephanie: “I’m a mom of two beautiful kids, and I breastfed both of them. No one tells you your breasts won’t be the same afterward. I could train, I could do a million push-ups, and it would not change this. This was probably my biggest insecurity. I knew if I got it done, it would boost my confidence and make me feel comfortable in my own skin again.”

What Makes Motiva Preservé Recover So Differently?

Dr. Agullo: It comes down to where the implant sits and how we get there. We make a small incision in the fold, about two and a half centimeters, and we open the pocket above the muscle, behind the breast gland. There is no cutting and no electrocautery. We use a balloon to create the space, so we are just pushing the tissues outward and letting the breast’s own ligaments hold the implant. We preserve the nerves and the arteries, and because the muscle is never released, the recovery is fast. We do not even need a mesh. Most patients are back to work the next day and back in the gym in about two weeks.

Her Implants Were Not a Matched Pair, Were They?

Dr. Agullo: No, and that is part of the artistry. Stephanie had a meaningful difference between the two sides, which is very typical, since we all have an asymmetric side. On the 3D simulation we planned a 265cc Demi Ergonomix on the right, with a little less projection, and a 315cc Full Ergonomix on the left. The Ergonomix implants move with the body, so they fill in beautifully and read as symmetric, even when she cuts weight for a fight.

What Was the Recovery Actually Like?

Stephanie: “Dr. WorldWide told me I’d be fully recovered in two weeks, and honestly I didn’t believe it until it happened. I had maybe a little discomfort for about three days, and after that it felt amazing. It’s been about four months and it truly feels like I didn’t get them done.”

Back in Camp Four Months Later. How Did Your Body Hold Up?

Dr. Agullo: I was surprised she never told her coach, but it made for a perfect test, because he was blinded to it. He watched her spar and train for the whole camp and thought she was in the best shape he had ever seen. That tells me the augmentation did not get in the way of her performance, her strength, or her range of motion, which is exactly the point of Preservé.

Stephanie: “Today I sparred 12 rounds and there was no pain. I can run seven miles, no problem. It feels like nothing, like they’re not even there. It’s maybe a pound of extra weight, and it feels like part of my body.”

Does That Mean the Surgery Helped Her Performance?

Dr. Agullo: No. The implants did not make her a better fighter. They boosted her confidence enormously, she does not stop talking about them, but they did not change her fighting. The whole point is that they did not affect it. They did not make her worse. That is what makes this such a good illustration of what the procedure can do for athletes, and really for all women.

How Do You Feel About the Result?

Stephanie: “They’re so symmetrical, so nice and perky. It’s taken my confidence from probably a six to a ten. I feel beautiful, I feel strong, I feel confident. And at the end of the day, I’m still Stephanie Han. I’m still a world champion boxer, still a police officer, still a mother of two, still a woman of God. This doesn’t change who I am. It’s just something I wanted for myself.”

Is This the Recovery Every Patient Should Expect?

Dr. Agullo: It is realistic for most women having Preservé on its own. Back to work within one to three days, back in the gym at about two weeks, the way I have seen with many patients. If a patient also needs a lift, or is having liposuction or a mommy makeover with a tummy tuck, that changes everything, and the recovery is dictated by those other procedures. For the full breakdown of the technique, the implant, and the recovery ladder, I wrote that up in Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means. The technique itself is on the Motiva Preservé page at agulloplasticsurgery.com, and the broader breast augmentation overview is on swplasticsurgery.com.

What Would You Tell a Woman Who Has Been Holding Back?

Stephanie: “This is one of the things I do not regret at all, and I honestly wish I’d done it sooner. Don’t listen to the stigma. You can still be strong, you can still be beautiful, and you can still perform at 100 percent. To every mom and every athlete, especially the women champion boxers and the moms who breastfed, if you have two weeks, you can do it.”

Ready to Talk?

If Stephanie’s story sounds like the version you want, the next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and your goals, and I will give you a recovery timeline I can actually defend. The goal is the body you recognize in the mirror, and a recovery you can plan your life around. #StayBeautiful.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

May 21, 2026

Preservation, Not Minimalism: I Wrote a Manifesto for Connectively

Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon in El Paso, Texas, in black scrubs in the operating room examining a facelift candidate as part of the preservation-era technique described in his bylined Connectively article.

Preservation, Not Minimalism: I Wrote a Manifesto for Connectively

I keep hearing the same thing in consults. “Doctor, plastic surgery is going smaller now, right? Less volume. Subtler results.”

Half true. Mostly misleading.

Connectively just published my bylined piece on this, and I wanted to push back on the frame in my own voice here too. Volume has not gone anywhere. Patients in my OR this month still wanted fuller breasts. Fuller hips. I still placed implants. I still grafted hundreds of cc of fat per side.

What changed in the last decade is what we refuse to damage when we add that volume.

The Old Bargain

For thirty years, adding volume came with a quiet compromise we did not really put into words for patients.

Breast augmentation, the way I was first taught to do it in training, meant a wide pocket dissection. That meant cutting through the suspensory ligaments of the breast. Those are the fibers that hold the breast up against gravity. We took them down to make room for the implant and we did not think twice about it. The implant looked great at six months. At year five, the breast started to bottom out, and by year ten the patient was back asking what happened.

Gluteal fat grafting in its early era was a free pass. Pre-2015, the field grafted into and through planes that we now know are dangerous. Plenty of surgeons added beautiful volume. A subset of patients did not survive it. The complication that killed people was fat embolism, and the cause was depth, not volume.

Facelifts of that era depended on tension. We pulled skin tight over tissue that had already failed structurally. At one year the patient looked rested. At ten years the patient looked pulled. The lateral sweep. The wind-tunnel mouth. That look did not come from “too much” facelift. It came from a facelift that was working only at the surface.

We did not really articulate any of that to patients at the time. Two reasons. The long-term follow-up data on these trade-offs was incomplete, and in some cases still is. And we did not have reliable alternatives. So we delivered volume, and the side effects came due fifteen years later in someone else’s consult room.

I had the luxury, during my Mayo Clinic plastic surgery fellowship, of seeing both eras in the same hospital. The old habits and the new evidence in the same hallway. That bothered me then. It still drives how I plan a case now. So does the Ponytail Academy training I did later, intermediate course in Pittsburgh, advanced course in Santa Monica, which gave me a deep plane facelift approach that holds at year ten the way an earlier-era SMAS tightening simply does not. Thirteen consecutive Castle Connolly Top Doctor years (2014 through 2026) is a long enough patient sample to feel honest about that claim.

What Preservation Actually Looks Like in My OR

The word “preservation” gets used loosely. So let me show you what it actually means at a case-planning level, by procedure.

Breast Augmentation

I am using ergonomic, lighter implants now (Motiva is the line I use most, see my Motiva Preserve post for what the recovery actually looks like). They project differently, with less weight per cc on the native tissue. That alone lets me use a slightly smaller implant for the same on-camera result.

My pocket dissection is narrower. The suspensory ligaments of the breast, particularly the inframammary ligament along the fold, are preserved instead of divided. The dual-plane release is precise rather than broad. The implant sits where I put it and stays there, because the soft tissue scaffold underneath it is still intact.

My patient leaves the OR with a result that looks finished on day one. The deeper test is what the breast looks like at year five and year ten. That is what preservation buys.

Gluteal Fat Grafting

If you are a regular reader, you know I do not graft above three or four hundred cc per side without a reason. The reason for me is not volume restraint. It is plane discipline.

Every BBL I do is ultrasound-guided. The probe sits on the buttock while I am cannulating. I can see the fascia. I can see the cannula. I can see the plane I am working in, in real time. That is not optional anymore. That is the standard.

Three hundred, four hundred, five hundred cc per side is achievable safely now in carefully selected patients with the right anatomy. Volumes that fifteen years ago carried a risk profile I would not accept. The volume number is not the safety story. The plane is the safety story.

This is the era I trained into. I sit on safety task forces for the Aesthetic Society and the conversation is no longer whether to use ultrasound. It is which probe and how to teach it.

Facial Volume

Here is where most patients have the wrong mental model entirely.

The patient sits down and tells me, “I do not want to look puffy. I do not want filler face.” Good. Neither do I. So I am going to put more volume in your face than you think, just not where you are picturing it.

Aging is not a wrinkle problem. Aging is a volume-loss problem. Deep facial fat compartments empty out over decades. Bone resorbs. The midface loses structural support. The skin you can see is the last thing to fail, and tightening it without restoring what collapsed underneath is the wind-tunnel facelift I described above.

A preservationist face today gets more volume, placed deeper, in the compartments that actually emptied. Buccal extension. Deep medial cheek. Pyriform aperture. Done correctly, the patient does not look “added to.” They look like themselves, ten years younger, because the architecture is back. I cover the technique side of this in my Deep Plane and Ponytail Lift post on this same site.

The Face Volume Surprise

I want to sit with this one for a paragraph because it is the most counterintuitive part of the whole conversation.

Filler trends pushed in the opposite direction. We watched a decade of overfilled, surface-level work go viral. Patients walked into my office showing me Instagram screenshots of what they did not want. Reasonable.

The correction was not less volume. It was deeper volume.

Volume placed superficially, in the wrong compartment, without regard for architecture, gives the puffed, frozen, unnatural read everyone fears. Same patient, same milliliter count, placed in the deep medial cheek and along the bony pyriform: that patient looks rested, not filled. The volume restored structure. It did not distort it.

This is also why I keep telling patients that fillers, used the wrong way, are a tax. You pay every nine to eighteen months, and you slowly add surface volume in places that should not carry it. A correctly planned surgical fat graft, deep, compartment by compartment, lasts years and does the architectural job instead of the cosmetic one.

What To Ask At Your Consult

If you take one practical thing from this piece, take this. The question to bring to a consultation is no longer “How much volume can I get?”

The better one is “What do I want preserved?”

For a breast augmentation: ask the surgeon how wide the pocket dissection is, and how they handle the inframammary ligament.

For a gluteal fat graft: ask whether ultrasound guidance is used intraoperatively, and which plane they graft into.

For a facelift or facial volume restoration: ask which compartments they target, and at what depth.

A surgeon who answers in those terms is operating in the modern framework. A surgeon who answers only with the volume number, with no thought to what is preserved underneath, is using a thirty-year-old playbook on a 2026 patient.

I wrote the full version of all of this for Connectively, with examples and the broader case the field needs to make to patients. You can read it here.

Volume was never the issue. It never was. What we have learned, sometimes the painful way, is that volume and preservation are not in opposition. The craft is knowing precisely where to put what you add, and what you refuse to damage to get there.

That is the shift worth paying attention to.

Ready to Talk?

If you want to have this conversation in person, my office line is (915) 590-7900 and our text consult line is 1-866-814-0038. Book online at agulloplasticsurgery.com. Follow along at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, and @AgulloPlasticSurgery on Facebook.

#StayBeautiful

May 13, 2026May 31, 2026

Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means

Editorial frontal before and after view of a Motiva Preserve breast augmentation with 315cc Motiva Ergonomix Full implants on a slim athletic young woman patient wearing a Dr. Worldwide bikini, breast augmentation by Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon at Southwest Plastic Surgery in El Paso, Texas.

The patient in the photos on this page walked back into her office the day after surgery. Two weeks later she was lifting weights again. Four weeks later she was running. The compression bra came off at three. None of those numbers used to be possible.

For most of my career, the honest answer to “when can I lift my kids” after a breast augmentation was four to six weeks. The honest answer to “when can I lift heavy at the gym” was six to eight. I gave those answers a thousand times. They reflected the real recovery from a traditional submuscular augmentation, where the pectoralis muscle is partially released to make room for the implant. The muscle heals. It just takes the time it takes.

I stopped giving those answers about a year ago. The reason is a technique called Motiva Preservé, and it has changed enough about how I plan a breast augmentation that I owe my patients a longer explanation.

What Preservation Actually Means in the OR

The word “preservation” in Preservé is a commitment. Smaller incision (2.5 to 3 centimeters, inside the natural shadow below the breast). The implant sits in front of the muscle and behind the breast tissue, held by the breast’s own ligaments, so there is no muscle release at all. A no-touch funnel so the implant never contacts skin on its way into the pocket. Less tissue dissection overall. The breast and chest wall handed back to the patient as close to their pre-operative state as the operation allows.

What patients feel is less swelling, less tightness, less of the bruised-rib soreness that traditionally defines the first week. The recovery curve compresses. The day-one experience now looks like the week-three experience used to look.

The case in the photos on this page was completed in under an hour in the operating room, under light sedation rather than general anesthesia. She walked out of the surgical suite the same morning and drove home (with someone else at the wheel) before lunch. That is not a marketing claim either. It is the operative report.

That is not a manufacturer claim. That is what every Preservé patient in my practice has told me, with a logbook that backs them up.

The Implant: Motiva Ergonomix Full

The implant in this case is a 315cc Motiva Ergonomix Full. Sixth-generation silicone gel, ProgressiveGel Ultima inside, SmoothSilk surface outside. The shape is what makes the Ergonomix line different from anything else in my OR.

Upright, the implant drapes into a teardrop that looks like real anatomy. Supine, on the back, it flattens and rounds the way breast tissue does. Nothing about its shape is fixed. The implant moves with the body the way tissue would. Patients describe the result as natural in a way I do not hear with older implant designs. That has shown up in my consult conversations and in the reaction shots my own patients send me a year later.

The Full profile is one of three Ergonomix projection options Motiva offers in the United States (Mini, Demi, and Full). For a slim athletic patient who wants visible projection but a natural silhouette, Full is the right end of the range. The 315cc volume was the result of careful sizing in the office. She did not want a striking change. She wanted proportion. For the full breakdown of the technique itself, the Motiva Preservé breast augmentation page on agulloplasticsurgery.com walks through every step.

Why I Stopped Promising Six-Week Recoveries

The single hardest number to defend in breast augmentation is recovery time, because the standard answer has been wrong for a long time. We told patients six weeks because that was the honest answer for the surgery we were doing. We are not doing that surgery anymore.

The Preservé recovery ladder, for a patient with this body type and this implant choice, looks like this. Day one: back to desk work, off the heaviest pain medication, sleeping upright. Day seven: showering, light walking, sleeping however she wants. Week two: back to lower-body gym work and short runs, with a sports bra. Week three: compression bra off. Week four: full upper-body programming, with the surgeon’s clearance.

None of those numbers come from a brochure. They come from the patients themselves, who tell me what they actually did, day by day, in the months after. I keep notes. I update the table I show in consults. The numbers have not slipped.

A Short Comparison

A simple way to see the difference:

Question	Traditional Submuscular	Motiva Preservé
Incision length	4 to 5 cm	2.5 to 3 cm
Muscle release	Significant	None (implant in front of the muscle)
Implant insertion	Hand placement	No-touch funnel
Back to desk work	5 to 7 days	1 to 2 days
Back to upper-body lifting	6 to 8 weeks	2 to 3 weeks
Compression bra	4 to 6 weeks	2 to 3 weeks
Shape behavior	Round or shaped, fixed	Ergonomic, position-responsive

The table flattens some real surgical detail. The full nuance lives in the clinical version of this post on agulloplasticsurgery.com (linked at the bottom of this post), where I walk through the operating room in more depth.

Who Is the Wrong Candidate

I will tell you who Preservé is not for. A patient with significant ptosis (drooping) needs a breast lift in addition to an augmentation, and the lift drives a different recovery curve. A patient with very thin tissue or a history of capsular contracture needs a more nuanced breast augmentation revision conversation. A patient who wants a dramatic enlargement well beyond what her frame supports is going to be unhappy with any technique, and I will tell her so before we book a date.

The right candidate is a patient with a reasonable skin envelope, a defined inframammary fold, and goals that lean toward proportion. The patient in the photos on this page is one of the easier candidates to plan for. Not every patient is.

Why I Trained on This System

I have placed thousands of breast implants going back to my plastic surgery fellowship at Mayo Clinic. Castle Connolly Top Doctor thirteen consecutive years. Clinical Associate Professor at Texas Tech University Health Sciences Center, where I teach breast augmentation to the residents I am responsible for. I do not adopt new techniques because a rep walks them in. I adopt them when the data and my own results justify the change.

Motiva earned FDA approval for its silicone gel implants in 2024 after years of leading the implant market in Latin America and Europe. I trained on the system directly before I placed an implant in a patient. I do not place a Motiva implant the way I place every other implant in my OR, because the technique is different and the implant rewards the difference.

One More Thing About Volume

Patients always ask about size in cubic centimeters first. The number matters less than the planning around it. A 315cc implant on the patient in these photos reads as proportional. The same 315cc on a different frame might read as dramatic. The same 315cc on a third frame might read as not enough. Size, projection, profile, the elasticity of the skin envelope, the position of the inframammary fold. All of those drive the answer to “what should the number be.”

The right surgeon will spend the consult walking you through that math. If the conversation starts and ends with a single number, you are in the wrong consult.

See the case on social: originally posted to Instagram and TikTok.

Ready to Talk?

If you are reading this on your phone and thinking “two weeks back to the gym sounds too good to be true,” the right next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and goals, whether 315cc is the right number for your frame, and whether augmentation alone is the right operation or whether you also need a lift. If the answer is “not the right time,” I will tell you that too. The goal is the face and body you recognize in the mirror. #StayBeautiful.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. For the longer clinical breakdown, see the agulloplasticsurgery.com post on this same case or the swplasticsurgery.com practice version. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.