Preservé™ Breast Augmentation in NYC

Preservé is a new approach to breast augmentation developed at the Establishment Labs Sulàyöm Innovation Campus in Costa Rica, with foundational work led by Dr. Manuel Chacón. The technique is sometimes called "Breast Preservation 2.0," "Preservation Breast Augmentation," or "tissue preservation breast augmentation."

Preservé is not a cancer or mastectomy procedure. The word "preservation" refers to preserving healthy native breast tissue and the ligaments that support the breast, not to oncologic preservation.

Dr. Smith’s U.S. Preservé procedure uses Motiva SmoothSilk Round Ergonomix implants. FDA approval of an implant and registration or listing of instruments are different regulatory categories; neither means the FDA has approved a named surgical technique. Dr. Smith received training in the Preservé technique through the ESTA Global Learning Center.

The breast is supported by two important structures:

• The circummammary ligament, a circular ligament approximately 1 cm thick that runs around the perimeter of the breast where it meets the chest wall.
• Cooper’s ligaments, a network of internal ligaments that give the breast its shape and lift.

Preservé is designed to create an implant pocket while preserving supporting structures, using blunt instruments and balloon expansion. Other augmentation techniques use different pocket-creation methods; the tissue work required depends on the selected plane, anatomy and surgical plan.

The procedure is typically completed in 45–60 minutes on an outpatient basis under intravenous sedation. The four key steps are:

Step 1: Measurement and implant selection

Dr. Smith takes detailed biodimensional measurements of the breast and uses 3D imaging and AI-assisted volume modeling to select the right implant size and projection. Implant sizers are not required.

Step 2: Small incision and tumescent anesthesia

A 2–2.5 cm incision (about ¾ to 1 inch) is made in the lower breast crease. Tumescent local anesthesia is placed using ultrasound guidance to ensure precise positioning.

Step 3: Channel creation

Using the Motiva Channel Separator, a single-use blunt instrument, Dr. Smith creates a tunnel through the breast tissue without cutting the supporting ligaments.

Step 4: Pocket creation and implant placement

The Motiva Inflatable Balloon is then inserted and gradually inflated to gently push tissue aside and form the implant pocket. The balloon is removed and the Motiva Ergonomix implant is placed using a no-touch insertion sleeve. The incision is closed and shortened slightly to a final length of approximately 2 cm.

Preservé is performed in the United States with the Motiva SmoothSilk Ergonomix implant. Several features make it particularly well-suited to this technique:

• SmoothSilk surface: implant-surface research examines biological tissue responses. Those findings do not by themselves establish a lower complication rate or faster recovery for every Preservé patient.
• Viscoelastic gel: round when lying down, teardrop when standing, mimicking the natural movement of breast tissue.
• Designed to fit through small incisions, which makes it compatible with the Preservé technique.
• RFID identification is an optional implant feature. Motiva implants containing RFID are labeled MR Conditional, which means MRI must follow the conditions in the device labeling. The RFID component can also produce an imaging artifact. Tell your imaging team which implant you have.
• Ask which Motiva support program applies to your implant and surgery date. Eligibility, enrollment deadlines, covered events, replacement benefits and any financial assistance depend on the applicable U.S. program terms.
• Program coverage does not mean that every future procedure or expense is paid. Review the applicable written terms before surgery.

Smaller incision

The incision is approximately ¾ to 1 inch, meaningfully smaller than traditional breast augmentation.

Preserving tissue support

The technique is designed to preserve native supporting tissue around the implant pocket. Implant position can still change over time, and malposition or further surgery remains possible.

Implant-surface research

Research on implant surface topography provides a biological rationale for surface design. It is separate from clinical evidence comparing the recovery or complication rates of different augmentation techniques.

Blunt pocket creation

The technique uses blunt instruments and balloon expansion to form the implant pocket. Bleeding remains a risk of breast augmentation, and the surgical plan is individualized.

Lighter anesthesia

Most patients undergo Preservé with intravenous sedation rather than general anesthesia.

Implant sizing for your goals

Dr. Smith selects implant size and projection around your breast dimensions, existing tissue and desired appearance. A smaller implant may suit some patients; the appropriate size and placement are determined at consultation.

Above-the-muscle placement

Preservé places the implant above the chest muscle. The approach aims to preserve native tissue, but breast augmentation can change nipple or breast sensation.

No animation deformity

The implant sits above the muscle, so flexing the chest does not cause the breast to move unnaturally.

Faster recovery

In Dr. Smith’s practice, patients generally plan to return to work the next day after Preservé, compared with approximately 48 hours after conventional augmentation. Timing depends on the demands of your job and your recovery; returning to work does not mean all lifting and exercise restrictions have ended.

A consultation is the only way to know for sure. Generally, you may be a strong candidate if you:

• Are pursuing a primary (first-time) breast augmentation
• Have a surgical plan suited to your skin, tissue and breast shape; if a lift is needed, other augmentation approaches may be a better fit
• Want a natural look with smaller, lighter implants
• Want a fast recovery
• Are in good general health and are a non-smoker
• Have realistic expectations about your results
• Are at least 22 years old (the FDA-required minimum age for silicone breast augmentation in the U.S.)

Read when Preservé may be a good choice, or explore breast augmentation options and the recovery guide.

Preservé may not be the right fit if:

• You are considering revision (secondary) breast augmentation. The technique is currently studied for primary cases.
• You have an active infection, untreated breast cancer or pre-cancer, or are pregnant or nursing.
• You want a very large implant that exceeds the natural width of your breast.
• You have significant breast ptosis (sagging) requiring complex lift planning. This is evaluated case by case.

Preservé for active and athletic women

For active patients with well-developed pectoral muscles, an implant beneath the muscle can move or change shape when the muscle contracts. Preservé places the implant above the muscle. In Dr. Smith’s postoperative protocol, patients recovering as expected can generally begin upper-body training at two weeks after Preservé, compared with four weeks after conventional over-the-muscle augmentation. Training resumes gradually; this is not clearance to return immediately to previous weights or unrestricted exercise.

Preservé as part of a mommy makeover

Preservé may be considered as the breast component of a mommy makeover. Dr. Smith evaluates the procedures together and recommends a combined or staged plan based on your anatomy, health and recovery needs. Recovery after combined surgery follows the complete operation, rather than the breast-only timeline.

• Day of surgery: outpatient procedure with same-day discharge. No drains. IV sedation.
• Day 1: light daily activity and a planned return to work, depending on your recovery and the demands of your job.
• Days 2–7: continue gentle walking and follow your individualized activity instructions.
• At two weeks: patients recovering as expected can generally begin upper-body training gradually under Dr. Smith’s guidance. His usual starting point after conventional over-the-muscle augmentation is four weeks.
• Progressing to full training: increase weights and intensity gradually. Unrestricted upper-body exercise and heavy lifting require individualized clearance.

Because the chest muscle is not dissected, patients generally avoid the deep muscle pain associated with traditional submuscular augmentation, and a chest band is not required. You should still expect soreness and swelling in the first weeks.

Preservé is a meaningful step forward, but every breast augmentation carries risk. Standard risks of breast implant surgery still apply, including capsular contracture, implant rupture, malposition, infection, hematoma, the possibility of reoperation, BIA-ALCL (extremely rare with smooth-surfaced implants), and Breast Implant Illness symptoms reported by some patients.

The references below address different parts of breast augmentation research. The Mia Femtech study examines a related procedure with a different incision and implant configuration. The five-year SmoothSilk study reports implant outcomes, predominantly with dual-plane placement. Other work examines implant-surface biology and minimal-scar augmentation. These findings should be interpreted in the context of the specific device and procedure studied; they do not establish the same outcomes for every Preservé patient.

Breast implants are not lifetime devices. Ongoing follow-up with Dr. Smith is recommended.

Preservé is sometimes confused with other approaches that use that term. Important distinctions:

• Transumbilical breast augmentation (TUBA): a different technique that places saline implants through a belly-button incision. Not the same as Preservé.
• Endoscopic transaxillary augmentation: uses an armpit incision and an endoscope. A different anatomical approach with different tradeoffs.
• Rapid recovery / 24-hour recovery breast augmentation: a perioperative protocol focused on faster recovery. Preservé builds on these principles but uses a fundamentally different method to create the implant pocket.
• Mia Femtech: a related Establishment Labs technology, but a separate product line from Preservé.

Dr. Darren Smith is a board-certified plastic surgeon practicing in Manhattan.

• Board-certified plastic surgeon, FACS
• Dual fellowship-trained: craniofacial surgery at the Hospital for Sick Children, Toronto, and the top aesthetic surgery fellowship at Manhattan Eye, Ear and Throat Hospital (MEETH)
• President, New York Regional Society of Plastic Surgeons (NYRSPS), 2025-2026
• Author of over 200 peer-reviewed publications, lectures and book chapters
• U.S. patent holder
• Author of an accepted, in-press chapter on the Preservé breast augmentation technique for Expert Techniques in Aesthetic Surgery (Elsevier).
• Among a small group of U.S. surgeons trained in the Preservé technique
• Solo practice at the Ritz Tower, 111 East 57th Street, Manhattan

Preservé breast augmentation in NYC is a premium primary breast augmentation procedure. Quotes are provided at consultation and include the surgeon’s fee, anesthesia, facility, implants, post-operative visits, and surgical garments.

Financing is available through CareCredit and Alphaeon Credit.

Ready to learn more? Schedule a consultation with Dr. Darren Smith at his Manhattan office to find out whether Preservé breast augmentation is right for you.

• Address: Ritz Tower, 111 East 57th Street, Ground Floor, New York, NY 10022

What is Preservé breast augmentation?

Preservé is a minimally invasive breast augmentation technique developed by Establishment Labs that creates the implant pocket without cutting the breast’s supporting ligaments. It uses the Motiva Channel Separator and Inflatable Balloon, paired with a Motiva Ergonomix implant, to deliver natural-looking volume through a small inframammary incision.

How is Preservé different from traditional breast augmentation?

Preservé uses blunt instruments and balloon expansion to create an above-the-muscle implant pocket with the aim of preserving supporting tissue. Conventional augmentation offers other pocket-creation methods and implant positions. The appropriate approach depends on your anatomy and goals; the references on this page do not establish universal superiority over other techniques.

Who is a candidate for Preservé?

Potential candidates are women age 22 or older considering a first-time breast augmentation who want a natural look, are non-smokers and have realistic expectations. Existing tissue, skin elasticity and the need for a lift affect the choice of technique. Prior augmentation or more complex lift needs may favor another approach. Candidacy is determined at consultation.

What does FDA approval cover?

Dr. Smith’s U.S. Preservé procedure uses Motiva SmoothSilk Round Ergonomix implants. The FDA approved this implant family for primary and revision breast augmentation in women age 22 and older. Implant approval and instrument registration are different regulatory categories: registration or listing does not mean that the FDA has approved or cleared a surgical technique. Review the implant’s patient labeling and decision checklist with Dr. Smith before surgery.

Which implants are used with Preservé?

Dr. Smith’s U.S. Preservé procedure uses Motiva SmoothSilk Round Ergonomix implants. Implant selection and eligibility are reviewed at consultation using the applicable U.S. labeling.

How long does Preservé surgery take?

Most Preservé breast augmentations are completed in approximately 45 to 60 minutes. The procedure is performed on an outpatient basis, usually under intravenous sedation, and patients return home the same day. Your anesthesia and surgical plan are determined at consultation.

What kind of anesthesia is used for Preservé?

The Preservé technique can be performed under general anesthesia, IV sedation, or in some cases local anesthesia. Most Preservé cases are performed under intravenous sedation, with a tumescent local anesthetic numbing the breast tissue. The decision is made at consultation.

How long is recovery after Preservé?

In Dr. Smith’s practice, patients generally plan to return to work the next day after Preservé, compared with approximately 48 hours after conventional augmentation. Patients recovering as expected can generally begin upper-body training at two weeks after Preservé, compared with four weeks after conventional over-the-muscle augmentation. Training resumes gradually, and unrestricted exercise requires individualized clearance. Work demands and your recovery may change these timelines.

Will I have nipple sensation after Preservé?

The technique aims to preserve native breast tissue, but changes in nipple or breast sensation can occur after any augmentation. Preserved sensation is not guaranteed. Dr. Smith discusses your anatomy, the proposed technique and this risk at consultation.

Can I breastfeed after Preservé breast augmentation?

No breast surgery, including Preservé, can guarantee successful breastfeeding. Outcomes depend on individual anatomy, prior surgeries and other factors. Discuss family planning and your surgical options at consultation.

How much does Preservé breast augmentation cost in NYC?

Preservé breast augmentation in NYC falls within the upper range of premium primary breast augmentation pricing because of the specialized instruments and Motiva implants. Quotes are provided at consultation and include the surgeon’s fee, anesthesia, facility, implants, post-operative visits, and garments. Financing is available through CareCredit and Alphaeon Credit, and the $500 consultation fee is applied toward any procedure you book.

Can Preservé be combined with a breast lift or mommy makeover?

Preservé may be considered with a breast lift or as the breast component of a mommy makeover. Dr. Smith evaluates the combination individually, taking account of the procedures needed and the overall surgical and recovery plan. A different augmentation approach may be preferable when a lift or more complex tissue work is needed.

Dr. Smith’s practice is at the Ritz Tower, 111 East 57th Street, Ground Floor, New York, NY 10022. The Midtown Manhattan office welcomes patients from the five boroughs, the tri-state area and farther afield.

See our travel and out-of-town patient guide for visit planning.

Choosing where you have surgery matters as much as choosing who performs it. New Yorkers come to Dr. Smith because his work reflects the city itself: refined, exacting, and never one-size-fits-all. Whether you’re a lifelong New Yorker or traveling in for a consultation, you’ll find a practice that treats every patient with precision and discretion that have made Manhattan a destination for plastic surgery patients from around the world.