Is Preservé Breast Augmentation Worth It? A Candid Look After 201 Consecutive Procedures
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 August 20, 2026, I have performed 201 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There are three, plus one piece of outdated thinking worth correcting.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 was introduced 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 201 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): 146 (73%)
- Implants and a breast lift (mastopexy): 42 (21%)
- Removal of previous breast implants, placement of new implants and lift: 13 (6%)
- In total, 73% of cases were performed without a mastopexy and 55 cases (27%) included one
- Average age: 39.4 years
- Wide Awake: 11 (5.5%)
- Average implant size: 203 cc
- Profile: Mini 39%, Demi 51%, Full 10%
Complications:
- Grade III or IV capsular contracture: none
- Infection: none
- Implant rupture: none
- Loss of nipple sensation: none
- Hematoma requiring a return to the operating room: one breast (0.2%)
- Reoperation for implant malposition (one implant slightly high): one breast (0.2%)
- Reoperation for inferior or lateral malposition: none
- Complication-related reoperations, total: two breasts (0.4%)
Reoperations (not for complications):
- One patient (Preservé augmentation with a mastopexy) elected a return to the operating room for larger implants; this was a patient preference, not a complication (0.4%)
These results reflect a consecutive series begun in September 2025, so mean follow-up is currently under one year. Capsular contracture and other late findings can appear months to years after surgery, and results will be updated as longer follow-up accrues.
Frequently Asked Questions
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 technique. Dr. Epstein owns stock in Establishment Labs.
Sections - Preserve Breast Augmentation
- Preservé™ Breast Augmentation – A New Era!
- Why choose Dr Epstein for Preservé?
- How to Choose a Preservé Breast Augmentation Surgeon
- Same-Day Recovery Breast Augmentation
- Preservé Breast Augmentation Recovery FAQ
- Wide Awake Preservé
- Preservé Breast Augmentation with a Breast Lift
- Preservé Breast Implant Revision and Replacement
- 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
- Is Preservé Breast Augmentation FDA Approved?
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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
