{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T16:40:32Z","timestamp":1786466432159,"version":"build-2736575974"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to describe the authors\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 4 (Therapeutic)<\/jats:title>\n                    <jats:p>For image description, please refer to the figure legend and surrounding text.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/asj\/sjag113","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T11:48:37Z","timestamp":1780573717000},"page":"S117-S126","source":"Crossref","is-referenced-by-count":1,"title":["Minimally Invasive, Tissue-Preserving Breast Augmentation: Insights From a Large Case Series, Technique and Surgical Pearls"],"prefix":"10.1093","volume":"46","author":[{"given":"Troy A","family":"Pittman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Steve","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamakshi","family":"Zeidler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy R","family":"Chidester","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Bradley","family":"Calobrace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081110403620900_sjag113-B1","author":"American Society of Plastic Surgeons"},{"key":"2026081110403620900_sjag113-B2","doi-asserted-by":"publisher","first-page":"887","DOI":"10.1093\/ASJ\/SJX127","article-title":"What's your micromort? A patient-oriented analysis of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)","volume":"37","author":"Sieber","year":"2017","journal-title":"Aesthet Surg J"},{"key":"2026081110403620900_sjag113-B3","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1097\/PRS.0000000000004948","article-title":"Anatomy of the superficial fascia system of the breast: a comprehensive theory of breast fascial anatomy","volume":"142","author":"Rehnke","year":"2018","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B4","doi-asserted-by":"publisher","DOI":"10.16966\/2470-0991.e107","article-title":"The 21st century silicone breast implant","volume":"2","author":"Sforza","year":"2016","journal-title":"J Surg Open Access"},{"key":"2026081110403620900_sjag113-B5","doi-asserted-by":"publisher","first-page":"255","DOI":"10.1016\/j.cps.2025.11.015","article-title":"Breast tissue preservation: a paradigm shift in aesthetic breast surgery","volume":"53","author":"Chac\u00f3n-Quir\u00f3s","year":"2025","journal-title":"Clin Plast Surg"},{"key":"2026081110403620900_sjag113-B6","doi-asserted-by":"publisher","first-page":"1255","DOI":"10.1097\/00006534-200104150-00027","article-title":"Dual plane breast augmentation: optimizing implant-soft-tissue relationships in a wide range of breast types","volume":"107","author":"Tebbetts","year":"2001","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B7","doi-asserted-by":"publisher","first-page":"1011e","DOI":"10.1097\/PRS.0000000000010497","article-title":"Practice patterns in primary breast augmentation: a 16-year review of continuous certification tracer data from the American board of plastic surgery","volume":"152","author":"Stein","year":"2023","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B8","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1097\/PRS.0000000000003627","article-title":"Prepectoral breast reconstruction: a safe alternative to submuscular prosthetic reconstruction following nipple-sparing mastectomy","volume":"140","author":"Sbitany","year":"2017","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B9","doi-asserted-by":"publisher","first-page":"1115","DOI":"10.1038\/s41551-021-00739-4","article-title":"The surface topography of silicone breast implants mediates the foreign body response in mice, rabbits and humans","volume":"5","author":"Doloff","year":"2021","journal-title":"Nat Biomed Eng"},{"key":"2026081110403620900_sjag113-B10","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1093\/asj\/sjaf245","article-title":"The study of the safety and effectiveness of motiva SmoothSilk silicone gel-filled breast implants in patients undergoing primary and revisional breast augmentation: 5-year clinical data","volume":"46","author":"Glicksman","year":"2026","journal-title":"Aesthet Surg J"},{"key":"2026081110403620900_sjag113-B11","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12051881","article-title":"Complication rates after breast surgery with the motiva smooth silk surface silicone gel implants-A systematic review and meta-analysis","volume":"12","author":"Aitzetm\u00fcller-Klietz","year":"2023","journal-title":"J Clin Med"},{"key":"2026081110403620900_sjag113-B12","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjag038","article-title":"Tissue-preserving inframammary fold breast augmentation: a 3-year clinical experience","volume":"6","author":"Randquist","year":"2026","journal-title":"Aesthet Surg J"},{"key":"2026081110403620900_sjag113-B13","doi-asserted-by":"publisher","first-page":"NP113","DOI":"10.1093\/asj\/sjy294","article-title":"Revisiting prepectoral breast augmentation: indications and refinements","volume":"39","author":"Sim","year":"2019","journal-title":"Aesthet Surg J"},{"key":"2026081110403620900_sjag113-B14","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1007\/S00266-004-0019-3","article-title":"Anatomic and physiologic advantages of totally subfascial breast implants","volume":"29","author":"Ventura","year":"2005","journal-title":"Aesthetic Plast Surg"},{"key":"2026081110403620900_sjag113-B15","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1097\/01.PRS.0000041601.59651.15","article-title":"Subfascial breast implant: a new procedure","volume":"111","author":"Graf","year":"2003","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B16","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjag059","article-title":"Anatomical basis of a posterior intra-lamellar plane in breast tissue-preservation surgery","author":"Lhuaire","year":"2026","journal-title":"Aesthet Surg J"},{"key":"2026081110403620900_sjag113-B17"},{"key":"2026081110403620900_sjag113-B18","author":"Scarpa"},{"key":"2026081110403620900_sjag113-B19","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1097\/00006534-199106000-00001","article-title":"Superficial fascial system (SFS) of the trunk and extremities: a new concept","volume":"87","author":"Lockwood","year":"1991","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B20","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1097\/01.prs.0000436798.20047.dc","article-title":"Understanding the fascial supporting network of the breast: key ligamentous structures in breast augmentation and a proposed system of nomenclature","volume":"133","author":"Matousek","year":"2014","journal-title":"Plas Surg Surg"},{"key":"2026081110403620900_sjag113-B21","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1007\/S00266-015-0455-2","article-title":"Anatomy of the superficial layer of superficial fascia around the nipple-areola Complex","volume":"39","author":"Komiya","year":"2015","journal-title":"Aesthetic Plast Surg"},{"key":"2026081110403620900_sjag113-B22","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.1002\/CNCR.10429","article-title":"Incidence of the superficial fascia and its relevance in skin-sparing mastectomy","volume":"94","author":"Beer","year":"2002","journal-title":"Cancer"},{"key":"2026081110403620900_sjag113-B23","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1097\/PRS.0000000000008671","article-title":"Anatomy of the breast fascial system: a systematic review of the literature","volume":"149","author":"Duncan","year":"2022","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B24","doi-asserted-by":"publisher","first-page":"194E","DOI":"10.1097\/PRS.0000000000006330","article-title":"Reply: subfascial breast implant: a new procedure","volume":"145","author":"Rehnke","year":"2020","journal-title":"Plast Reconstr Surg"},{"key":"2026081110403620900_sjag113-B25","doi-asserted-by":"publisher","first-page":"e10353","DOI":"10.47511\/SAPSJ.V4.10353","article-title":"Preservation of breast ligamentous structures in mastopexy: achieving aesthetic excellence with minimal complications","volume":"4","author":"Torres-Arciniegas","year":"2024","journal-title":"Sci Art Plast Surg J"},{"key":"2026081110403620900_sjag113-B26","doi-asserted-by":"publisher","first-page":"NP1013","DOI":"10.1093\/asj\/sjad276","article-title":"Sensory evaluation of the nipple-areolar complex following primary breast augmentation: a comparison of incision approaches","volume":"43","author":"Rancati","year":"2023","journal-title":"Aesthet Surg J"},{"key":"2026081110403620900_sjag113-B27","author":"Establishment Labs"},{"key":"2026081110403620900_sjag113-B28","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1016\/J.CJPRS.2024.12.002","article-title":"Breast augmentation complications with three planes of implant placements","volume":"7","author":"Zhao","year":"2025","journal-title":"Chin J Plas Reconstr Surg"},{"key":"2026081110403620900_sjag113-B29","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1038\/s41598-023-28399-1","article-title":"Appropriate screening mammography method for patients with breast implants","volume":"13","author":"Park","year":"2023","journal-title":"Sci Rep"},{"key":"2026081110403620900_sjag113-B30","doi-asserted-by":"publisher","first-page":"93","DOI":"10.15430\/JCP.2018.23.2.93","article-title":"The impact of implant location on breast cancer characteristics in previously augmented patients: a systematic literature analysis","volume":"23","author":"Azzi","year":"2018","journal-title":"J Cancer Prev"},{"key":"2026081110403620900_sjag113-B31","doi-asserted-by":"publisher","first-page":"209","DOI":"10.5507\/bp.2007.036","article-title":"The role of various modalities in breast imaging","volume":"151","author":"Prasad","year":"2007","journal-title":"Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub"}],"container-title":["Aesthetic Surgery Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/46\/Supplement_2\/S117\/70611145\/sjag113.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/asj\/article-pdf\/46\/Supplement_2\/S117\/70611145\/sjag113.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T15:44:12Z","timestamp":1786463052000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/asj\/article\/46\/Supplement_2\/S117\/8758954"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,11]]},"references-count":31,"journal-issue":{"issue":"Supplement_2","published-online":{"date-parts":[[2026,8,11]]},"published-print":{"date-parts":[[2026,8,11]]}},"URL":"https:\/\/doi.org\/10.1093\/asj\/sjag113","relation":{},"ISSN":["1090-820X","1527-330X"],"issn-type":[{"value":"1090-820X","type":"print"},{"value":"1527-330X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,9]]},"published":{"date-parts":[[2026,8,11]]}}}