The Preserve Breast Augmentation at Southwest Plastic Surgery: A Prepectoral Approach Explained
Patients who come to Southwest Plastic Surgery in El Paso often arrive with the same goal and the same worry. They want fuller breasts, frequently to restore what changed after pregnancy or weight loss, and they have heard that augmentation means weeks of soreness. Dr. Frank Agullo offers a technique that rewrites the second half of that expectation.
It is called the Preserve augmentation, and the central difference is simple. The chest muscle is never cut.
What Makes Preserve Different
The Preserve is a prepectoral augmentation. Dr. Agullo places the implant in front of the pectoralis muscle and behind the breast gland, above the muscle and below the gland. The muscle is not cut, released, or disturbed.
That contrasts with a traditional submuscular augmentation, where the implant goes behind the muscle and the muscle is partially released off the chest wall. That release is what historically caused the long six-to-eight-week recovery. Because Preserve never goes under the muscle, that recovery chapter is avoided.
Dr. Agullo creates the pocket with balloon dissection, gently pushing the tissues outward rather than cutting them, with no electrocautery. The breast’s own ligaments define the pocket and hold the implant in position, which is why no mesh is needed. Preserving the area also helps protect the nerves and arteries, supporting a higher likelihood of keeping sensation and breast function.
How Sizing Works
Cup size is only a starting point at Southwest Plastic Surgery. Dr. Agullo plans from each patient’s dimensions and a Chrysalix 3D simulation, so the result can be previewed before surgery.
Most women have some natural asymmetry, which is normal. Different implant volumes may be used on each side to bring the breasts closer to even. Because the implant sits above the muscle, the volume can be placed exactly where the breast needs it most, so a smaller implant can read as a larger size and add a little lift.
How the Procedure Compares
| Question | Traditional Submuscular | Preserve at Southwest Plastic Surgery |
|---|---|---|
| Implant position | Behind the muscle | In front of the muscle, behind the gland |
| Muscle cut | Partially released | Never touched |
| Pocket created by | Cutting and cautery | Balloon dissection |
| Support | Muscle and capsule | The breast’s own ligaments |
| Return to work | Several weeks | One to three days |
The Implants Dr. Agullo Uses
Dr. Agullo uses Motiva Ergonomix implants. The old rule about replacing implants every ten years does not apply to them. The rupture rate is under half a percent, and they carry a lifetime guarantee.
Their nano-surface, called SmoothSilk, produces the lowest inflammatory response of any implant and an extremely low risk of capsular contracture. The implants are soft, the gummy bear type, and they move with the body, settling into a natural teardrop shape when a patient stands.
What Recovery Looks Like
The procedure is performed under light conscious sedation, so the patient breathes on her own and remembers little. Dr. Agullo places Exparel, a long-acting local, between the ribs to keep the breast comfortable for about the first three days.
The incision is two and a half to three centimeters in the fold under the breast, and the implant placement takes about thirty minutes. Many patients raise their arms overhead and go home within an hour, return to work within one to three days, and resume the gym at about two weeks when augmentation is the only procedure. Adding a breast lift or liposuction extends the timeline. For patients who want to speed comfort and healing, the practice also offers post-surgical massage as recovery progresses.
Who Is a Candidate
The Preserve augmentation suits a patient who wants more fullness, often to restore what changed after pregnancy, breastfeeding, or weight loss, and who has enough natural breast tissue to cover an implant placed above the muscle. Because the technique preserves the breast’s own ligaments and nerves, it is especially appealing to women who care about keeping sensation and breast function. Candidates in good general health who do not smoke heal cleanest. During the consultation, Dr. Agullo evaluates tissue thickness, breast shape, and any asymmetry, then uses the Chrysalix 3D simulation to show a likely result before anything is scheduled.
Mammograms and Planning
Because the implant sits in front of the muscle and behind the gland, dense breast tissue does not change how the procedure is planned. Dr. Agullo does ask that patients who are due for a mammogram complete this year’s screening before surgery if their last one was over a year ago, and the practice can send the order or coordinate with a primary doctor. The 3D simulation and a careful exam together set the size, the implant profile, and any side-to-side difference that will bring the breasts closer to even.
When a Different Approach Fits
Preserve is not the only path. For a very thin patient with little breast tissue, Dr. Agullo may recommend breast fat injection or a different implant plan. The consultation exists to match the technique to the patient, not the other way around.
About Dr. Frank Agullo
Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and completed a plastic surgery fellowship at the Mayo Clinic. Motiva trained him directly as one of roughly twenty selected surgeons in the country, and he traveled to Costa Rica twice for that certification. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and a Castle Connolly Top Doctor for thirteen consecutive years.
See the Other Versions
For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing question-and-answer version, see the companion post on agulloplasticsurgery.com.
Ready to Talk?
The right size and implant come from an exam and a 3D simulation at Southwest Plastic Surgery. Bring your photos and come in.
Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.
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