My experience with Dr. Darren Smith and his staff made it obvious that I should never consider another plastic surgeon! I had several consultations with other cosmetic surgeons for a breast lift procedure before making the indisputable choice to go with Dr. Darren Smith.
Preservé Breast Augmentation in NYC
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.
4.9 from 150+ reviews
Before & After: Breast Augmentation NYC
Explore our gallery of real patient results. These before-and-after photos reflect the life-changing outcomes of plastic surgery performed by Dr. Smith.
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“Being a Nurse I look at medical and surgical procedures slightly differently. So I guess you can say I’m more critical than most. But I only have the upmost positive take away from my experience with Dr Darren Smith and all of his staff. Everything from beginning (consultation) to end (post op care) was exceptional. He listened to my concerns and guided me to a natural enhanced outcome …
Dr Smith takes a personal approach and really listens with guidance toward the best fit for your concerns. I can’t be happier and will definitely be back.”
— S G
SCHEDULE A CONSULTATIONPreservé vs. Traditional Breast Augmentation
| Attribute | Preservé | Traditional Submuscular | Traditional Subglandular |
|---|---|---|---|
| Incision length | ~2–2.5 cm (¾–1 in) | 4–5 cm typical | 4–5 cm typical |
| Tissue plane | Breast Preservation Space (intra-glandular) | Below pectoralis major | Above pectoralis, below gland |
| Supporting ligaments | Preserved | Transected | Transected |
| Typical anesthesia | IV sedation | General | General |
| Blood loss | Negligible; no electrocautery | Requires electrocautery | Requires electrocautery |
| Animation deformity risk | None (supra-muscular) | Possible | None |
| Return to normal activity | ~24 hours typical | Several days to weeks | Several days to weeks |
| U.S. implant compatibility | Motiva Ergonomix only | All FDA-approved implants | All FDA-approved implants |
What Is Preservé?
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.
In the United States, the Motiva Channel Separator and Inflatable Balloon used in Preservé are FDA-registered, and they are paired with FDA-approved Motiva SmoothSilk silicone gel implants. Preservé was introduced to the U.S. through training conducted at the ESTA Global Learning Center, and Dr. Smith is among a small group of U.S. surgeons trained in the technique.
The Anatomy: Why Ligaments Matter
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.
In every traditional breast augmentation method, these ligaments are cut to create space for the implant. Preservé places the implant in a different plane — between the breast gland’s own outer capsule and the gland tissue itself — so the supporting ligaments are pushed aside rather than transected. This space is called the Breast Preservation Space.
How the Preservé Procedure Works
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.
Why the Motiva Ergonomix Implant
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 — a nano-textured surface associated with low inflammatory response in published research.
- 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.
- Built-in RFID identification (Q Inside Safety Technology) for non-invasive implant verification, MRI-compatible.
- Always Confident Warranty (lifetime coverage for rupture) plus a 5-year extended warranty exclusive to Preservé patients.
- Woman’s Choice Program — up to $1,500 in financial support if a patient later chooses to remove the implants.
Benefits of Preservé
Smaller incision
The incision is approximately ¾ to 1 inch — meaningfully smaller than traditional breast augmentation.
Long-term implant stability
Because the supporting ligaments are preserved, the implant has natural support and is less likely to shift downward or to the side over time. Published 3-year clinical data shows 0% inferior malposition with this technique.
Less inflammation
The combination of minimal tissue trauma and the Motiva SmoothSilk surface is associated with a lower foreign body response in the published literature.
No electrocautery, minimal blood loss
Because the technique avoids cutting through vascular tissue, electrocautery is not required and blood loss is negligible.
Lighter anesthesia
Most patients undergo Preservé with intravenous sedation rather than general anesthesia.
Smaller implants, fuller-looking results
Because the implant is precisely positioned where volume is most needed — usually the upper and upper-inner breast — smaller, lighter implants can produce a fuller appearance than traditional techniques. Smaller implants place less long-term stress on the breast.
Preserved nipple sensation and pectoral muscle
Because the chest muscle is not lifted or cut, upper-body strength and nipple sensation are protected.
No animation deformity
The implant sits above the muscle, so flexing the chest does not cause the breast to move unnaturally.
Faster recovery
Most patients return to light daily activity within 24 hours.
Am I a Candidate for Preservé?
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
- Are pursuing a primary breast augmentation combined with a breast lift (mastopexy)
- 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.)
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
Because the pectoralis muscle is not disturbed during Preservé, upper-body strength, range of motion, and athletic performance are preserved. Patients who lift, run, swim, do yoga, or train at high intensity often appreciate that their chest function is not compromised.
Preservé as part of a mommy makeover
For postpartum patients considering a mommy makeover, Preservé can be a particularly good fit. The smaller incision, reduced tissue trauma, and faster recovery pair well with abdominoplasty and liposuction performed in the same session. Preserving native breast tissue also supports overall breast health, although no breast surgery — including Preservé — can guarantee future breastfeeding.
Recovery Timeline
- Day of surgery: outpatient procedure with same-day discharge. No drains. IV sedation.
- Day 1: most patients resume light daily activities.
- Days 2–7: return to desk work and gentle walking.
- Weeks 2–3: most non-impact exercise can resume.
- Weeks 4–6: full upper-body activity, lifting, and high-intensity training.
Because the chest muscle is not dissected, patients do not experience the deep muscle pain associated with traditional submuscular augmentation, and a chest band is not required.
Risks and What We Know So Far
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 published clinical data supporting Preservé is growing. Most outcomes data comes from international markets where the Motiva Ergonomix2 implant — not yet FDA-approved — was used. The Preservé instruments themselves are FDA-registered and are used in the U.S. with FDA-approved Motiva SmoothSilk implants. Key references include Chacón-Quirós et al. (Aesthetic Surgery Journal, 2025), Glicksman et al. (Aesthetic Surgery Journal, 2025, 5-year U.S. safety data), Doloff et al. (Nature Biomedical Engineering, 2021), and Zeplin (2021).
Breast implants are not lifetime devices. Ongoing follow-up with your plastic surgeon is recommended.
How Preservé Differs from Other "Minimally Invasive" Techniques
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.
About Dr. Darren Smith
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)
- Author of 200+ peer-reviewed publications
- U.S. patent holder
- Author of a textbook chapter on Preservé breast augmentation with Motiva implants
- Among a small group of U.S. surgeons trained in the Preservé technique
- Solo practice at the Ritz Tower, 111 East 57th Street, Manhattan
Pricing and Scheduling
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.
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: 111 East 57th Street, Manhattan, NY
Preservé Breast Augmentation: Frequently Asked Questions
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?
Traditional breast augmentation requires cutting through the circummammary ligament and surrounding tissue — and often the pectoralis muscle — to create an implant pocket. Preservé uses blunt instruments to displace, rather than cut, these supporting structures. The result is a smaller incision, less bleeding, and a faster recovery.
Who is a candidate for Preservé?
Strong candidates are women age 22 or older pursuing a first-time (primary) breast augmentation or a primary augmentation with breast lift, who want a natural look, are non-smokers, and have realistic expectations. Adequate skin elasticity and existing breast tissue typically yield the best results. Candidacy is determined at consultation.
Is Preservé FDA-approved?
The Motiva Channel Separator and Inflatable Balloon — the instruments used to perform Preservé — are FDA-registered. They are used with FDA-approved Motiva SmoothSilk implants. Most of the published Preservé clinical data comes from international markets using Motiva Ergonomix2, which is not yet FDA-approved in the U.S.
Which implants are used with Preservé?
In the United States, Preservé is performed with the Motiva SmoothSilk Ergonomix implant. The implant’s nano-textured surface, viscoelastic gel, and ability to fit through a small incision make it the only implant currently compatible with the Preservé technique domestically.
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 under intravenous sedation, and patients return home the same day. Operative time is shorter than traditional augmentation because there is less dissection and no electrocautery.
What kind of anesthesia is used for Preservé?
Preservé is typically performed under intravenous sedation rather than general anesthesia. A local anesthetic with tumescent solution numbs the breast tissue. General anesthesia remains an option and is decided collaboratively with the anesthesiologist based on patient preference and medical history.
How long is recovery after Preservé?
Most patients resume light daily activities within 24 hours, return to desk work within a few days, and can resume non-impact exercise around two to three weeks. Full upper-body activity, including lifting and high-intensity training, is typically permitted at four to six weeks. Recovery is faster than traditional augmentation.
Will I have nipple sensation after Preservé?
Preservé is specifically designed to preserve native breast tissue and the surrounding nerves that supply nipple sensation. By avoiding transection of the supporting ligaments and remaining within the breast itself, the technique aims to maintain nipple sensitivity better than traditional submuscular or subglandular augmentation.
Can I breastfeed after Preservé breast augmentation?
Preservé preserves breast tissue and ductal structures more than traditional techniques, which may favor future lactation. However, no breast surgery — including Preservé — can guarantee successful breastfeeding. Outcomes depend on individual anatomy, prior surgeries, and other factors. Discuss family planning 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 surgeon fee, anesthesia, facility, implants, post-operative visits, and garments. Financing is available.
Can Preservé be combined with a breast lift or mommy makeover?
Yes. Preservé is approved for primary breast augmentation with simultaneous mastopexy (breast lift). It can also be performed as the breast component of a mommy makeover alongside abdominoplasty and liposuction. Combining procedures requires careful surgical planning and is evaluated on a case-by-case basis.
Schedule a Preservé™ Breast Augmentation NYC Consultation with Dr. Darren Smith
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"Within the first couple of minutes of meeting him, I knew he was the doctor for me."
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New York, NY
4.9
4.9 from 150+ reviews
Ready to enhance your body with a smoother, tighter lower abdomen?
Schedule a consultation with Dr. Darren Smith today to explore how a mini tummy tuck can help you achieve your aesthetic goals in the most exclusive surgical setting in NYC.
111 East 57th Street, New York, NY, 10022
Schedule a consultation with Dr. Darren Smith today to explore how a mini tummy tuck can help you achieve your aesthetic goals in the most exclusive surgical setting in NYC.
111 East 57th Street, New York, NY, 10022
