Preservé vs Traditional Over-the-Muscle Breast Augmentation: What's Different?

What is the difference between Preservé and a traditional over-the-muscle breast augmentation? We were actually just discussing this at a conference, and I think the explanation really comes down to tissue preservation and how the pocket is created.

There are different layers of the breast to consider:

• Under the muscle (submuscular): The implant sits beneath the pectoralis major muscle
• Over the muscle (subglandular): The implant sits under the breast tissue and over the pectoralis major
• Subfascial: A type of over-the-muscle placement where we lift the fascia of the muscle to create a protective layer

Many of us are doing subfascial augmentations, where we lift the fascia off the muscle. The reason: we want to protect the implant from the surface of the breast.

We don't want to cause cuts, rents, or openings in the posterior surface of the breast because there's a concern that bacteria could spill from the ductal system — potentially leading to biofilm or infection.

With a traditional subglandular augmentation using cautery, the posterior lamella — that very back layer of breast tissue — is pretty easy to damage. The fascia provides an extra layer of protection.

With Preservé, the approach is fundamentally different:

1. A cannula is placed under ultrasound guidance
2. Hydrodissection opens the space between the breast and the muscle — using fluid to gently separate the planes
3. No cautery, no retractors making holes in tissue
4. A balloon expander goes into the space that's already been created and gently expands it

The result: you're not using retractors that could tear tissue, you're not using cautery that could burn through layers. You're preserving the posterior lamella of the breast, which should reduce the risk of biofilm or bacterial contamination from the ductal system.

I know there will be disagreements about whether this is truly different from a traditional over-the-muscle augmentation. But if you look inside the cavity with an endoscope after it's created, the undersurface of the breast looks quite different than it does after a traditional dissection.

The tissue is more intact, the planes are cleaner, and the preservation of that protective posterior layer is the key differentiator.

Preservé is designed to minimize tissue damage during pocket creation. By using hydrodissection and balloon expansion instead of cautery and retractors, we preserve the natural protective layers of the breast — which may reduce the risk of biofilm, infection, and capsular contracture.