Minimally Invasive, Tissue-Preserving Breast Augmentation: Insights From a Large Case Series, Technique and Surgical Pearls.

BACKGROUND: Breast augmentation rates have remained relatively stagnant due to ongoing concerns regarding implant safety, fear of an oversized aesthetic, and trepidation surrounding general anesthesia. Advances in understanding breast anatomy have enabled innovative techniques that enhance breast volume while preserving surrounding soft tissues. This study presents the initial US experience with a minimally invasive, tissue-preserving breast augmentation (MI-BA) technique utilizing atraumatic tunneling, balloon-assisted pocket creation, and sixth-generation silicone implants. OBJECTIVES: The aim of this study was to describe the authors' early experience with an inframammary-based MI-BA, including its anatomical rationale, surgical technique, learning curve, early outcomes, satisfaction, and practical insights to guide broader adoption. METHODS: A prospective multicenter analysis was performed across 5 surgical centers over a 6-month period. Patient demographics, implant characteristics, anesthesia modality, early complications, patient-reported recovery, and satisfaction scores were prospectively collected. 161 consecutive patients were enrolled across five sites, but 2 were removed from the analysis due to age, as they were implanted off-label. Of note, the 2 patients removed were highly satisfied and had no complications. RESULTS: In total, 159 consecutive female patients underwent MI-BA, with 13% undergoing concomitant fat transfer and/or mastopexy. All patients received tumescent infiltration, 95% of procedures utilized a bolus anesthesia technique, with 58% performed under local anesthesia with sedation. No early postoperative hematomas, loss of breast sensation, sensory disturbances, or abnormal pain were reported. Surgeon satisfaction was high (96%), and most patients reported being satisfied or extremely satisfied (94%). CONCLUSIONS: This early US experience demonstrates a minimally invasive, tissue-preserving approach to breast augmentation that leverages implant-specific technologies to enable procedures under local anesthesia, minimize soft-tissue trauma, and facilitate rapid recovery. Although early outcomes are favorable, continued long-term follow-up is underway and will be reported in future studies. LEVEL OF EVIDENCE: 4 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.