Preservé Breast Augmentation

Preservé is a breast augmentation technique that changes how the space for the implant is created. Instead of the conventional approach of cutting and cauterising tissue to form the implant pocket, Preservé uses specialised instruments and controlled expansion to open the space gradually, with the aim of leaving the surrounding breast tissue and the chest muscle as undisturbed as possible. The implant is placed above the muscle, beneath the breast gland, through a smaller incision in the fold under the breast.

It’s worth being clear about what Preservé is and isn’t. It’s sometimes described as “low impact” breast surgery, and the technique is designed to reduce tissue disruption. It is still breast augmentation. It involves an incision, an implant pocket and a breast implant, it’s performed under anaesthesia in an accredited facility, and it carries the risks and long-term considerations that come with any breast implant surgery. What it may change, for the right patient, is the early recovery experience. What it doesn’t change is the need for careful assessment, informed consent and realistic expectations.

Dr Shepherd has undertaken specific training in the Preservé technique and offers it alongside conventional breast augmentation. His approach to breast surgery starts with assessing the individual rather than selecting a procedure. At consultation, he’ll consider your anatomy, your reasons for considering surgery, and whether Preservé, a conventional augmentation, a different procedure, or no surgery at all is the right answer for you.

Most patients who ask about Preservé are considering breast augmentation for the same reasons as anyone else: a wish for more breast volume, a loss of fullness after pregnancy, breastfeeding or weight change, or a difference in size between the two sides. What draws them specifically to Preservé is usually one of three things.

The first is the prospect of a different recovery. Because the chest muscle isn’t dissected and the tissue disruption is designed to be less, some patients experience less early discomfort and a shorter initial recovery than is typical after a conventional augmentation. This is not guaranteed and it is not the same as no recovery, but for patients with young children, physically demanding work or limited time off, it can be a meaningful consideration.

The second is physical activity. Patients who train regularly, particularly those who rely on their pectoral muscles for sport or work, are sometimes drawn to an approach that leaves the muscle untouched. Above-muscle placement avoids the animation deformity (movement of the implant when the chest muscle contracts) that can occur with placements involving the muscle.

The third is a preference for a smaller incision and a technique built around preserving the existing breast anatomy, including the tissue that carries sensation to the nipple.

None of these reasons makes Preservé the right choice on its own. Above-muscle placement suits some anatomies and not others, and the assessment at consultation is what determines whether the technique is appropriate for you.

The implant, the incision location and the end goal are broadly the same as a conventional augmentation. The differences are in how the pocket is made, where the implant sits, and how much of the surrounding tissue is disturbed along the way.

Pocket creation. Conventional augmentation creates the implant pocket by dissecting tissue with electrocautery. Preservé uses specialised instruments and a controlled balloon expansion technique to open the space progressively, which is designed to separate tissue planes rather than cut through them.

Implant position. The implant is placed in the subglandular position: beneath the breast gland and above the pectoral muscle. The chest muscle isn’t dissected, released or lifted to accommodate the implant.

Incision. Preservé uses a smaller incision in the inframammary fold beneath the breast than a conventional augmentation. The instruments used to create and access the pocket are designed to work through this smaller opening.

Tissue disruption. The technique is built around leaving the existing breast anatomy, including the blood supply and the nerves that carry sensation, as undisturbed as possible. This is the reason it’s sometimes described as tissue-preserving or low impact.

Preservé is performed with Motiva Ergonomix2 implants. This is a next-generation soft implant recently introduced into Australia for use with Preserve. Like the implants used in conventional augmentation, they vary in profile, base diameter and volume, and the choice is made together at consultation based on your measurements, your existing tissue, the changes you’re considering and what suits an above-muscle placement.

The long-term picture is the same as for any breast implant. Implants aren’t lifetime devices. They may need to be replaced or removed in the future for medical reasons such as rupture or capsular contracture, or for personal reasons, and the breast and the tissues around the implant continue to change with age, pregnancy, breastfeeding and weight. Long-term follow-up, including imaging where appropriate, is recommended for everyone with breast implants regardless of the technique used to place them. The implant-specific benefits, limitations and risks are covered in detail at consultation and in the written information you’ll receive before consent.

Preservé isn’t a technique for every patient who wants breast augmentation, and the honest answer to whether it suits you comes from an examination rather than a website. That said, there are patterns in who tends to be a good candidate and who isn’t.

Preservé is generally considered for patients seeking a small to moderate increase in breast volume whose anatomy suits an implant placed above the muscle. That usually means there’s enough existing breast tissue to provide soft tissue cover over the implant. Patients with very thin tissue cover are at higher risk of visible or palpable implant edges with any subglandular placement, and a dual plane placement (which involves the muscle, and therefore isn’t Preservé) may be the better option for them.

It may also suit physically active patients, or those who specifically want to avoid dissection of the chest muscle. It won’t suit patients who need a lift, patients whose anatomy calls for a larger implant than above-muscle placement can support well, or patients with significant asymmetry or a developmental breast shape that needs a different approach.

Existing breast volume, chest and breast anatomy, skin quality, the degree of change being considered and your general health all influence which technique is appropriate. If Dr Shepherd assesses that a conventional augmentation, a different procedure, or no surgery is the better option for you, he’ll say so and explain why.

May suit

• Small to moderate volume increase
• Enough existing breast tissue to cover an above-muscle implant
• Physically active patients or those wanting to avoid muscle dissection
• Patients seeking a technique designed to minimise tissue disruption

Less likely to suit

• Very thin soft tissue cover
• Larger volume increases
• Breasts that need lifting as well as volume
• Significant asymmetry or tuberous breast shape needing a different approach

Preservé is performed under general anaesthesia or local/local with sedation in an accredited facility and usually takes one to two hours. A small incision is made in the inframammary fold beneath the breast. Specialised instruments and a controlled expansion technique are then used to progressively open the space for the implant beneath the breast gland and above the pectoral muscle, without cautery dissection of the pocket. The implant is placed, its position checked, and the incision closed.

In selected patients, fat grafting may be considered as part of the surgical plan, for example to refine contour or soften the transition at the edge of the implant. Whether that’s appropriate depends on your anatomy and the outcome you’re after, and it’s discussed at consultation rather than added on the day.

The procedure is performed as day surgery. Most patients go home the same day with a support person. Dr Shepherd performs Preservé at a number of hospitals across Sydney.

Recovery after Preservé varies from person to person, and it’s important not to go in expecting no downtime. Because the technique is designed to minimise tissue disruption and doesn’t involve the chest muscle, some appropriately selected patients report less early discomfort and a quicker return to light daily activity than is typical after a conventional augmentation. Others find their recovery feels much the same. The difference, where there is one, is mostly in the first one to two weeks.

Swelling, bruising, tightness and temporary changes in sensation are all normal in the early period. A surgical bra is worn continuously for several weeks, including overnight. Work, exercise and other activities need to be modified during the initial recovery and reintroduced gradually according to Dr Shepherd’s advice. Heavy lifting, vigorous exercise and overhead activity should wait until the implant pocket has healed, which is typically around six weeks. Driving waits until pain is controlled without strong analgesia and you can move your arms freely enough to handle the car safely.

The breasts continue to change as swelling settles and the tissues adapt around the implants. It can take several months for the longer-term shape to become apparent, and scars take 6-12 months to mature, going through a pinker phase before they fade. The recovery advice you’re given at discharge is specific to your operation and your circumstances, and it takes priority over anything general on this page.

Preservé is designed to reduce tissue disruption, not to remove the risks of breast augmentation. It's a surgical procedure with a breast implant, and the recognised risks are the same as for any augmentation. They include: