{"id":847021,"date":"2025-10-15T13:00:00","date_gmt":"2025-10-15T10:00:00","guid":{"rendered":"https:\/\/analyse.optim.biz\/?p=847021"},"modified":"2025-10-15T13:00:00","modified_gmt":"2025-10-15T10:00:00","slug":"a-kinder-gentler-boob-job-may-be-upon-us","status":"publish","type":"post","link":"https:\/\/analyse.optim.biz\/?p=847021","title":{"rendered":"A Kinder, Gentler Boob Job May Be Upon Us"},"content":{"rendered":"
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PLASTIC SURGERY<\/span><\/span><\/div>\n<\/div>\n<\/div>\n

A Kinder, Gentler Boob Job May Be Upon Us<\/h1>\n<\/div>\n
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Should we believe the \u201cminimally invasive\u201d marketing?<\/div>\n
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By <\/span>Jolene Edgar<\/span><\/span><\/span><\/div>\n

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Adobe Stock<\/span><\/div>\n<\/div>\n<\/figure>\n<\/div>\n<\/div>\n<\/header>\n<\/div>\n
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Doubling down on the undetectable movement in plastic surgery, breast implant manufacturer Motiva is poised to launch a new augmentation technique in the U.S. that promises a modest size enhancement without the usual scarring, discomfort, and downtime of traditional breast surgery. Called \u201cPreserv\u00e9,\u201d the procedure debuted in Brazil followed by 28 other countries earlier this year. Its aim is to preserve the breast\u2019s inherent anatomy and function while delivering strategically placed volume and an understated aesthetic, using a specific style of small silicone-gel implants, alongside newly designed surgical tools.<\/p>\n

Over the summer, 36 board-certified plastic surgeons from across the U.S. visited Motiva headquarters in Costa Rica to observe and then perform the procedure under the guidance of plastic surgeon Manuel Chac\u00f3n Quir\u00f3s, MD, the scientific director of the Breast Tissue Preservation Program at Establishment Labs (Motiva\u2019s parent company). And it was a big deal: \u201cThis is the first new technique requiring training in breast augmentation in\u2026 well, I went into practice in 1995, and there has never been a time [in my career] when we\u2019ve had to take an instructional course where we\u2019re using entirely new concepts and instrumentation,\u201d says Steven Teitelbaum, MD, a board-certified plastic surgeon in Santa Monica. (He owns stock in Establishment Labs and helped the company develop the protocols for its U.S. clinical trial for Motiva implants.)<\/p>\n

Now, in advance of the official U.S. launch of Preserv\u00e9 in early 2026, each of those 36 surgeons is doing 10 cases in their respective practices, with the purpose of promoting the procedure and collecting data for eventual publication. I talked to seven of these early adopters\u2014as well as surgeons who aren\u2019t involved in Motiva\u2019s training\u2014to find out what might make this new technique a breakthrough in the evolution of the boob job. Here are 9 things you should know:<\/p>\n

1. Preserv\u00e9 is all about, yes, preserving more breast tissue than other augmentation techniques.<\/strong><\/div>\n

Tissue preservation is a concept that plastic surgeons have been discussing for decades, but it really took hold in the rhinoplasty realm a few years back before trickling down to facelifts with the emergence of the preservation-style deep plane last year. Now, the preservation conversation is all about the breasts.<\/p>\n

Preserv\u00e9 is only compatible with the Motiva SmoothSilk Ergonomix (teardrop-shaped) breast implants, which the FDA approved last year, following a lengthy clinical trial that demonstrated unprecedentedly low rates of complications. (They were the first breast implants to ever win an Allure Best of Beauty Breakthrough Award.) The surface of the Motiva implant has been shown to minimize the immune response and inflammation known for triggering capsular contracture (a hardening of the scar tissue that forms around the implant) and other implant-related problems, like rupture. The Ergonomix is also made of a gel compressible enough to squeeze through the tiny incision made for this procedure.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Even prior to Preserv\u00e9\u2019s arrival, the Motiva implants had begun fueling a shift in the way some surgeons perform breast augmentation, compelling them to more frequently place implants on top of the chest muscle instead of underneath it, as has been customary for decades. (Allure<\/em> reported on the resurgence of the over-the-muscle technique in 2024.) \u201cThis is the first step towards the general concept of preservation, because you\u2019re not taking the muscle off the chest wall,\u201d explains Daniel J. Gould, MD, PhD, a board-certified plastic surgeon in Beverly Hills.<\/p>\n

While proponents of over-the-muscle augmentation\u2014some of whom have been touting \u201cbreast preservation\u201d for more than a year\u2014avoid cutting the muscle and generally aim to minimize damage during dissection, there\u2019s usually still an element of trauma involved. \u201cWe\u2019re still going through ligaments\u2026 we\u2019re still raising the fascia [off the muscle] and disturbing that layer of the breast,\u201d says Renee Burke, MD, a board-certified plastic surgeon in South Barrington, Illinois. (The fascia is the connective tissue covering the pectoralis muscle. When surgeons position implants over the muscle, they sometimes secure them underneath this layer.)<\/p>\n

Preserv\u00e9, on the other hand, reimagines the very notion of dissection. After making a 2.5-centimeter cut in the skin of the breast fold, surgeons surrender their usual scalpels and cautery wands (which cut with electrical current) in favor of the few select tools that Motiva has engineered for the purpose of protecting the ligaments, blood vessels, and nerves of the breasts.<\/p>\n

2. This surgery involves a smaller incision.<\/strong><\/div>\n

So about that 2.5 centimeters\u2014that\u2019s about 20 to 40% shorter than the 3- to 4-centimeter incision that\u2019s typical in a breast augmentation. (For reference, 2.5 centimeters is slightly more than the diameter of a quarter.) And then there\u2019s what typically happens after<\/em> the initial cut\u2014a surgeon doing a breast augmentation will dissect through layers of tissue to carve out a space for the implant. But even when \u201ctrying to stay in the right area and to be exact\u2026 we really have no way of knowing what we\u2019re actually preserving and what we\u2019re not, because we can\u2019t always see the ligaments,\u201d says Michael R. Schwartz, MD, a board-certified plastic surgeon in Westlake Village, California. (Dr. Schwartz is a clinical trial investigator and paid educator for Establishment Labs; he also owns stock in the company.) Ligaments can easily become collateral damage as surgeons create a pocket for the implants. In some cases, \u201cwe might be dissecting 13 centimeters across and mowing down all the ligaments to create enough space for a wide implant,\u201d says Dr. Burke.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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With Preserv\u00e9, however, only one ligament is punctured, and only at the point of entry; all other tissue is spared\u2014\u201cwe\u2019re talking the most minimal disruption,\u201d says Dr. Burke. Surgeons insert a narrow, blunt-tipped tool called a channel separator\u2014\u201cit\u2019s designed to push the tissue out of the way,\u201d says Dr. Burke\u2014using it to tunnel up to the part of the breast they want the implant to occupy. They remove the rod and traverse that same tunnel with an inflatable balloon. Once surgeons see on ultrasound that the balloon is in the right spot, they dilate it. As the balloon expands, it sweeps surrounding breast tissue off to the sides, creating a pocket for the implant. (The balloon comes in different sizes, which correlate with the width of the implants.) The surgeon withdraws the balloon and then squeezes the implant in through a sterile funnel before closing the incision.<\/p>\n

If you prefer a slightly more poetic explanation, Dr. Teitelbaum offers an analogy: \u201cIf you\u2019re walking through a field of tall grass, you could take a machete and cut a swath for your feet as you move through or<\/em> you could just put your hands up in front of you and push the leaves to the side, so they sort of wrap around your body\u2014that\u2019s the idea here,\u201d he says.<\/p>\n

Surgeons taking a wait-and-see approach to Preserv\u00e9, however, don\u2019t entirely agree with this characterization of a standard augmentation. \u201cNobody\u2019s disrupting more of the breast tissue than they need to\u2014or at least they shouldn\u2019t be,\u201d says Darren Smith, MD, a board-certified plastic surgeon in New York City, who has not trained on Preserv\u00e9. When a conventional breast augmentation is done properly, \u201cwe\u2019re making a pocket that\u2019s exactly the dimensions of the implant, under direct vision, with no bleeding,\u201d says William P. Adams, Jr., MD, a board-certified plastic surgeon in Dallas. \u201cAnd that, I\u2019d argue, is way more preserving and precise than any sort of blunt, blind dissection.\u201d (\u201cBlunt\u201d refers to the lack of cutting; by \u201cblind,\u201d he means operating in a closed space where you can\u2019t clearly see the anatomy. When I ask if the ultrasound makes the procedure less \u201cblind\u201d: \u201cIt\u2019s better than just plain blind, but I don\u2019t think it\u2019s the same as looking at [the tissues] with your eyes.\u201d) In Dr. Adams\u2019 opinion, \u201cthere\u2019s nothing gentle about blunt dissection\u2014it\u2019s tearing tissue, it\u2019s unpredictable.\u201d (Dr. Adams is a paid educator for breast implant manufacturers Allergan, Mentor, and Sientra. He was also an investigator on the clinical trial for the Motiva implants, but has not received training on Preserv\u00e9.)<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Dr. Teitelbaum contends that \u201cPreserv\u00e9 is the most precise technique of all because the balloon size matches the implant and makes an exact \u2018hand in glove\u2019 pocket. It gently separates along a natural tissue plane, and inspection of the pocket with an endoscope shows it to be absolutely pristine. With no bruising and minimal discomfort, we know there isn\u2019t tearing or trauma.\u201d<\/p>\n

3. Patients can get more from less.<\/strong><\/div>\n

With Preserv\u00e9, surgeons\u2019 first step is selecting an implant whose base width doesn\u2019t breach the boundaries of what\u2019s known as the \u201ccircummammary ligament.\u201d Anchored atop the pectoralis muscle, this circular ligament resembles a sturdy rubberband, defining the perimeter of the breast and containing the breast tissue. \u201cWe intentionally use much narrower implants with Preserv\u00e9 to make sure we\u2019re not disrupting the circummammary ligament\u201d or the vital nerves and vessels that travel through it, says Troy Pittman, MD, a board-certified plastic surgeon practicing in Washington, DC and New York City. (Dr. Pittman is a Preserv\u00e9 trainer for Motiva and serves on the company\u2019s advisory board.) Separate from the circummammary ligament, but also worthy of protection, are other ligaments that run through the breasts, providing structure and support. With Preserv\u00e9, these ligaments help to buoy the implant, \u201ckeeping it right where we want it and projecting it forward as much as possible,\u201d Dr. Gould says.<\/p>\n

When a patient comes in for Preserv\u00e9, their surgeon takes measurements, including the width of the breasts and the distance from nipple to nipple, and plugs the data into a three-dimensional imaging system, which returns a specific range of implants that will fit the person\u2019s chest. (The largest implants allowed with Preserv\u00e9 are 315 ccs, but surgeons say their patients are most often choosing volumes between 150 and 265 ccs.) For each size option, there are three degrees of projection\u2014mini, demi, and full.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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During breast augmentation consultations, \u201cthe most common thing I hear is: I don\u2019t want to go a lot bigger; I just want to add volume here<\/em> [the upper part of the breasts]. And I usually have to explain that the volume starts low and fills up as you go larger. If you don\u2019t go big enough, you can\u2019t get that fill up top,\u201d says Dr. Teitelbaum. But with Preserv\u00e9, rather than mandatorily placing implants at the breast fold, where, like it or not, they fill the entire breast from the bottom up, surgeons can put implants right where they want them and that changes the conversation. \u201cInstead of us telling them, \u2018You need this size implant to fit your chest wall,\u2019 they\u2019re<\/em> telling us<\/em> where they want the volume\u2014and now we can give it to them,\u201d says Kelly Killeen, MD, a board-certified plastic surgeon in Beverly Hills and a paid consultant for Establishment Labs. Surgeons can boost just the upper breast and cleavage lines, or, in someone who lacks volume all over, they can center the implant in the middle of the breast for more diffuse fullness.<\/p>\n

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By not disturbing the breast anatomy, surgeons doing Preserv\u00e9 claim that they can almost leverage the tissue that collects around the implant, taking advantage of the subtle padding it provides, to better conceal the implant (so it\u2019s less visible and palpable) and<\/em> to amplify its overall effect. \u201cI just did a patient with a 160 cc mini,\u201d Dr. Pittman tells me. \u201cIf you hold this implant in your hand, it looks like a poached egg\u2014it\u2019s tiny. But when you see this patient, it looks like she has a 350 cc implant. It\u2019s wild.\u201d Other surgeons have confirmed this phenomenon. \u201cIt\u2019s 100% true,\u201d Dr. Gould says. Placed in front of the muscle with the Preserv\u00e9 technique, \u201ca 100 to 200 cc Motiva implant looks like a traditional 300 to 350 cc implant under the muscle.\u201d<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n

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Dr. Teitelbaum chalks up the appearance of added oomph to placement over tissue manipulation: \u201cA smaller implant will look larger when you selectively place it where you want it, because a lot of the perception of size has to do with d\u00e9colletage fullness.\u201d By pinpointing the volume, you can better control the shape of the breasts and \u201ccreate the illusion of more volume than you\u2019ve actually given them,\u201d he says.<\/p>\n