What is the Preserve Breast Augmentation Technique?

Dr. Kuruvilla (00:12):
Welcome back to Behind the Double Doors. I'm Dr. Shannon Kuruvilla with Basu Aesthetics and Plastic Surgery. In a prior podcast, we went in depth on breast augmentation and how we perform breast augmentation here at Basu Aesthetics and Plastic Surgery. We also did a podcast on Motiva. Towards the end of that podcast, I mentioned a special new technique called Preserve. So we're going to go into more detail about that today. I brought our beautiful, cute Motiva implant. This is a sizer, so it is purple. So there's a difference between sizers and the permanent implant that goes in your body. The permanent implant is sterile, so of course I didn't have one of those for you today, but we can re-sterilize these sizers or they are disposable. So here you have it. It's a small Motiva sizer. They're cute and purple. The permanent implants are cute and blue, but we're going to go over how Preserve can introduce this cute little implant into your breast tissue and keep it minimally invasive and preserve all of your anatomy.

(01:06):
So the most important thing to know about Preserve is that this is not a new implant. This is a new way of introducing that implant into your breast tissue. Preserve is a type of minimally invasive breast augmentation that respects your native anatomy. The reason this is important is that it will help your recovery be significantly shorter. It will also help preserve the longevity of your results by not interrupting a lot of your anatomy, your pain is going to be less, and you're going to be able to just get back to your life sooner. A traditional breast augmentation is surgery. The way we perform surgery is with something called cautery. It dissects tissue. It can cause inflammation. So in order to make a breast implant pocket in your standard breast augmentation, you are using cautery to dissect your pocket out in order to create room for your implant.

(01:57):
Preserve does not use cautery. It doesn't dissect any of your tissue. It actually will just stretch and expand your tissue. So nothing is being divided. No strength ligaments are being divided. Your circummammary ligament around your breast is being respected and no muscle is being divided. So it more stretches things than actually divides them. So the Preserve technique came from Costa Rica. So it was developed by Dr. Manuel Chacon, who also developed Motiva implants, of course. He has been refining this technique internationally for years before training US surgeons to perform this. There are three essential tools for this Preserve technique that allows us to create this space for your implant in your native breast tissue. The first one is something called a channel separator. So this device, it is not sharp. It's very gently tapered at the end, will be used in a very gradual twisting motion to get into the retromammary space.

(02:58):
So there's something called your circummammary ligament. It's a fascial apparatus that surrounds all of your breast tissue. We're respecting this in Preserve. And so we use this to get behind it. We are still on top of your muscle. We are still on top of your muscle fascia, but we're behind the breast space. So this will introduce it. Once we get into that space and we know what size implant you want, which is also limited in this technique, we'll go over that later, we will inflate this balloon. So it's originally folded around a similar dissector. We get that into the space. It goes behind your breast tissue and then we inflate it just with air. We let that sit for a while. It will stretch your ligaments and create a nice very hand in glove pocket for your implant. So we are creating the exact size space that you need for the implant that is going inside of your body, minimizing risk of any malposition, any movement or implant flipping.

(03:52):
The last tool will then be something called a funnel or there's different types of funnels on the market, but we use Motiva's funnel, which is just a way of introducing this through that space without using our hands. So it's a no touch technique. And then we just introduce it into that pocket. There are limitations to who is a good candidate for this technique. So we are limited in how large of an implant we can place. And that is just because as it's minimally invasive, we're making very small incisions. These implants, we do use the ergonomix implant. They're very natural. They move with your breast tissue, so they can be introduced through a funnel through that small space, but we are limited to sizes up to around 315 CCs. But these ergonomic implants do mold and move with your body and so we can introduce them into that space with that funnel.

(04:40):
This cute size I'm holding is a 205 CC implant, 205. Preserve goes above the muscle. This is important. So again, we're talking about tissue preservation, respecting anatomy, minimally invasive surgery. There are very good reasons for going below the muscle in certain patients, but a lot of times it is not necessary. And this is one of those cases. So by being able to use your breast tissue to camouflage these implants that have minimal rippling that also feel and look very natural, we are able to stay above your muscle. It's very important for patients who like to lift and exercise and use their pec muscles a lot, minimize the risk of something called animation deformity where every time you are flexing your pec muscles, that implant can get pushed inferiorly and laterally. It also can just be uncomfortable knowing that your implants are moving with exercising. But I think more importantly, especially for moms or people with young children or people who just have to get back to their life very soon, you have a lot less swelling and there's much shorter activity restrictions postoperatively.

(05:41):
We let you get back to exercising or get back to your job if it requires a lot of heavy lifting or strenuous activity. We allow you to get back to it sooner after this because we have not divided that muscle. Here's our ergonomics implant and as I'm squeezing it, you're seeing it function as that true monoblock technology, meaning that the shell and the gel inside are one unit. It's not separate layers, it's one monoblock unit. So that's what allows it to squeeze through that little incision. Your ergonomix implant functions kind of similarly or similar concept to kind of the older saline implants, just in that when you stand up, it does kind of form slightly more of the shape of the breast, giving a little bit more of a natural teardrop shape and meaning it moves with the breast tissue as opposed to holding a very firm upper pole, which can be a goal for some patients.

(06:34):
So that's the ergonomix. Now it isn't as heavy in bottom heavy as saline implants, but just kind of similarly when you stand up, it does kind of take more of that teardrop shape of the breast. Textured surfaces of implants is very important because there has been new research recently showing a correlation of a very rare form of cancer with something called macro textured implants. Now these are not macro textured implants. Macrotextured implants have a very obvious and rough surface irregularity to them. We do not offer macro textured implants. The reason textured implants are helpful in the breast augmentation world is they can be less inflammatory. They don't stimulate the body's inflammatory response as much. Up until Motiva implants, so the implant of choice is a smooth shell. However, Motiva has introduced something called nanotexturing. So the microns of the irregularity are only about four microns. So it is not your macrotextured implants.

(07:32):
There is no association with ALCL, but we do have that benefit of being less inflammatory to the body with that nanotexturing. You cannot even see a micron with your eyes. Now these macro textured implants, it is very clear that you can see the texturing, you can feel the texturing. These essentially feel smooth, but it is that microscopic nano texturing that also has the same benefit of being less inflammatory and stimulating to your body's inflammatory response. So let's go through a day in the life as a Preserve patient, depending on the anesthesia that you have selected, which is important. So this can be done under local anesthesia where you're wide awake. It can also be done under just some gentle IV sedation or it can be done under general anesthesia where you are completely asleep. And that really is personal preference and we'll have that conversation at your consultation.

(08:25):
For today's talk, we're going to pretend like this is a local anesthesia case just because I think that is something very special to Preserve as being an option. So you will come into your pre-op. Obviously you'll have your standard history and physical, all of our nurses get cleared by our team and then marking. So marking is very important because we'll mark exactly on your body where your circummammary ligament is and where we want that implant to sit. Different surgeons have different techniques for how they select that area. It'll also be a conversation between you, the patient and us. So then we'll get you back to the operating room and we will spend a good amount of time getting you numb. So what that looks like is we'll mark out a little incision in the breast crease, so that inframammary incision that's hidden. We'll numb that with a sharp needle.

(09:12):
You'll probably feel that initial sting and a slight burning and then we will make a small incision and then inject some, what's called local kind of tumescent anesthesia into the breast pocket. That also helps our dissection. That helps our dissection be less bloody and just helps it be more exact with our instruments coming later. Similar to patients who have maybe had some small volume liposuction while they're awake, we get that initial skin very numb and then once we get into the deeper tissues, it's a lot easier to get more numb and we inject just a little bit larger volume of, it's called two medicine, but it includes some numbing medicine as well as some medicine that helps constrict your blood vessels and reduce bleeding. So it numbs out kind of like the entire breast pocket. Once we've confirmed that you are nice and numb, we will then very gently introduce our channel separator.

(10:03):
We'll get to that exact implant pocket that we want. We'll take it out. We'll introduce our balloon. We'll expand that pocket. We'll let it sit and then we'll go do your other side and then we will wash both areas and then very gently introduce the implant. Usually close the incision with all solvable sutures, put you in a nice bra for compression. We'll let you shower the next day. You can go back to work the next day. If you didn't take any anxiolytics and didn't go under general anesthesia, you're back home probably within like 20, 30 minutes of operating with just make sure your pain's well controlled. I do like to keep this procedure very sterile. So we will have the standard surgical drapes draped out around your chest wall. And so with that, your face is not included, unfortunately, but we'll have our nurse or circulator sitting with you.

(10:53):
We can talk to you the entire time. Obviously we want your feedback if you're feeling any sort of discomfort, but you can bring headphones, listen to music. We do like to kind of have your arms out so you're not really using your arms for that period of time, but you're not able to see the surgery happening unfortunately, but we can walk you through everything that's happening, you're aware of every single step that's happening. We do a lot of filming at our practice. We're happy to share that with you, but just by nature of keeping the procedure as sterile as possible, I don't think it's possible for you to physically look down and watch the surgery happen. It takes a certain skill and experience to be able to keep the patients comfortable in local procedures where they are awake and also just being able to take the time to make sure the patient is comfortable.

(11:37):
And so yeah, I think that comes with a lot of reps basically. And just understanding the patients and anxiety levels. So who is a good candidate and who is not a good candidate for breast augmentation via the Preserve technique? So you are probably a good candidate for Preserve if this is your first augmentation. So you'll see something called primary breast augmentation. We are not taking implants out and switching them around. This has to be your first breast augmentation just because revision augmentation is a little bit more nuanced, it does require a larger incision. Those ligaments have probably already been dissected a little bit in your prior augmentation. So primary breast augmentation, you want a very natural result, a very proportional results, and you're not looking for a significant volume. So over that 300, 315 cc range and you're somebody who wants minimal downtime and wants to get back to work the next day and just get back to living life.

(12:35):
So in terms of deciding whether you opt for this Preserve technique or your standard augmentation mammoplasty, it really has to do with the look you're going for. So another term I've heard for Preserve is less so breast augmentation, more so breast enhancement or like the ballerina boobs. So kind of the look that people want to get when they put a pushup bra on, you're increasing the volume a little bit, but not significant that everybody's going to know you went and had a breast augmentation. If you are somebody whose goals, and which is totally fine because your goals is to have a significantly augmented look, you don't have much volume as it is and you want significantly more volume, then that's going to be your standard breast augmentation. Now there are things we do still to preserve your anatomy and our standard breast augmentation. We still try to go above your muscle when we can, atraumatic dissection, and of course maintain that hand and glove fit to minimize any sort of malposition of that implant.

(13:34):
What is recovery like after surgery from Preserve? So we tell you that you can get back to work tomorrow. You can get back to walking kind of light exercise at one week, and then you get back to your standard heavy lifting, strenuous activity, two to three weeks, just depending on your anatomy and what type of exercises you're doing. This is different from a standard augmentation mammoplasty where we're asking you to do no exercising, no power walking, and then definitely no heavy lifting for closer to that four week mark. After Preserve in terms of bra selection, you essentially are seeing your final result that day. So the swelling is very minimal. It's not like we're waiting for weeks for your swelling to go down before you go bra shopping. That being said, we ask you to stay in our nice compression bra until we clear you at that two to three week mark and then you can go bra shopping.

(14:25):
But a lot of patients are looking for just that very subtle augmentation look.You might not even need to buy more bras, but that'll all just be determined by the volume you select. Okay. So if you are listening and you've been interested in having a breast augmentation, this is your first breast augmentation and you're wondering if you would be a good candidate for Preserve or if Preserve would reach the goals that you have in mind for yourself, you can schedule a consultation. We tailor the consultation to you and your anatomy and we'll give you a broad overview of both options and review things. So you can either book on our website, you can DM our Instagram or you can call us.

Announcer (15:07):
Basu Plastic Surgery and Aesthetics is located in Northwest Houston in the Town Lake area of Cyprus. To learn more about the practice or ask a question, go to basuplasticsurgery.com/podcast. On Instagram, follow Dr. Basu and the team at Basu Plastic Surgery. That's B-A-S-U Plastic Surgery. Behind the Double Doors is a production of the Axis, T-H-E-A-X-I-S.io.