Preserve and MIA breast augmentation

Preserve and MIA breast augmentation are implant-based approaches also researched as tissue-preserving breast augmentation. With these methods, we aim to preserve existing breast tissue and its relationship with supporting structures. If you are considering adding volume, we can begin by discussing how your desired fullness fits your breast tissue thickness and chest anatomy.

MIA refers to a minimally invasive breast augmentation approach that limits surgical access and the space prepared for the implant. Preserve centers on preserving breast tissue, nerves, ligaments, and muscle. Procedures described by these names use implants and involve preparing a surgical pocket that fits the implant’s dimensions.

The tissue-preserving approach to breast augmentation

When making room for the implant, we choose which layers between the breast tissue and muscle to separate. This choice is based on the area the breast occupies on the chest wall and the tissue that will remain in front of the implant. We also adapt the surgical space to the implant’s width, height, and forward projection.

The breast consists of milk glands, fat tissue, and the connective tissue surrounding them. Behind these structures lies the large chest muscle, the pectoralis major, with a thin connective tissue covering called fascia on its surface. The breast skin and subcutaneous tissues form the outer part of the coverage that will lie in front of the implant.

Extensions of connective tissue running through the breast connect the skin to deeper tissues. These supporting ligaments contribute to the breast’s position and shape. The inframammary fold, the natural crease at the lower breast boundary, also relates to tissue attachments and guides the lower boundary of the implant pocket.

We explain what tissue preservation means for you by showing which structures will remain in front of and behind the implant. An implant above the muscle is covered by the existing breast tissue and, depending on the chosen plane, the muscle fascia. This covering needs to be thick enough for us to recommend this placement.

How is the Preserve approach planned?

With the Preserve approach, we aim to preserve the breast’s natural structure and supporting tissues. Breast tissue, nerves, ligaments, and muscle are the anatomical elements of this plan. When making room for the implant above the muscle, we work from the breast’s existing boundaries and volume distribution.

The implant may be placed beneath the breast tissue or beneath the muscle fascia. Placement beneath the breast tissue is called subglandular, and placement beneath the muscle fascia is called subfascial. In both, the implant lies above the pectoralis major muscle, and the pocket is prepared without cutting the muscle.

We reach the area where the implant will sit through a small incision. We plan the skin entry point and the boundaries of the internal pocket according to the implant’s dimensions. Incision length and pocket width are different measurements within the same operation.

When discussing the Preserve option, we consider tissue thickness in your upper breast, the length of the lower breast, and its lateral boundary. These measurements indicate the coverage that will lie over the implant. They also allow us to explain whether your desired fullness is compatible with placement above the muscle.

In a subglandular pocket, the muscle fascia remains behind the implant. In a subfascial pocket, this layer is separated from the muscle surface and becomes part of the covering in front of the implant. Muscle fascia is thin connective tissue, while the underlying muscle differs in thickness and structure.

Minimally invasive breast augmentation with MIA

In the MIA approach, a small incision provides access to prepare a defined pocket sized to the implant. The implant lies above the muscle and behind the breast tissue. During pocket preparation, we consider the relationship between the space needed for the implant and the breast’s existing supporting structures.

The term narrow pocket, which you may encounter in descriptions of MIA, refers to a space tailored to the implant’s dimensions. The pocket is prepared to accommodate the implant’s width and height. Volume selection also takes account of the breast tissue that will cover this limited space.

The space behind the breast tissue and the space beneath the muscle fascia are different layers above the muscle. A pocket beneath the muscle fascia is called a subfascial pocket. MIA’s limited pocket approach is based on placement behind the breast tissue, with the muscle remaining behind the implant.

For MIA, we select the implant according to the boundaries of the existing breast base. Moderate volume means a size suited to your breast base and tissue coverage. If your desired volume requires a pocket extending beyond this area, a different augmentation plan is considered.

When considering Preserve and MIA, you can ask about the access route and the layer in which the implant will sit. We explain these details in relation to your own breast anatomy at the examination. If repositioning a low nipple is also being considered, the skin adjustment needed for a lift becomes part of the plan.

MIA incision site and implant access

In the MIA approach, the incision lies in an underarm skin crease. A passage is prepared from this entry point toward the breast to reach the implant pocket above the muscle. The implant is placed through this route into the space behind the breast tissue. The underarm entry point and the area of the breast that will gain volume are different parts of the same surgical route.

An implant inserted through an underarm incision is positioned within the breast according to the selected width and height. A skin incision located away from the breast does not include an adjustment that repositions the nipple. If nipple repositioning or reduction of the areola, the colored area around it, is desired, a separate skin plan is needed for those changes.

How the mechanism differs from submuscular and dual plane placement

In conventional submuscular placement, the implant is placed in a space prepared beneath the pectoralis major muscle. Muscle tissue lies in front of the implant, particularly its upper portion. Adjustment of the muscle’s lower attachments varies with the scope of the selected submuscular technique.

Dual plane means placement in two planes. The upper part of the implant is covered by muscle and the lower part by breast tissue. The lower edge of the muscle and the attachments between breast tissue and muscle are prepared accordingly. The name describes different portions of the same implant lying beneath different tissue layers.

With the above-muscle placement discussed in Preserve and MIA, the chest muscle remains behind the implant. Because the breast’s own tissue covers the front of the implant, we choose its dimensions according to the thickness of that covering.

Incision site and placement plane are different features. Entry points such as the fold beneath the breast or the underarm describe where the surgical space is accessed. The terms beneath the muscle, above the muscle, and beneath the muscle fascia describe the implant’s position relative to the tissues.

When breast tissue is thin, including muscle in the implant coverage may be considered. For an implant that will remain above the muscle, the coverage provided by breast tissue is the basis of the plan. This difference in mechanism does not mean that the same implant or volume will be selected for every placement plane.

Who might be a candidate for Preserve and MIA?

We consider these approaches for people planning their first breast augmentation who have no pronounced sagging and enough breast tissue to cover the implant. When describing your desired volume, you might refer to upper breast fullness or the side view. We relate this expectation to breast base and skin envelope measurements.

When there has been no previous breast surgery, the natural breast base and relationships between tissues can be examined directly. Tissue thickness differs from one breast to another. A breast with little volume may have sufficient coverage, while some areas of a breast with substantial volume may be thin.

To assess sagging, we measure where the nipple lies relative to the fold beneath the breast. If upper breast volume has decreased while nipple position is maintained, the augmentation plan addresses that need for fullness. If the nipple sits low and excess skin is pronounced, we explain the need for a lift separately.

Sufficient tissue refers to its distribution as well as overall breast size. The areas that will cover the upper and inner implant edges are examined separately. Tissue concentrated in the lower breast does not indicate equally thick coverage in the upper breast.

Skin elasticity relates to how the chosen implant will fit within the breast’s existing envelope. Breast base width and skin envelope length are different measurements. When the desired volume fits these measurements, an anatomical plan for placement above the muscle can be developed.

Completed breast development and general health suitable for surgery are also part of candidacy for these approaches. Cosmetic augmentation is not planned during pregnancy or breastfeeding because breast tissue volume and distribution change during these periods. Plans for pregnancy can be discussed when choosing volume based on the current breast shape.

When is a different plan needed?

Pronounced sagging, very thin tissue coverage, a wish for substantial volume, and previous breast surgery require separate planning beyond a limited pocket approach. If any of these apply to you, you can also ask at the consultation about other surgical options suited to your desired volume and breast shape.

For pronounced sagging, a lift involves repositioning the nipple and adjusting excess skin. If additional volume is also desired, augmentation and a lift can be included in the same surgical plan.

With very thin breast tissue, the coverage available for an implant above the muscle may be limited. We explain other placement options according to which part of the breast has limited tissue thickness. Placement beneath the muscle fascia also requires breast tissue to cover the implant.

When substantial volume is desired, the implant’s base and forward projection are assessed against the limits of the existing tissues. If your volume expectations do not fit the limited pocket approach, we discuss the area the implant would occupy on your chest and alternative placement options. Breast base width informs the volume decision in each of these options.

Revision means operating again on a breast that has already undergone surgery. The existing implant pocket, previous incisions, and altered tissue attachments form part of the new plan. The narrow pocket preparation described for a first augmentation therefore does not, by itself, explain the scope of revision surgery.

The pinch test and breast measurements at the examination

To assess tissue thickness, we examine the covering in different breast areas by touch. In the pinch test, the skin and underlying soft tissue are held between the fingers. The resulting fold provides information about coverage thickness. Findings in the upper, inner, and lower regions are related to the area where the implant will sit.

The fold held during the pinch test contains both skin and underlying tissues. Its thickness relates to the soft tissue covering in front of the implant. Because breast volume and muscle structure are separate features, the test is complemented by other examination findings, such as breast base width and nipple position.

We measure the distance from the nipple to the fold beneath the breast to understand the space available for the implant in the lower breast. Nipple height and fold position may differ between the right and left sides. We use these measurements to determine the implant base and the pocket’s lower boundary.

The examination also includes chest width, the area the breasts occupy on the chest wall, and the distance between them. Using this anatomy, we clarify whether you would like upper breast fullness or forward projection. Because implants of the same volume can differ in width and forward projection, we also show you these dimensions during selection.

Differences in the shape of the right and left chest wall may contribute to breasts pointing in different directions or sitting at different heights. Implant selection distinguishes which part of the difference comes from breast tissue and which from the chest wall. Each breast’s base, chest wall slope, and nipple direction are recorded accordingly.

Implant volume, base width, and profile are distinct features. Profile describes forward projection relative to the base. Implants of the same volume may have different widths and profiles. A narrow breast base limits the width that can be selected, while the existing tissue coverage informs how much forward volume can be added.

If you would like a moderate increase in fullness, we can begin with where in the breast you would like it. Filling the upper breast and increasing forward projection involve different implant dimensions. In a tissue-preserving pocket plan, we relate this expectation both to the base where the implant will sit and to the tissue covering its front.

The nipple’s position relative to the chest midline helps determine where the implant will be centered. When the nipple points outward, the center of the implant base is determined together with the position of the breast’s own tissue on the chest. The slope of the fold beneath the breast and the breast’s outer boundary are also anatomical landmarks for locating the pocket.

Any previous breast imaging, biopsy results, and family history of breast disease form a separate topic from surgical measurements at the augmentation consultation. A biopsy is the removal of a tissue sample for examination. Implant placement above the muscle does not change this breast health assessment; necessary investigations are selected according to the person’s history and examination findings.

Photographs can provide preliminary information about breast contours, shape differences between the right and left sides, and nipple direction. Skin elasticity and the thickness of the tissue that will cover the implant are assessed through examination by touch. Particularly when placement above the muscle is being considered, these measurements provide information distinct from the size visible in a photograph.

Choosing anesthesia

For implant-based breast augmentation, anesthesia options include general anesthesia or, in suitable cases, local anesthesia with sedation. Local anesthesia numbs the surgical area, while sedation adjusts the level of consciousness under an anesthesiologist’s supervision. The choice depends on the scope of surgery and the person’s health.

Anesthesia selection for Preserve and MIA depends on the person’s health and the scope of the surgical plan. The implant placement area, any accompanying need for a lift, and previous breast operations all form part of that scope. Current medications, medical history, and previous anesthesia experiences are recorded at the anesthesia assessment.