RESET!!! What do I mean by “RESET?” I have been a plastic surgeon for thirty-five years and during this time, I have seen a lot of changes and innovations in breast augmentation. Saline implants, silicone implants, smooth, textured, below the muscle, above the muscle, armpit, nipple, under the breast and even belly button incisions. Maybe you know nothing of breast augmentation, maybe you have some idea from what your friends have told you, or what you heard on social media, the internet or even ChatGPT. Trust me, none of this matter at this point. I am going to ask you to FORGET EVERYTHING YOU HAVE EVER LEARNED OR HEARD, as I am going to introduce you to the most recent innovation in breast augmentation which will now be available in the United States, as it has already taken Europe, Asia, Central and South America by storm! There is only so much I can discuss in this article, but a great deal more information is available on my website. If you are interested in breast augmentation, and your surgeon can offer you this amazing technique, then you can be confident that you are receiving the most current innovation in breast augmentation surgery.
What is Breast Preservation?
With every possible method of creating a space for breast augmentation, there is destruction of the breast anatomy. This destruction occurs by way of surgical manipulation and transection of tissue to create a space (pocket) for the implant. Breast Preservation has nothing to do with mastectomy or breast reconstruction for cancer. What it refers to is a method of creating a pocket for a silicone implant inside the breast with preservation of all the ligaments that are otherwise cut during all other methods of implant placement. How is this possible?
Preserving the support of the breast: The breast is attached to the chest by a circular ligament approximately 1 cm thick called the circummammary ligament. You can identify this ligament easily under your breast as it lies where the lower breast crease lies. If you press your breast against your chest, you will see the upper border of your breast where the upper margin of the ligament lies. If an implant is placed within this circular ligament, it will lie within the breast and provide a natural look. If the ligament is disrupted and the implant lies outside of this circle, then the implant pocket will extend past the breast tissue and consist of chest wall skin over the ribs or muscle. That will not look normal and very likely result in secondary deformities with time. If you are desirous of a huge augmented, unnatural breast with a high risk of needing reoperation, then do not waste your time reading this article – just turn the page.
Is the Implant Above or Below the Muscle?
This is an excellent question. While there is actually only one plane under the muscle (between the pectoralis major muscle and the rib cage), there are actually three possible planes above the muscle. They are:
- Between the pectoralis muscle and the overlying muscle fascia
- Between the pectoralis muscle fascia and the capsule of the overlying breast gland
- Between the capsule of the overlying breast gland and the body of the breast gland/fat
What is the Breast Preservation Space?
In Preservation Breast Augmentation, the space for the implant is the latter, between the capsule of the overlying breast gland and the body of the breast gland/fat. This is called the “Breast Preservation Space.” When the implant pocket is created in this space, the circummammary ligament that surrounds the breast and all the ligaments contained within the breast are preserved.
How is the pocket created?
A tiny incision is made in the lower crease of the breast. Local anesthesia is then placed across the breast just above the pectoralis major muscle. Ultrasound guidance is used to ensure that the local anesthesia is placed in the proper plane.
A 2.5 – 3 cm incision is made along the lower breast crease. Next, a special dissector instrument is used to create a channel through, but not cutting, the circummammary ligament and up through the breast. Next, a balloon is inflated to create the pocket. When the balloon is properly placed in the “Breast Preservation Space”, all the ligaments are pushed aside, along with the breast tissue. The process of pushing the breast tissue aside is what permits a smaller implant than usual to be used. Normally, the ideal breast implant is as wide, or almost as wide, as the breast. This necessitates destroying the circummammary ligament which then results in destabilizing the breast and leads to implant malposition down and/or to the side. With Preservation Breast Augmentation, the implant is no wider than the space within the confines of the circummammary ligament, and breast tissue is moved to the sides of the breast. In most breasts in which augmentation with an implant is desired, the area of the breast most lacking volume is the upper and inner breast. Preservation Breast Augmentation allows the surgeon to specifically target these areas and provide the necessary volume and balance to create a rejuvenated, augmented but natural looking breast.
After the pocket is created, the implant is introduced into the pocket using a funnel. The wound is then closed, and in doing so, the incision length is shortened slightly to allow the final incision length to be approximately 2 – 2.5 cm (3/4 – 1 inch).
So, what is different about Preservation Breast Augmentation Surgery?
Traditionally, breast augmentation is an operation that provides a high degree of satisfaction for patients, but it is not without its share of complications. This includes malposition of the implant down and/or to the side, capsule contracture, hematoma (bleeding after surgery), animation deformities (breast moves when contracting the pectoralis muscle) just to name a few.
Preservation breast augmentation is a true departure and improvement upon every possible method of breast augmentation that I have ever tried or knew about. It is a true innovation that will carry us into the next generation of breast augmentation. The complication rate is the lowest I have ever seen with breast augmentation and the results are absolutely beautiful!
There are many differences between Preservation Breast Augmentation and all other traditional methods of breast augmentation. Below is a brief summary of the distinguishing aspects of Preservation Breast Augmentation:
Anesthesia: The surgery is usually performed with local anesthesia with sedation given by an anesthesiologist. General (going to sleep) is an option, but generally not necessary. Patients are generally awake, or nearly so, when the surgery concludes.
Incision: The incision is ¾-1 inch in length, smaller than other techniques. It is made in the lower breast crease.
Ultrasound guidance: Ultrasound is used to guide the surgery so that the implant is pocket is precisely created.
Bloodless: Zero blood loss. An electrocautery, which is always needed during traditional breast augmentation to cauterize bleeding vessels cut during surgery simply is not necessary during Preservation Breast Augmentation.
Implant pocket: The implant pocket is created utilizing a minimally invasive technique that does not cut the circummammary ligament and furthermore preserves all the internal (Cooper’s) ligaments of the breast. This provides far more support to the breast, offering much greater long term stability of the breast. While implant malposition (implant dropping below the initial crease or falling to the sides when you lie down) is a common complication with all other traditional breast augmentation techniques, experience with this technique in other countries reveals that implant malposition is becoming a thing of the past. The difference here is that the implant is “nested” within the ligamentous structures of the breast, preventing stretching of the pocket and implant malposition, and does not shift. In traditional breast augmentation techniques, the ligaments are all cut.
Intelligent Breast Volume Placement: With this technique, smaller implant sizes are required to give similar an appearance similar to traditional techniques. How does this make sense? With traditional augmentation, a pocket is made the extends from the far inner to the far outer breast and from the lower breast crease all the way up to, and often higher than, the upper border of the breast (circummammary ligament). This is simply not necessary. The fact is, there are parts of the breast that already have adequate tissue, or near adequate tissue, and some areas, particularly above the areola, that are very devoid of breast tissue. By using a smaller implant, but creating a pocket WHERE THE VOLUME IS NEEDED, one can achieve a beautiful, full breast with a smaller implant. The smaller the implant, the less stress it will place on the breast and the better the breast will look over the ensuing years to come. When I was first introduced to Preservation Breast Augmentation, I found this the hardest to believe. Having performed this procedure, as well as watching numerous other surgeons do so as well, I am now a total believer in this concept!
Implant: In the United States, the only breast implant that can be used to perform this technique is the Motiva™ Ergonomix™ (“teardrop”) implant with SmoothSilk™ surface, which I have seven years of experience with, and I can attest to how natural a breast with this implant will look and feel!
Ultra-Fast One Hour Recovery: I have championed One Day Recovery Breast Augmentation for over twenty years. The recovery from Preservation Breast Augmentation is even faster!
AI Visual modeling before and after of total breast volume. Computer imaging of the breasts is performed at consultation. Accurate estimations of breast volumes are taken. Based upon measurements of the size of the circummammary ligament, an implant width is selected. From this width, and according to the desires of the patient, implant projection is also selected. Based upon these parameters, a breast implant size and projection is selected for implantation at surgery. No sizers are required!
Who is a candidate for Preservation Breast Augmentation?
Anyone undergoing a primary (first time) breast augmentation or primary breast augmentation with a mastopexy (breast lift) is a candidate for Preservation Breast Augmentation.
Summary
Preservation breast augmentation is the latest, most innovative technique to perform breast augmentation with the least amount of tissue trauma and bleeding, fastest recovery, least amount of necessary implant volume, lowest complication rate, and best overall, stable results.
Chapters – Breast Augmentation Guide
- Intro to Breast Augmentation
- Preservation Breast Augmentation – A New Era!
- Motiva Breast Implants
- 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
