Medically reviewed by Mark D. Epstein, MD, FACS. Last updated: July 9th, 2026.
Next scheduled review: October 9th, 2026.
Short answer: for a first-time breast augmentation patient who wants a natural result of up to 315 cc per side, Preservé is worth it. The recovery is dramatically easier, the tissue that supports your breast is preserved rather than cut, and the procedure can be done without general anesthesia. And for many women with prior below-the-muscle implants and poor long-term results, Preservé offers a second chance at beautiful, natural breasts. For patients who want larger implants it is not an option, and no reputable surgeon should sell it to you as one.
As of July 1, 2026, I have performed 165 Preservé procedures, to my knowledge the largest single-surgeon experience in the United States, alongside thousands of traditional augmentations over more than 30 years. That means I am not comparing Preservé to a technique I read about. I am comparing it to my own hands and my own long-term results. Here is the balanced picture.
What are the real advantages of Preservé?
- Tissue preservation: The circum-mammary and Cooper's ligaments are preserved. These are the natural support structures inside and around the breast. Traditional dissection cuts or releases portions of them; Preservé keeps them intact, which supports implant stability, preventing malposition of the implant while maintaining a natural feel.
- Recovery: No muscle is cut and blunt dissection replaces sharp dissection, so there is less bleeding, less bruising, and far less pain. Most of my patients are back to normal daily activity within a day or two.
- Anesthesia options: Because the operation is so gentle, it can be performed wide awake under local anesthesia with either no sedation or light sedation for appropriate candidates. For others who prefer to have no awareness of the procedure, intravenous sedation ("twilight," like during a colonoscopy) is offered. No breathing tube, no grogginess, no anesthesia hangover.
- Scar: The incision is smaller than a traditional augmentation incision.
What are the honest downsides of Preservé?
There are three, plus one piece of outdated thinking worth correcting. I discuss all of them at every consultation.
- Size limit: Preservé uses Motiva SmoothSilk Ergonomix implants from 150 to 315 cc only. If your goal is a large, dramatic result, this is not your operation. I use 3D imaging with computerized simulation during my consultations. In reality, just about all of my patients find a result they love well within the range of available implant sizes. My observation is that breasts tend to look larger with any given implant when the Preservé method is used because the volume is focused more to the upper, inner breast where it is needed most.
- First-time patients only? Not anymore!: The traditional thinking was that only patients who have never had breast implants or prior breast surgery are candidates. I have been using Preservé quite successfully for women who have had previous under-the-muscle augmentations with poor long-term results (implant malposition, recurrent capsular contracture, oversized and stretched implant pockets) and who now get a second chance to have beautiful, natural, full breasts. For women who have had previous breast lifts, Preservé should work fine in the majority of cases. For women who have undergone a previous breast reduction or above-the-muscle augmentation, a Preservé-like procedure may be able to be performed using the advantages of balloon-assisted pocket creation, but the internal supportive ligaments of the breast need to be presumed to be gone.
- Cost: The single-use instrumentation and premium implants make Preservé more expensive than a traditional augmentation.
- It is new: Preservé received FDA clearance in the United States recently, so multi-decade outcome data does not yet exist for the technique itself, although the Motiva implants it uses have extensive clinical data, including the FDA trial in which I served as a Principal Investigator. Preservation breast surgery, which includes Preservé, has been performed in other countries, and several published studies with three years or longer of follow-up demonstrate the safety and effectiveness of the procedure.
Who should choose traditional augmentation instead?
You should choose a traditional augmentation if you want implants larger than 315 cc, possibly if you have had a prior above-the-muscle breast augmentation or breast reduction, or if budget is the deciding factor. I perform both operations, so my recommendation at your consultation is based on your anatomy and goals, not on which procedure I am able to offer.
What have my 165 Preservé patients actually experienced?
I have an interesting perspective on recovery after breast augmentation. I have been a pioneer of One Day Recovery Breast Augmentation in this country since 2004, having performed thousands of such procedures. These were patients who had their implants placed under the muscle, which involved cutting the muscle and using an electrocautery (an electric needle used to cut or separate tissue) to create the implant pocket. Here are my preliminary observations thus far:
Patient breakdown:
- Implants only (no lift): 113 (68%)
- Implants and a breast lift (mastopexy): 43 (26%)
- Removal of previous breast implants, placement of new implants and lift: 9 (6%)
- Recovery: While I was thrilled that my previous traditional patients could sometimes go out to dinner or shopping later in the day after surgery, I am seeing an even faster recovery with Preservé. My patients recover faster in my surgical facility, leave with little to no discomfort whatsoever, and often go out to lunch and shopping right after surgery or a couple of hours later. The next day they have a little discomfort, nothing that Tylenol or Advil can't mitigate, and overall they look more comfortable than my traditional breast augmentation patients.
- Activity schedule after surgery: Same day as surgery: treadmill fast walking or cycling with no resistance, sex is OK (no Olympic sex!), and lifting a child up to 30 pounds. If no sedation was given during surgery, they may drive. Day after surgery: OK to drive. Two weeks after surgery: full aerobic activity, swimming in a pool. Three weeks after surgery: light lifting workout. Four weeks after surgery: no restrictions.
- Implant malposition: With traditional breast augmentation, it was not uncommon to see the lower breast crease drop with subsequent loss of upper breast fullness, sometimes making the nipple look a little high on the breast mound. With time, the implant pocket also stretches laterally to the side of the chest, so when the patient lies down, the implant rolls off the chest to the side. With Preservé, I am not seeing any of this. I cannot recall any patients with implant malposition downward or to the side. They maintain their upper breast fullness, and this also means that I am not reoperating on my patients for this reason.
- Loss of nipple sensation: None
- Capsular contracture: None
- Hematoma (bleeding after surgery requiring a return to the operating room): One breast = 0.3%
- Revision of implant position: One breast in a very early case required revision as it was slightly too high. 0.3%
- Infections: None
- Implant ruptures: None
- Overall patient satisfaction: Extremely high
- Requests to replace with larger implants: One patient, 0.6%
No surgeon and no procedure is completely without risk, but these statistics are far better than I have ever seen in my practice over the preceding 32 years, and I do not know of any other surgeons with better outcomes than this utilizing a traditional method of breast augmentation.
Frequently Asked Questions
Is Preservé breast augmentation worth the higher price?
For first-time patients seeking a natural result up to 315 cc, yes, and the same is true for many women replacing below-the-muscle implants that have shifted or hardened over time. You get preserved breast support structures, a recovery measured in days rather than weeks, and the option of avoiding general anesthesia. For patients wanting larger sizes, traditional augmentation is the better operation.
What are the main downsides of Preservé?
The implant size range is limited to 150 to 315 cc, it costs more than traditional augmentation, and long-term data on the technique itself is still accumulating.
Is Preservé safer than traditional breast augmentation?
Preservé involves less tissue trauma, less bleeding, and can avoid general anesthesia, which reduces certain risks. All breast augmentation carries risks such as capsular contracture and the possibility of future revision. In my opinion, based upon my patient experience thus far, Preservé is a better, safer method of breast augmentation with a lower complication rate than traditional breast augmentation.
Can I get Preservé with a breast lift? Will it affect my recovery?
You can absolutely get Preservé with a breast lift (mastopexy). It has been my observation that there is no increase in pain or downtime when a lift is performed at the same time as a Preservé breast augmentation!
Can I get Preservé if I already have implants?
Yes! If the previous breast implants were placed below the muscle, Preservé is a fantastic option to restore beautiful breast contours with the least risk of complications and reoperation. In the past, I found salvaging an overstretched, below-the-muscle implant pocket an extremely difficult task with a substantial rate of failure or unsatisfactory results. Preservé is a second chance procedure to restore beauty to your breasts.
Disclosure: Dr. Epstein is a paid investigator in the Motiva U.S. FDA clinical trial and is compensated by Establishment Labs to train surgeons on the Preservé breast augmentation technique.
Sections - Preserve Breast Augmentation
- Preservé™ Breast Augmentation – A New Era!
- Why choose Dr Epstein for Preservé?
- Wide Awake Preservé
- Awake Preservé Breast Augmentation: No General Anesthesia
- Dr Epstein training other Preservé surgeons
- New innovation: Epstein Preservé Channel Dilator
- Preservé Breast Augmentation Cost (2026): What Determines the Price
- Is Preservé Breast Augmentation Worth It? Pros, Cons and Limits
Prev Chapter: Intro to Breast Augmentation »
Next Chapter: Motiva Implants – What You Need to Know »
Chapters – Breast Augmentation Guide
- Intro to Breast Augmentation
- Preservation Breast Augmentation – A New Era!
- Motiva Implants – What You Need to Know
- Five key decisions you need to make
- One-Day Recovery Breast Augmentation
- Anesthesia – General, Sedation or Local?
- Breast Lift (Mastopexy) with/without Implants or Fat
- What else should I know about breast augmentation?
- Important Things to Consider When You Decide to Move Forward With Breast Augmentation
- Revision of breast augmentation
- ALCL and Breast Implant Illness
