Preservation Breast Augmentation: A Safer Approach with Reduced Risks

By Dr. Michael Somenek & Troy Pittman MD FACS

For many women considering breast augmentation, the excitement of enhancing their figure is tempered by concern about potential complications. Headlines about capsular contracture, implant rupture or rare lymphomas can make the decision feel daunting. At Somenek+Pittman, we believe in empowering our patients with transparent information and offering surgical solutions that minimize risk while delivering the most natural results. Our Preservation Breast Augmentation technique is designed to protect your natural tissue, employ advanced notouch insertion and use nextgeneration Motiva implants. In this article we demystify the most common complications, explain what causes them, and show how preservation surgery lowers those risks.

Understanding Breast Augmentation Complications

Breast augmentation is one of the most performed cosmetic surgeries in the world, but it is still surgery—complications can occur. Being aware of these risks allows you to make informed decisions and work with your surgeon to prevent them. Here are the most discussed complications: 

• Capsular contracture – A normal scar capsule forms around any implant. In some patients the capsule tightens abnormally and compresses the implant. This can cause the breast to feel hard and appear high or distorted. Capsular contracture occurs in 2–18 % of primary augmentations and up to 25–36 % of revision surgeries. It often arises from factors such as bleeding, infection or bacterial biofilms inside the pocket. Surgeons reduce this risk by minimizing implant handling and contamination during insertion. 
• Rippling or wrinkling – When the implant edges are visible through the skin, causing folds or ripples. It is more common with saline implants and in patients with very thin tissue. Choosing an appropriate implant size and placing it under the muscle or fascia can reduce rippling. 
• Implant malposition or displacement – Implants can shift if the pocket is improperly created or if postoperative bleeding or seroma stretches the pocket. Incidences range around 5 % in primary augmentations. Correct sizing and precise pocket creation help prevent this. 
• Animation deformity – With submuscular implants, the breast may visibly move or distort when the chest muscles contract. Studies report animation deformity in up to 75 % of subpectoral reconstructions. Prepectoral or subfascial placement greatly reduces this issue. 
• Bleeding, infection and scarring – As with any surgery, there is a risk of bleeding, infection or poor scar formation. These risks are generally low when patients are screened appropriately and aftercare instructions are followed. 
• Implant rupture – The silicone shell can tear. Ruptures are more obvious with saline implants (they deflate) and may be “silent” with silicone implants, requiring MRI or ultrasound to detect. 
• Breast implant–associated anaplastic largecell lymphoma (BIAALCL) – A very rare lymphoma that develops in the capsule of some textured implants. As of April 2022, 1,130 cases were reported worldwide. This malignancy is associated with textured implants and not smooth implants. 

While these complications can sound alarming, they are rare in the hands of qualified surgeons. The next sections explore how surgical technique and implant technology influence these risks.

Why Technique Matters: Traditional vs. Modern Approaches

The way your surgeon handles tissues and places your implant dramatically affects complication rates.

Traditional Submuscular & Subglandular Placement 

In conventional augmentations, implants are placed either beneath the pectoral muscle (submuscular) or above the muscle but below the breast gland (subglandular). Each approach has pros and cons: 

• Submuscular placement provides more softtissue coverage and can lower capsular contracture rates compared with subglandular placement. However, it carries a high risk of animation deformity and a longer, more painful recovery. 
• Subglandular placement offers quicker recovery and less pain, but increases the risk of rippling and capsular contracture because the implant sits directly under breast tissue.

Traditional techniques often involve manually pushing implants through incisions with fingers, increasing the chance of contamination and trauma. Pocket dissection may also cut through breast ligaments and muscle attachments, creating bleeding and a larger scar. These factors contribute to higher rates of capsular contracture and malposition.

The Keller Funnel and NoTouch Insertion 

Modern surgeons mitigate contamination by using devices such as the Keller Funnel—an FDAapproved tool shaped like a piping bag. With this device, the implant slides through a lubricated sleeve and into the pocket without touching the surgeon’s hands or the patient’s skin. Studies show that Keller Funnel insertion allows smaller incisions, faster healing and less implant stress. By reducing skin contact and bacterial contamination, the Keller Funnel lowers the risk of infection and capsular contracture. 

Preservation Breast Augmentation: A Safer Way Forward 

At Somenek+Pittman, we perform Preservation Breast Augmentation—an innovative technique that protects your natural tissues and minimizes trauma. Our approach combines: 

• Subfascial (or prepectoral) placement – Implants are positioned under the thin fascia layer covering the pectoral muscle. This technique avoids cutting muscle, minimizing bleeding and postoperative pain. It also minimizes animation deformity and decreases interference with pectoral muscles. Subfascial placement offers lower capsular contracture rates than subglandular placement and a faster recovery. Patients often report less pain and a quicker return to workouts. 
• Motiva SmoothSilk® implants – We use sixthgeneration Motiva implants with a unique SmoothSilk® surface. Scientific studies show that SmoothSilk has the least inflammation and low bacterial attachment compared to other implant surfaces. Fiveyear data report capsular contracture rates around 0.5 %, rupture rates 0.6 % and infection rates 0.9 %. A separate FDA study noted that SmoothSilk had less than 1 % capsular contracture and zero cases of BIAALCL or BIASCC worldwide. 
• Balloonassisted, notouch insertion – We employ a specialized balloon device and the Keller Funnel to place the implant through a tiny incision. This notouch technique reduces trauma and bacterial contamination, leading to smaller scars, less swelling and faster healing. 
• Preservation of Cooper’s ligaments and blood supply – By preserving the natural ligaments and blood vessels, we maintain the breast’s natural support and sensation. This not only improves aesthetic results but also lowers the risk of nerve damage and longterm complications. 

Complication	Typical risk with traditional surgery	How preservation techniques lower risk
Capsular contracture	2–18 % of primary augmentations; risk increases with contamination and bleeding	SmoothSilk® implants show ~0.5 % contracture in 5year studies; notouch insertion limits bacterial contamination and preserving tissues reduces bleeding and inflammation
Infection	Postoperative infection risk around 1–2 % depending on technique	Motiva SmoothSilk implants reported only 0.9 % infection; Keller Funnel reduces skin contact, lowering bacterial exposure
Rupture	Variable rates; older implants had higher rupture rates	Motiva SmoothSilk implants have a 0.6 % rupture rate at five years and the TrueMonobloc® shell provides additional integrity
Animation deformity	Common with submuscular implants (75 % in reconstruction)	Subfascial placement avoids muscle disruption, eliminating animation deformity
BIAALCL/BIASCC	Rare but associated with textured implants	SmoothSilk surface has zero reported cases of BIAALCL or BIASCC worldwide
Rippling	More common with saline implants and thin tissue	Subfascial placement provides more coverage than subglandular, reducing rippling; cohesive Motiva gels maintain shape without visible edges

In short, preservation surgery uses modern science to tackle the root causes of complications: contamination, inflammation and tissue trauma.

Tips to Minimize Your Risk

Whether you opt for traditional or preservation augmentation, you can play an active role in reducing complications: 

1. Choose a boardcertified plastic surgeon. Verify that your surgeon performs many breast procedures and uses accredited surgical facilities. A skilled surgeon who follows notouch protocols can significantly reduce complication rates. 
2. Discuss implant options. Ask about sixthgeneration implants like Motiva that have demonstrated low capsular contracture and rupture rates. Smooth surfaces may reduce the risk of BIAALCL. 
3. Follow pre and postoperative instructions. Quit smoking, maintain a healthy weight and stop certain medications before surgery; after surgery, keep incisions clean, wear your support bra and avoid strenuous activities until cleared by your surgeon. 
4. Report unusual symptoms. Persistent swelling, pain, hardness, sudden asymmetry or fluid accumulation should be evaluated promptly. Early intervention prevents minor issues from becoming major complications.

Can complications still occur with preservation breast augmentation? 

While preservation techniques drastically lower risks, no surgery is completely free of complications. Very rare events such as implant rupture or infection can still occur, but the rates are significantly lower than with traditional implants. Selecting an experienced surgeon, following aftercare instructions and attending regular followups will help ensure the best outcome. 

Experience Safe, Beautiful Results with Somenek+Pittman 

At Somenek+Pittman, we believe your beauty journey should be as safe as it is rewarding. Our surgeon Dr. Troy Pittman is a pioneer in preservation breast augmentation in the United States. By combining subfascial placement, notouch insertion and Motiva implants, we minimize complication risks and deliver results that feel and look authentically yours. From the moment you walk into our Washington, D.C., or New York City offices, you’ll experience a conciergelevel approach where your comfort, privacy and confidence come first. 

Ready to learn how preservation breast augmentation can give you the curves you want without the worries you don’t? Schedule a private consultation and let Somenek+Pittman become your aesthetic home.