Abstract Background Breast surgery often compromises structures, potentially leading to complications that affect aesthetic outcomes, lactation, breast tissue health, and the patient experience. Tissue-Preserving Breast Augmentation (TPBA) is a novel concept designed to enhance breast and implant stability by preserving the breast’s stabilization system, including the circummammary ligament and Cooper’s suspensory ligaments. Objectives This study presents the TPBA approach, performed in a minimally invasive manner to minimize surgical stimuli and protect the parenchymal breast tissue, along with outcomes observed over a three-year period. Methods This two-center, multi-surgeon retrospective observational study included consecutive female patients undergoing primary breast augmentation or primary augmentation–mastopexy using TPBA between December 2022 and June 2025. All procedures involved an inframammary incision and creation of a pre-pectoral pocket via balloon expansion. Complications were assessed by monitoring cumulative incidence during follow-up visits at 2 weeks, 6-, 12-, and 24-months. Results A total of 330 procedures were performed. At a mean follow-up of 18 months, the complication rate was 0.9%. No cases of acute complications including seroma, wound breakdown, or infection were observed. Follow-up evaluations revealed no capsular contracture (grade III and IV), implant rupture, lateralization, or inferior malposition. Superior malposition occurred in 2 patients (0.6%), and bleeding was observed in 1 patient (0.3%). Implant rippling was reported by 3 patients (0.9%). Conclusions TPBA offers a standardized, reproducible approach to breast enhancement via the IMF, performed under general or local anesthesia. It preserves stabilization structures, features a short learning curve, and carries a low risk of complications.
Randquist et al. (2026) studied this question.