Motiva is celebrating the Preserve method of breast augmentation with a well-constructed media package. As a plastic surgeon, I appreciate the idea and largely agree with their views. The only thing missing from their message is context.
And there is a lot to unpack.
Smaller Implants, When They’re Right, Are the Right Choice
The Preserve method is designed to enhance breasts using relatively small implants. In breast surgery, “the bigger, the better” simply does not apply. If a patient’s goals can be met with smaller implants—based on both volume and dimensions—then a small implant is not a compromise. It’s a perfect choice.
Determining the ideal implant for a patient, however, is not always simple. My personal preference is to have patients try on a range of implant sizers so they can see and feel what works best for their bodies. I then verify that choice using a three-dimensional photographic system, Vectra. This approach clarifies expectations and allows me to detect subtle volume differences between the breasts, sometimes leading to the use of different implant sizes to improve symmetry.
Small Incisions and Balloon Dissection: A Proven Concept
Preserve also emphasizes relatively small incisions combined with balloon dissection—and that’s a great idea. In fact, it’s an approach I’ve used for decades.
Traditional breast augmentation techniques often involved large incisions and extensive tissue elevation—from the collarbone to the side of the breast, from the sternum to the upper abdomen. Over time, the “hand-in-glove” method became popular, particularly with textured implants, and for good reason.
Balloon dissection is simply a more efficient and less traumatic way to create an implant pocket than repeatedly inserting and removing sizers. Less trauma generally means less swelling, less discomfort, and a smoother early recovery.
Above-the-Muscle Placement: Gentle, but Not for Everyone
Preserve breast surgery relies on placing the implant above the muscle. This is a very gentle way to operate and, for the right patient, it works beautifully. However, it requires sufficient breast tissue thickness to camouflage the edges of the implant. Without that coverage, the breast can appear “stuck on” over time—especially after pregnancy, weight changes, or simply with aging.
This approach works best with lighter, smaller implants. When the patient is well selected, recovery can be remarkably quick, with normal activities resuming in hours or a few days.
The Trade-Offs of Other Approaches
Submuscular or dual-plane breast augmentations can be more painful and typically require several days of recovery. Larger implants also add weight, which can increase discomfort and prolong healing.
It’s true that if a Preserve-style approach doesn’t hold up long term, revision surgery is possible. But my philosophy is simple: understand the patient’s goals, choose the correct technique, and do it right the first time. Ideally, it’s something we only need to do once.
A Rebrand of a Sound, Established Approach
In many ways, Motiva is rebranding a standard, time-tested approach to breast augmentation under a new name. That’s not a criticism—it’s simply context.
Motiva makes an excellent product. Every implant manufacturer strives for excellence on behalf of patients, and that is a goal I share as well. The Preserve method highlights important principles in breast augmentation; it just needs to be understood within the broader framework of surgical judgment, patient selection, and long-term planning.
