If you have researched breast augmentation in Dallas recently, you have probably seen the word Preservé. It is one of the most talked-about developments in breast surgery in years, and it is a technique I now use regularly in my practice. It is also surrounded by a lot of marketing, so here is a plain-language explanation of what it is, what it does well, and what we still do not know.
This post is drawn from a recent episode of Beauty and the Beasts, the podcast I co-host with San Diego plastic surgeon Dr. Sal Pacella, where we spent a full episode debating whether Preservé is real progress or clever branding.
What Is Preservé Breast Augmentation?
Preservé is a breast augmentation technique developed by Establishment Labs, the company behind Motiva breast implants. The core idea is to place a small implant directly behind the breast gland without cutting through the surrounding tissue.
Here is how it works in the operating room:
- Hydrodissection. Fluid is infiltrated into the natural plane behind the breast gland, which gently separates the tissue layers on its own.
- Balloon expansion. Through a small incision, about three centimeters, a balloon is inserted and inflated to open the pocket. Nothing is cut. The tissue is pushed aside rather than divided.
- Funnel insertion. A Motiva Ergonomix implant, which is unusually soft and deformable, is placed through a funnel so it never touches the skin.
Because the surrounding structures are left intact, including a fibrous band around the breast called the circummammary ligament, the implant ends up remarkably well anchored. When I finish a Preservé case and try to push the implant sideways or downward, it does not move much. It sits in a natural nest of tissue.
Who Is a Good Candidate?
This is the part the marketing tends to skip. Preservé is designed for women who want a modest, natural increase in size. The implants are deliberately smaller than the base width of the breast. If your goal is to look the way you look in a good push-up bra, Preservé may be an excellent fit. If your goal is a dramatic change in cup size, it is not the right operation, and a traditional breast augmentation will serve you better.
Preservé can be performed under general anesthesia or with sedation. You may have seen it advertised as an “awake” or local-anesthesia procedure. That is possible, but to me it is not the main selling point. The technique is what matters, not the anesthesia.
Why Motiva Implants Matter Here
Two things about Motiva implants make them well suited to this approach.
First, the Ergonomix implant is the most deformable implant available in the United States, which is what allows it to pass through such a small incision. With other brands, the incision would need to be closer to four to four and a half centimeters.
Second, Motiva’s surface. Historically, surgeons avoided placing implants in front of the muscle because of a higher risk of capsular contracture, the hard scar tissue that can form around an implant. Motiva’s published data through roughly five years shows a capsular contracture rate around one percent, compared with six to eight percent through ten years for the older implants most of us trained on. That is not an apples-to-apples comparison, and I say so to every patient. But in more than 100 Motiva cases in my own practice, I have not yet seen a capsular contracture.
What We Do Not Know Yet
I am a believer in Preservé, and I still want patients to hear the honest caveats.
- The Motiva safety data was collected from implants placed behind the muscle or under the fascia. Preservé places the implant in a different plane, directly behind the gland. We do not have long-term data for that specific placement yet.
- Preservé has been available in the U.S. for roughly a year, and Motiva implants for about a year and a half. Early results are excellent. Five- and ten-year results are still ahead of us.
- Whether the balloon itself is essential, or whether the real benefit comes from respecting the anatomy and using appropriately sized implants, is an open question. Preservé has changed how I do all of my breast augmentations, including the ones that do not use a balloon.
Is Preservé Right for You?
Preservé is a real advance, not just a new name. It is also a specific tool for a specific patient: someone who wants a subtle, natural result, a small incision, and a fast recovery. The best way to find out whether it fits your anatomy and your goals is an in-person evaluation, where we measure your breast and talk honestly about what different implant sizes will actually look like on your frame.
Dr. Sam Jejurikar is a board-certified plastic surgeon in Dallas, Texas, and has been named to Newsweek’s list of America’s Best Plastic Surgeons for five consecutive years. To learn more about Preservé breast augmentation or to schedule a consultation, call 214-827-2814 or request an appointment online.
Listen to the full episode: The Truth About Preservé Breast Augmentation on the Beauty and the Beasts podcast.
