The Journal / Breast Augmentation
Who is a good candidate for Preserve breast augmentation?
Ten characteristics Dr. John Burns looks for, and when a traditional technique is the better choice.
Medically reviewed by John L. Burns Jr., MD, FACS · Board-certified plastic surgeon · Dallas, Texas · Updated November 2026
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The short answer
The best candidates for Preserve breast augmentation are healthy women having their first augmentation who want a natural increase of about one to two cup sizes, have minimal sagging and fairly symmetrical breasts, and have enough breast tissue to cover an implant placed above the chest muscle.
Not sure where you fit? Start a free online consultation for Preserve breast augmentation and Dr. Burns' team will follow up.
In this article
What is Preserve breast augmentation?
Breast augmentation has evolved dramatically over the past several decades. Today's patients want more than just larger breasts. They want beautiful, natural-looking results, minimal downtime, less discomfort, and a procedure that preserves their body's natural anatomy. For many women, Preserve breast augmentation by Motiva represents an exciting advancement in modern breast enhancement.
Preserve (also known as Preservé) is an innovative, minimally invasive breast augmentation technique designed to maintain the breast's natural supporting structures while creating a precise pocket for the implant. Unlike traditional breast augmentation, which often involves more extensive tissue dissection, Preserve uses specialized instruments, including a blunt dissector and an inflatable balloon, to gently create space for the implant while minimizing disruption to surrounding tissues.
How the Preserve technique creates a precise implant pocket. Learn more on Dr. Burns' Preserve breast augmentation in Dallas page.
The implant is placed above the pectoralis muscle, typically in the subfascial plane, allowing the breast to move naturally without interference from the chest muscle.
For appropriately selected patients, Preserve can be performed using local anesthesia with light IV sedation rather than general anesthesia. Because the technique avoids cutting through the pectoralis muscle and minimizes tissue trauma, recovery can be remarkably quick.
However, not every woman is an ideal candidate for Preserve breast augmentation. Understanding who benefits most from this technique is essential to achieving beautiful, natural, and potentially long-lasting results.
Here are ten characteristics I look for when evaluating patients for Preserve breast augmentation.
1–2
cup sizes: the modest-to-moderate increase Preserve is particularly well suited for
22+
minimum age for Motiva silicone implants in U.S. cosmetic breast augmentation
25+
years of aesthetic surgery experience for Dr. John Burns
01
Ideal candidate
Women who want smaller, more natural breast implants
Preserve breast augmentation is particularly well suited for patients seeking a modest to moderate increase in breast size rather than an extremely large augmentation.
Many patients today prefer a natural, proportional enhancement that complements their body without creating an obviously augmented appearance.
Preserve is an excellent option for women who want:
Smaller implants are particularly compatible with preservation techniques because they can be accommodated within the breast's existing anatomical framework without excessively stretching or disrupting the natural support structures.
The goal is to create a secure, precisely sized pocket that allows the implant to nest within the surrounding breast tissue.
My philosophy is simple: the best breast augmentation is not necessarily the largest implant, but the implant that creates the most beautiful shape, proportion, and symmetry for the individual patient.
Dr. John Burns
02
Ideal candidate
Women with minimal breast sagging (ptosis)
One of the most important considerations for Preserve breast augmentation is the position of the natural breast tissue and nipple.
Ideally, candidates have relatively youthful breasts with little or no ptosis, the medical term for breast sagging.
These patients typically have:
When the breast is already well positioned, an implant can enhance its existing shape without requiring extensive reshaping.
Conversely, women with significant breast sagging may benefit more from a traditional breast augmentation combined with a breast lift.
While Preserve can sometimes be incorporated into breast lift procedures, significant ptosis generally requires additional surgical correction. See how Dr. Burns approaches a breast lift with implants.
Degrees of breast ptosis (sagging).
An implant adds volume, but it does not replace a breast lift when substantial sagging is present.
Dr. John Burns
03
Ideal candidate
Women with good natural breast symmetry
Preserve works particularly well in patients who already have relatively symmetrical breasts.
Although almost every woman has some degree of natural asymmetry, ideal candidates typically have similar:
The preservation technique is designed to respect and maintain the breast's existing architecture.
When the natural breasts are relatively symmetrical, we can enhance both breasts while maintaining their natural relationships.
This is particularly beneficial because Preserve relies on precise pocket creation rather than extensive dissection or repositioning of breast structures.
Women with substantial asymmetry, significantly different breast folds, or complex chest wall differences may require a more customized traditional approach.
At my Dallas practice, we use Crisalix 3D breast imaging to simulate potential results before surgery. This allows patients to visualize their expected breast size and shape and participate in selecting the most appropriate implants.
Crisalix 3D simulation is a planning tool, not a guarantee of results.
04
Ideal candidate
Women having their first breast augmentation
One of the best candidates for Preserve is a woman undergoing her first breast augmentation, also known as primary breast augmentation.
In these patients, the natural breast anatomy has not been altered by previous implant surgery.
The breast ligaments, fascial structures, and surrounding soft tissues are generally intact, allowing the preservation technique to work as intended.
Preserve is designed to maintain important anatomical structures, including the circum-mammary support system that helps define and stabilize the breast.
By preserving these structures, the technique aims to reduce unnecessary tissue disruption while creating a stable pocket for implant placement.
Patients who have undergone previous breast augmentation may have scar tissue, altered implant pockets, or compromised supporting structures that make traditional revision techniques more appropriate.
Dr. Burns' view
While every case is individualized, primary breast augmentation is generally the ideal setting for Preserve.
Wondering whether you are a Preserve candidate?
A consultation with Dr. Burns includes an exam, implant sizing and Crisalix 3D imaging, so you can see which technique fits your anatomy and goals.
05
Ideal candidate
Women who prefer above-the-muscle breast implants
One of the greatest advantages of Preserve breast augmentation is that the implant is positioned above the pectoralis major muscle.
Traditional breast augmentation frequently places implants partially or completely beneath the chest muscle.
Although submuscular breast augmentation remains an excellent technique for many patients, it can involve greater postoperative discomfort and a longer recovery because the muscle must accommodate the implant.
In addition, submuscular implants may move or become distorted when the chest muscle contracts. This is known as animation deformity.
With Preserve breast augmentation, the pectoralis muscle is left undisturbed.
This offers several potential advantages:
- No implant animation caused by pectoralis muscle contraction.
- Less postoperative muscle discomfort.
- Natural breast movement.
- No need to surgically release the pectoralis muscle.
- Potentially faster return to normal daily activities.
Above-the-muscle placement also allows the breast and implant to move together more naturally.
However, adequate breast tissue coverage is essential. Patients with very thin tissues may be better candidates for submuscular or dual-plane placement to minimize implant visibility and rippling. For more on implant planes, read why subfascial breast augmentation is making a comeback.
06
Ideal candidate
Athletic women and fitness enthusiasts
Preserve breast augmentation is particularly appealing to athletic women who want breast enhancement without interfering with their chest muscles.
This includes patients who regularly participate in:
For women who frequently activate their pectoralis muscles, implants placed beneath the muscle can sometimes produce unwanted breast movement or distortion.
Because Preserve leaves the pectoralis muscle intact, patients avoid this muscle-related implant animation.
This is especially attractive for women who have well-developed chest muscles and want their implants to remain naturally positioned during exercise.
Another important benefit is the possibility of a quicker return to an active lifestyle.
Although recovery varies, avoiding muscle dissection can reduce postoperative discomfort and allow patients to resume certain activities sooner. Strenuous exercise and heavy chest workouts must still wait until the surgeon confirms that adequate healing has occurred.
For active women, Preserve offers an opportunity to enhance breast shape while respecting the anatomy that supports their athletic lifestyle.
Dr. John Burns
07
Ideal candidate
Women who want to avoid general anesthesia
One of the most exciting features of Preserve breast augmentation is that the procedure can be performed without general anesthesia in appropriately selected patients.
Traditional breast augmentation is commonly performed under general anesthesia, requiring the patient to be fully unconscious.
Preserve can often be performed using local anesthesia combined with light intravenous sedation.
With this approach, the breast is thoroughly anesthetized, and the patient remains comfortable while breathing independently. Depending on the level of sedation, she may be awake or lightly asleep during the procedure.
Many patients find this option appealing because they wish to avoid:
At my practice, we carefully select patients who are appropriate candidates for this anesthesia approach and work with qualified anesthesia professionals to ensure safety and comfort.
Avoiding general anesthesia does not eliminate all anesthesia-related risks, and some patients may still be better served by general anesthesia.
Good to know
For patients who qualify, however, awake or lightly sedated Preserve breast augmentation offers an appealing alternative to traditional surgery.
08
Ideal candidate
Women who want an ultra-fast recovery
Recovery is one of the most common concerns among women considering breast augmentation.
Busy professionals, mothers, students, and athletes often want to know how quickly they can return to their regular routines.
Preserve was developed with the goal of reducing surgical trauma, and that can translate into a more comfortable postoperative experience.
Several features contribute to its rapid-recovery potential:
01
No muscle dissection
The pectoralis major muscle remains intact, avoiding much of the muscular discomfort associated with submuscular augmentation.
02
Minimal tissue disruption
Specialized blunt and balloon dissection techniques create the implant pocket while preserving surrounding structures.
03
Precise implant pocket
The implant is positioned within a carefully controlled space rather than a widely dissected pocket.
04
Non-narcotic pain management
When appropriate, multimodal pain control may limit or eliminate the need for opioid medications.
Many appropriately selected patients can resume light daily activities within a few days. Some may feel comfortable sooner, although experiences vary.
Return to exercise is individualized. Walking and gentle activity can begin relatively early, while strenuous exercise, heavy lifting, and chest training require additional healing time.
In my practice, we emphasize rapid recovery without compromising safety.
Preserve breast augmentation recovery timeline (estimates)
The timeline below summarizes typical milestones. Your own schedule depends on your healing and Dr. Burns' clearance. For more detail, see ultra-fast recovery after Preserve breast augmentation.
Day of surgery
Go home the same day with a companion. Walking around the house is encouraged.
First few days
Many appropriately selected patients resume light daily activities. Some feel comfortable sooner.
About 1–2 weeks
Some patients return to selected lower-impact exercise, depending on healing and surgeon clearance.
After clearance
Heavy lifting, vigorous exercise and strenuous chest workouts resume once healing is confirmed.
The ultimate goal is not simply getting patients back to normal faster, but doing so with less discomfort and a predictable healing process.
Dr. John Burns
09
Ideal candidate
Women who want undetectable, natural-looking breast implants
One of the most common requests I hear from patients is:
"I want my breasts to look natural. I don't want people to know I've had implants."
This concept of an undetectable breast augmentation has become increasingly popular.
Patients want better shape, fullness, and cleavage, but they don't want the unmistakable appearance of breast implants.
Preserve is particularly compatible with this aesthetic philosophy.
Because the procedure maintains the natural breast framework, the implant can be integrated into the existing breast anatomy.
The technique can be combined with Motiva implants designed to provide softness, natural movement, and proportional breast enhancement. Compare Motiva implants vs. traditional silicone implants.
A natural-looking augmentation depends on several factors:
Breast augmentation before and after by Dr. John Burns. Individual results vary. See more in the before and after gallery.
In properly selected patients, Preserve can create a result that looks beautiful in a swimsuit, evening dress, or athletic clothing without appearing overly augmented. Read more about natural-looking breast implants.
“
My goal is for patients to look like the best version of themselves—not like someone who has obviously undergone breast surgery.
Dr. John Burns
10
Ideal candidate
Women who want beautiful, long-term results
An important but sometimes overlooked consideration in breast augmentation is how the breasts will look years after surgery.
The initial result is important, but maintaining implant position, breast shape, and symmetry over time is equally valuable.
Traditional breast augmentation involves creating a pocket for the implant. If that pocket is excessively large or the supporting tissues stretch over time, the implant can shift downward or laterally.
This can contribute to complications such as:
Preserve is designed to minimize unnecessary disruption of the breast's supporting ligaments and fascial attachments.
By maintaining more of these natural structures and creating a precise pocket, the technique aims to provide better implant stability.
The nesting effect
I often describe this as a nesting effect: the implant rests securely within the surrounding natural tissues rather than occupying an extensively dissected space.
This anatomical preservation may help limit unwanted implant movement and support long-term breast shape.
However, it is important to understand that breast implants are not lifetime devices. Natural aging, pregnancy, weight fluctuations, tissue stretching, and implant-related complications can still change the breasts over time.
Although early clinical experience with preservation techniques is encouraging, long-term comparative evidence is still developing. No surgical technique can guarantee that implants will never shift, sag, or require revision. Read more about how Preserve may support a more durable result.
The objective of Preserve is to achieve a beautiful result today while respecting the natural structures that may help support that result in the future.
Dr. John Burns
Who may not be an ideal candidate for Preserve breast augmentation?
While Preserve offers exciting advantages, it is not necessarily the best choice for every patient.
Women who may benefit from a more traditional technique include those with:
01
A desire for very large implants
Patients seeking dramatic increases in breast volume may require a larger or differently constructed implant pocket.
02
Significant breast ptosis
Women with substantial sagging often need a breast lift to achieve proper breast and nipple positioning.
03
Very thin breast tissue
Inadequate soft tissue coverage can make above-the-muscle implants more visible or palpable and may increase the risk of rippling.
04
Significant breast asymmetry
Complex differences in breast size, nipple position, or inframammary fold location may require more extensive surgical correction.
05
Previous breast implant surgery
Revision cases may involve scar tissue, stretched pockets, or altered anatomy requiring a different approach.
06
Poor skin quality or substantial tissue laxity
Severely stretched tissues may not provide adequate support for an implant without additional surgical techniques.
Additionally, all breast augmentation candidates must be in appropriate overall health, have realistic expectations, and meet the medical and regulatory requirements for silicone implants. In the United States, Motiva silicone breast implants are approved for cosmetic breast augmentation in women aged 22 and older.
Risks to discuss before Preserve breast augmentation
Preserve is a technique for creating the implant pocket; it does not remove the risks that come with any breast implant surgery. The U.S. Food and Drug Administration lists the main risks and complications of breast implants, and Dr. Burns reviews each of them at consultation. They include:
- Capsular contracture (scar tissue tightening around the implant)
- Implant rupture, which with silicone may be "silent" and found only on imaging
- Changes in nipple or breast sensation, infection, bleeding and poor scarring
- Visible or palpable implant edges and rippling, especially with thin tissue above the muscle
- Implant malposition, asymmetry and the possibility of revision or implant removal later
- Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and systemic symptoms some patients report, sometimes called breast implant illness
Because silicone implants are not lifetime devices, the FDA recommends periodic imaging to screen for silent rupture; see the FDA's breast implant information and the American Society of Plastic Surgeons' breast augmentation overview for patient guidance.
Preserve breast augmentation in Dallas: planning your consultation
Dr. Burns performs Preserve breast augmentation at his practice at 9201 N. Central Expressway in Dallas. Your visit includes a detailed breast exam, measurements, implant selection and Crisalix 3D imaging, so you can see whether you fit the Preserve profile or would be better served by another technique described on our Dallas breast augmentation page.
Cost depends on the implant, anesthesia approach and whether additional procedures such as a lift are needed. Our guide to the cost of Preserve breast augmentation in Dallas explains what is included, and your personal quote is provided at consultation. Many patients plan Preserve alongside other goals, such as a mommy makeover.
Plan with confidence
Flexible monthly payment plans are available through CareCredit, PatientFi and Cherry. Explore financing options or request your Preserve consultation online.
Why surgeon experience matters with Preserve
Preserve breast augmentation requires a different approach to pocket creation than traditional breast augmentation.
Rather than relying on extensive surgical dissection, the surgeon uses specialized instruments to gently develop a pocket while maintaining the surrounding breast anatomy.
This requires a precise understanding of breast anatomy, implant selection, tissue characteristics, and the supporting structures of the breast.
As a board-certified plastic surgeon with more than 25 years of aesthetic surgery experience, I have performed breast augmentations using a wide range of techniques, including submuscular, dual-plane, subglandular, and subfascial approaches.
I am also actively involved in teaching Preserve breast augmentation to other board-certified plastic surgeons from across the country. Surgeons travel to my Dallas practice to observe this innovative technique and learn how to incorporate preservation principles into their own practices.
My experience with traditional and preservation breast augmentation allows me to evaluate each patient's anatomy and select the technique that best matches her individual goals.
Preserve is an outstanding option for the right patient, but the best operation is always the one tailored to the individual—not the other way around.
Dr. John Burns
Is Preserve breast augmentation right for you?
The ideal Preserve patient is a healthy woman who wants a natural, proportional enhancement, has relatively symmetrical breasts with minimal sagging, and prefers smaller implants placed above the chest muscle.
It is especially attractive to athletic women, patients considering their first breast augmentation, and those who wish to avoid general anesthesia or minimize postoperative downtime.
For these women, Preserve offers a compelling combination of anatomical preservation, natural aesthetics, reduced muscle-related discomfort, rapid-recovery potential, and a technique designed to support long-term implant stability.
At my Dallas plastic surgery practice, I evaluate every patient individually using a detailed examination and Crisalix 3D breast imaging. Together, we select the implant size, profile, and surgical technique most likely to achieve her goals.
As a national educator in Preserve breast augmentation, I am passionate about bringing these advanced techniques to my patients while continuing to teach fellow plastic surgeons.
If you are considering breast augmentation and want to learn whether Preserve is the right choice for you, I invite you to schedule a personalized consultation. You can also read patient reviews before your visit.
Your surgeon
Why patients choose Dr. John Burns for Preserve breast augmentation in Dallas
Dr. Burns teaches the Preserve technique to board-certified plastic surgeons who travel to his Dallas practice, and he has performed submuscular, dual-plane, subglandular and subfascial augmentation, so he can recommend Preserve only when it truly fits your anatomy.
- Board-certified by the American Board of Plastic Surgery; Fellow of the American College of Surgeons (FACS)
- More than 25 years of experience in aesthetic plastic surgery
- First plastic surgeon in the U.S. to complete a fellowship in laser surgery, at UT Southwestern Medical Center, where he is a Clinical Instructor of Plastic Surgery
- Plastic surgery residency at the University of Texas Medical Branch (summa cum laude, Research Honors Program; Alpha Omega Alpha); microvascular training at MD Anderson Cancer Center
- Graduate of Vanderbilt University; cosmetic surgery training in Miami, Florida
- Named one of America's Best Plastic Surgeons by Newsweek (2022, 2023, 2024, 2025, 2026); 2026 categories: breast augmentation, eyelid surgery, facelift, liposuction, rhinoplasty and tummy tuck
- D Magazine Best Doctors (2023, 2024, 2025, 2026) and D Magazine's "The Face of Breast Augmentation" (2024, 2025)
- Texas Monthly Super Doctors (2024)
- Medical Director of JOLA Aesthetics, an Allergan Double Black Diamond practice ranked among the top 20 in the U.S.
- Past President of the Dallas Plastic Surgery Institute
- Board of Directors and contributing surgeon, Share-A-Smile Foundation
Frequently asked questions about Preserve breast augmentation
What is Preserve breast augmentation?
Preserve (Preservé) by Motiva is a minimally invasive breast augmentation technique that uses a blunt dissector and an inflatable balloon to create a precise implant pocket above the pectoralis muscle, typically in the subfascial plane, while maintaining the breast's natural supporting structures.
Can I get Preserve breast augmentation if I have very small breasts?
Yes, potentially. Many women with naturally small breasts are excellent candidates. The critical factor is having enough tissue to adequately cover the implant. Women with extremely thin tissue may benefit more from an implant beneath the muscle.
Is Preserve breast augmentation better for small implants?
Generally, Preserve is particularly well suited to smaller and moderately sized implants that fit within the natural breast dimensions. Implant selection depends on the patient's anatomy, breast width, tissue characteristics, and the specific implants compatible with the technique.
Can Preserve correct sagging breasts?
Preserve adds volume but does not replace a breast lift. Women with minimal ptosis may achieve excellent results with augmentation alone, while those with more significant sagging may require a lift. Preserve can sometimes be combined with mastopexy in selected patients.
Can Preserve breast augmentation be done while awake?
Yes. Appropriately selected patients can undergo Preserve breast augmentation using local anesthesia with light IV sedation, potentially avoiding general anesthesia.
How quickly can I exercise after Preserve breast augmentation?
Most patients can begin walking and gentle daily activity relatively soon after surgery. Some may return to selected lower-impact exercise within approximately one to two weeks, depending on healing and surgeon clearance. Heavy lifting, vigorous exercise, and strenuous chest workouts may require longer restrictions.
Does Preserve prevent breast implant bottoming out?
Preserve is designed to maintain the natural breast ligaments and supporting structures, potentially improving implant stability. However, it cannot completely prevent bottoming out or other implant-position changes. Longer-term clinical studies are needed to determine the extent of this advantage.
How long do Preserve breast implants last?
There is no predetermined expiration date for silicone breast implants. Some implants remain intact and aesthetically satisfactory for many years, while others require earlier revision. Regular follow-up and recommended implant-integrity imaging remain important regardless of surgical technique.
Is Preserve breast augmentation safe?
Preserve is performed by board-certified plastic surgeons with FDA-approved silicone implants, but it carries the same implant-related risks as any breast augmentation, including capsular contracture, rupture, rippling, malposition and the possibility of revision. Dr. Burns reviews these risks and your health history at consultation.
How much does Preserve breast augmentation cost in Dallas?
Cost depends on your implant, anesthesia approach and whether a lift or other procedure is added. See our Preserve cost guide; your personal quote is provided at consultation, and financing is available.
The takeaway
Preserve breast augmentation is best for healthy women having a first augmentation who want a natural one-to-two cup increase, have minimal sagging, reasonable symmetry and enough tissue to cover an implant above the muscle. Women who want very large implants, have significant sagging, very thin tissue or previous implant surgery may do better with a traditional technique. The right answer comes from an in-person exam and 3D imaging, not a checklist. Dr. Burns will recommend Preserve only when it fits your anatomy and goals.
Dallas Plastic Surgery Institute
Preserve breast augmentation in Dallas with Dr. John Burns
Find out whether you are a Preserve candidate. Schedule an in-person or virtual consultation with Dr. Burns at the Dallas Plastic Surgery Institute.
John L. Burns Jr., MD, FACS · 9201 N. Central Expressway, Suite 350, Dallas, TX 75231 · 214-515-0002 · Mon–Fri 9 AM–5 PM
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Continue reading
How Preserve may support a more durable result
Why preserving natural anatomy matters years after surgery.
This article is for education and is not medical advice. Individual results vary.