There has been lots of excitement about Preservé™ on social media and we are getting calls about this procedure so let’s discuss what it is and what it isn’t. Surgeons are posting about it on social media as being one of their favorite techniques and the buzz is spreading! I am one of the few surgeons in the United States who has trained and been certified on Preservé™ and offers this surgical option.
Preservé™ is described by Motiva®’s as a “Minimally-invasive breast surgery utilizing tissue preservation, specialized technologies, and techniques to reshape the breast while conserving its intrinsic structure and function.”
I agree with some of the claims that surgeons are making about the technique, but not all of them. I would like to take a few moments here to give you my opinions.
The first claim is that it allows the patient to benefit from smaller scars. This is nonsense. My routine breast augmentation incision is between 2.5 to 3 centimeters. The introducer for the Preservé™ device requires a 3 centimeter incision. Yes some surgeons make excessively long breast implant incisions. That is a surgeon problem as a good surgeon can place breast implants using a Keller Funnel via a 3 centimeter incision. So a smaller incision is not advantage of the technique. I can show you hundreds of photos of patients with 3 centimeter incisions with my traditional technique.
The next claim is that there is no cutting so the balloon does not disrupt native breast tissues which allows for a quick recovery. They claim it to be less invasive and to allow breast stability. There is in fact cutting during the initial incision. This is stitched back together at the end of the surgery. So it is not completely noninvasive. What the balloon does is expand a space without disrupting ligaments in the breast. This may be true. There is a cadaver study that shows that this. Does this actually give better long term support for the implant? The jury is out on this as there is no long term data about what actually happens to results 5, 10, or 15 years down the road. My biggest problem with the dissector is that it is not performed under direct vision. I create a pocket under vision artfully shaped to maximize implant position. The balloon simply expands a space with little control. Is this as good as what I normally do? Does this actually preserve ligaments (where the name comes from) or does it stretch things with a balloon? Only time will tell with long term results. I tell my consults about how this works and let them decide what they would like done as there are pros and cons. In addition this pocket is neither under the muscle nor under the fascia of the muscle. By design and intention we are placing implants in the breast gland itself. Does this make mammograms harder? Does this lead to higher capsular contracture rates? We need long term data.
The next claim is that by using Motiva®’s SmoothSilk® implant there is a low amount of inflammation and this decreases potential complications. This is true, but I use Motiva®’s SmoothSilk® implant on most of my surgeries. Same implant, different way of placing it. So the claim that the implant is better is not an advantage of the technique itself. In fact only the ergonomic implant can be used and I like Motiva®’s Round implant better. To me, a final major drawback is that only small implants can be placed with this technique. Lots of patients want implants larger than 300cc and there is a maximum that can be placed with Preservé™. The only implant that can be used is a small ergonomic implant. This significantly limits who would be a candidate for the procedure. I have already discussed in a previous post my thoughts on the Ergonomic versus Round implants. If you can only place ergonomic implants with the device and the ergonomic implant ripples more than the round implant is this a win?
The procedure is performed as follows. Local anesthesia is used to numb the area that the implant will be placed. This is often done under anesthesia sedation but can be done fully awake. After this an introducer is placed via a small incision to create a tunnel to the breast in the space above the muscle. A balloon is then used to expand the tissue to create a space for the implant. A Keller funnel like device is then used to place the implant. The following is a diagram from Motiva®’s website:
Balloon dissection of pockets is not new. Implants were placed via the belly button (umbilical incision) by many surgeons for years. I have so many issues with this. Is the ballon as good as accurate direct visualized pocket creation that we have done for years. How does one control bleeding? I have already heard of a surgeon having a hematoma from the technique so complications are not zero. Hematomas can occur with all surgeries and I worry about an increased risk of this without direct control of bleeding. Once again, we do not have good statistics on this and patients must be educated about risks in order to make good decisions. How does one control pocket shape. Yes you carefully place the balloon and control where it expands but is this as good as direct vision? Perhaps it is. Every surgery that plastic surgeons do is based on precision and control. I want to see published controlled study data with long term follow up data? What are the complication rates? What are the downsides? Every surgical technique we do has potential risks, as well as pros and cons.
As far as this procedure being performed completely awake, the patient is usually sedated while the numbing solution is injected. The sedation is frankly a deeper sedation than some patients are being led to believe. Once the breast is numb certainly the patient can be awake. So you can indeed be awake if you would like for part of your surgery. You might even remember the part that you were awake for. But any subglandular augmentation could be done this way. This is not unique to Preservé™and to claim this is a bit misleading. A submuscular augmentation would be much more difficult to perform under lighter sedation but that is not what is being done here. The patient wakes up with little pain. Once again this is because the breast was numbed in order to place the implants. This is not magical nor a result of the Preservé™device in and of itself. Surgeons have performed liposuction in awake patients for years using the same numbing medications.
The name Preservé™is genius in terms of marketing a device and clearly has a great appeal to patients. Clever marketing does not necessarily mean better. Surgeons offering something because they are one of the first to be trained in a technique does not make it better. I am certified to offer Preservé™ but am going to have honest discussions with patients about what is best for each individual patient.
Is the recovery easier? Subfascial muscle sparing breast augmentation already has improved upon my already quick Rapid Recovery Breast augmentation techniques. Many of my patients do not take any pain medication other than ibuprofen or Tylenol. How much of an improvement can it therefore be? Truth is I placed implants under the muscle for over 20 years with quick recoveries. Dr. John Tebbetts of blessed memory published articles on “Breast Augmentation with a 24 hour recovery” in the year 2002.
Cost is another factor. The Preservé™ system is quite costly. It is being sold to patients as an expensive procedure because it is new and better. Each patient will need to decide if this extra cost is justified.
I watch plastic surgeons on social media describing how great this new technique is. I have trouble with their bold pronouncements about this great new technique that does not have very long term follow up. Patients see posts about the revolutionary technology. This can be misleading to a patient with limited knowledge about breast implant surgery who is doing her research. I have a feeling that some surgeons are happy to advertise that they are one of a select group of surgeons in the country able to do something that nobody else is doing. Surgeons need to be critical thinkers and advocates for their patients. They shouldn’t just disregard all of the knowledge and skills developed over years because there is a shiny new toy available. Just because it is new does not make it better! I have studied the technique and have it available to my patients as an option. I will not sell it to them as an improvement in what I have offered for years until I can say for sure that the advantages outweigh the risks. It’s an alternative. It is not a replacement for the refined techniques that breast surgeons have developed over the years. It will be up to every patient to decide if Preservé™ is right for them but they need honest information to help them make these decisions. For many years the motto of the American Society of Plastic Surgery was to “Do your homework” and patients can only do this if honest information showing both pros and cons is shared.