Preserve (also referred to as Preservé) is a tissue-preserving surgical approach in breast augmentation based on preparing the pocket in which the implant will sit by controlled expansion rather than by cutting the tissues. In Turkish it is often called “tissue-preserving” or “muscle-preserving” breast augmentation.
In classic breast augmentation, the implant pocket is created by cutting and separating the tissue with electrocautery and surgical instruments. In the tissue-preserving approach, the pocket is prepared by gently separating the tissues from one another with the help of a balloon-shaped expander. The aim is to leave the chest muscle, the supporting ligaments that carry the breast, and the vascular and nerve structures in place as far as possible.
What is described here is not the implant itself but the form of the surgical approach. The choice of implant (volume, shape, surface characteristics) is a separate topic and is determined according to the person's anatomy. For information under the general breast augmentation heading, you can refer to the breast augmentation page.
The table below has been prepared to describe the technical differences between the two approaches; it does not imply the superiority of one over the other. Which approach is suitable varies from person to person.
| Topic | Classic approach | Tissue-preserving (Preserve) approach |
|---|---|---|
| Preparation of the pocket | Separation of the tissue by cutting | Separation of the tissue by expansion |
| Chest muscle | With under-the-muscle placement, part of the muscle may be detached | The aim is to leave the muscle uncut |
| Implant plane | Under the muscle, over the muscle or dual plane | Usually over the muscle (subglandular) or under the fascia (subfascial) |
| Supporting ligaments | May be affected during dissection | The aim is to preserve them |
| Drain | May be used as the case requires | Usually not needed |
| Change in shape with muscle movement | May be seen with under-the-muscle placement (animation deformity) | Not expected, because the muscle is preserved |
On the other hand, over-the-muscle placement has its own limitations: in people with thin tissue coverage, the edges of the implant may become noticeable or rippling may be seen. For this reason, the choice of plane is made according to measurements and examination findings, not according to the name of the technique.
It is not suitable for every person. Where the tissue coverage is very thin, where there is pronounced sagging, or where the intended increase in volume exceeds the capacity of the tissue, a different plan may come into consideration — for example, evaluation together with a breast lift. Suitability is determined only through an examination.
1. Examination. The thickness of the breast tissue, skin elasticity, chest wall measurements, nipple position and, if present, asymmetry are assessed. The medical history and, if necessary, breast imaging are reviewed.
2. Planning. Whether the tissue-preserving approach is suitable is determined; if it is, the volume and shape of the implant, the plane in which it will be placed and the incision site (mostly the inframammary fold) are decided.
3. Procedure. It is performed under general anesthesia in a hospital setting. The implant pocket is prepared by controlled expansion and the implant is placed.
4. Follow-up. Use of a supportive bra may be recommended; healing is monitored through check-ups.
Because the aim is to keep tissue trauma limited, the tightness and swelling in the first days are reported to be felt less. However, this is a surgical procedure; recovery varies markedly from person to person.
Important: Breast implants are not medical products with a lifetime guarantee. Regardless of the technique used, replacement or removal may be needed in later years.
The tissue-preserving approach does not change the fact that breast augmentation is a surgical procedure. The known risks apply to this procedure as well:
This list does not cover all possibilities. Your personal risk profile, medical history and current health status are assessed in detail at the examination and shared with you as part of the consent process.
In the classic approach, the implant pocket is mostly created by cutting tissue with electrocautery and surgical instruments. In the tissue-preserving approach, the pocket is prepared by separating the tissues with the help of a balloon-shaped expander. Both approaches are surgical procedures; which one is suitable is determined at the examination according to the person's anatomy.
In this approach, the implant is generally placed under the breast tissue (subglandular) or under the membrane that covers the chest muscle (subfascial); the chest muscle is not cut. This plane also has its own characteristics and limitations, and it may not be suitable for every person.
No. The thickness of the breast tissue, skin quality, the intended volume and, if present, the degree of sagging are decisive. With a very thin tissue structure, or where pronounced sagging is present, a different plan may come into consideration. Suitability is assessed only through an examination.
In procedures where tissue trauma and bleeding are kept limited, a drain is generally not needed. However, the use of a drain may vary according to the person and the findings during the operation; this is a surgical decision, not a rule.
Preserving the nerve structures is one of the goals of this approach. However, no definite assurance can be given that there will be no change in sensation with any surgical method; temporary or permanent change in sensation is among the known risks of all breast surgery.
In placements where the chest muscle is cut, movement of the implant when the muscle contracts (animation deformity) may be seen. This is not expected in placements where the muscle is preserved. On the other hand, with over-the-muscle placement, the edges of the implant becoming noticeable may come into question in people with thin tissue coverage.
Planning is carried out with the aim of preserving the breastfeeding function. However, no definite guarantee can be given. It is important for people who plan a future pregnancy and breastfeeding to mention this during the examination.
Preserve is a tissue-preserving approach in which the pocket for the implant is prepared by controlled expansion rather than by cutting the tissues; it is a surgical technique, not an implant brand. Whether this approach is suitable for the person is evaluated at the examination in Antalya, taking into account the tissue structure and the characteristics of the planned implant.
The term tissue-preserving describes minimizing the surgical trauma to the muscle and surrounding tissues while the implant pocket is being prepared. This does not mean it will give the same result in every patient; the choice of technique is made according to the person's anatomy.
Specialist in Plastic, Reconstructive and Aesthetic Surgery. A graduate of Selçuk University Faculty of Medicine; he completed his specialty training at the University of Health Sciences, Afyonkarahisar Health Application and Research Center. He works at Antalya Yaşam Hastanesi (Şirinyalı, Muratpaşa / Antalya).
