Preservé or Standard Augmentation: How I Choose for Each Patient

One of the most common questions I’m asked in consultation is, “Which type of breast augmentation is best?” My honest answer is that there isn’t a best operation, only the best operation for you. I offer two main approaches: Motiva Preservé and standard breast augmentation. Each one suits a different kind of patient, and much of my job in the first consultation is working out which group someone falls into.

For Preservé in particular, patient selection is everything. When I choose the right patient, the technique can give a lovely, natural result with a remarkably easy recovery. If I chose it for the wrong patient, neither of us would be happy. Here is how I make that decision.

The first question: what kind of look are you hoping for?

I always start with the result a patient has in mind, because it narrows the options quickly.

When someone tells me they want a natural look, something that looks like their own breast only fuller, I start thinking about Preservé. That isn’t only because of the technique; it’s also the implant. Preservé uses Motiva Ergonomix 2 implants. In my experience these give a more natural shape, with less fullness in the upper part of the breast than a round implant (I’ve written more about round versus teardrop shapes). The breast slopes gently from the top, as most natural breasts do, rather than showing a rounded “shelf” at the top.

If a patient wants more noticeable upper fullness and cleavage, or a larger change in size, a standard augmentation is often the better fit, because I have a wider range of implant shapes, sizes and pocket positions to work with. Choosing the right volume is a conversation in itself; see how to choose the right implant size for your body.

The second question: how much breast tissue do you already have?

This is the most important anatomical factor in my decision, and it’s the one patients are least aware of.

Preservé places the implant over the muscle, in front of the chest muscle and behind the breast tissue. For the implant to look and feel natural in that position, it needs a covering of the patient’s own tissue. So I only recommend Preservé to patients who already have some breast tissue of their own.

If a patient has very little breast tissue to start with, an implant over the muscle is more likely to show its edges, or rippling, through thin skin. For these patients I usually recommend an under-the-muscle or dual-plane approach, which is a standard augmentation. The muscle adds an extra layer of cover over the upper part of the implant, giving a softer, more natural transition.

I assess this at consultation with a simple pinch test: I gently pinch the skin and breast tissue at the top of the breast to gauge how thick the soft-tissue cover is. If the pinch is less than 2cm, I will usually recommend placing the implant under the muscle rather than using Preservé. Together with measurements of the breast, this gives me a clear, objective guide rather than a guess. You can read more about who is a good candidate for Motiva Preservé.

The third question: would you rather stay awake?

I perform Preservé under local anaesthetic, so you are awake throughout and there is no general anaesthetic. I’ve answered the most common questions about this in awake breast augmentation under local anaesthetic. For many patients this is one of the main attractions. Some have had a difficult experience with a general anaesthetic in the past, some have medical reasons to avoid one, and some simply prefer not to be put to sleep.

Over time I’ve noticed that the awake approach tends to self-select the right patients. People who come to me asking for Preservé have usually already thought about being awake and are comfortable with the idea before they arrive.

That said, being awake isn’t for everyone. Some patients are understandably very nervous, and for a very anxious patient staying awake may not be the right choice. In that situation I suggest considering a general anaesthetic, so the experience is calm and comfortable from start to finish (my guide to anaesthesia for cosmetic surgery explains the options). That would usually mean a standard augmentation rather than Preservé.

I would add a note of reassurance, though. Some of the most anxious patients I’ve treated awake have been absolutely brilliant during the procedure. We talk through every step, and the theatre team are very experienced at helping patients relax. Anxiety on its own doesn’t rule anyone out; it’s something we discuss openly so you can make the choice that feels right.

Recovery: what patients tell me

Preservé uses a short incision and a gentle, tissue-preserving technique, and in my experience recovery is often quicker than after a traditional augmentation. Some of my patients have told me they were back at work in the office two days after their procedure.

I’m always careful to add that everyone heals differently. Your recovery will depend on your job, your general health, how you feel and the advice I give you on the day, so we plan your time off together at consultation rather than assuming the quickest timeline. There is a week-by-week guide in Motiva Preservé recovery, and every operation carries risks, which I cover openly in Motiva Preservé risks.

When standard breast augmentation is the right choice

A standard augmentation remains the most versatile option and is often what I recommend when:

• there is very little natural breast tissue, so the implant needs the extra cover of an under-the-muscle or dual-plane pocket;
• the patient wants a larger change in size or more upper-pole fullness;
• there is asymmetry or a tuberous breast shape that needs more extensive reshaping;
• the patient prefers, or would be better suited to, a general anaesthetic.

If a breast has also dropped noticeably, an implant alone may not give a good result, and I may discuss a breast lift or augmentation mastopexy instead.

A quick side-by-side

• Motiva Preservé: natural, gently sloping result; Ergonomix 2 implants; over the muscle; needs some existing breast tissue; local anaesthetic, awake; often a quick recovery. From £9,500 (Preservé cost guide).
• Standard breast augmentation: the widest choice of implant shape, size and pocket (under the muscle or dual plane); suits patients with little breast tissue or who want a bigger change; usually under general anaesthetic. From £8,500 (breast augmentation cost guide).

All prices are “from” and are confirmed after assessment, and the consultation fee of £150 is charged separately. The full list is on my prices page.

Who is not suitable for Preservé?

To summarise, I would usually steer a patient away from Preservé if:

• they have very little breast tissue of their own;
• they want a large increase in size or a rounder, fuller upper breast;
• they would feel very anxious being awake and would prefer a general anaesthetic;
• the breast has dropped significantly and an uplift would give a better result;
• they have marked asymmetry or a tuberous breast shape that needs more complex surgery.

Both options are for adults aged 18 and over who are in good health.

The bottom line

Choosing between Preservé and standard augmentation isn’t about which is newest or most popular. It comes down to three things: the look you want, the tissue you have, and how you feel about being awake. Whoever you see, check your surgeon’s credentials carefully. My role is to examine you carefully, listen to what you’re hoping for, and recommend the approach most likely to give you a result you’re happy with, even if that isn’t the one you came in asking about.

If you’d like to talk it through, you can book a consultation at CLNQ in Manchester or Knutsford, or at Deansgate Hospital in Manchester. I also see patients for Preservé in Manchester, Cheshire and London.