October 01, 2026 | Breast Augmentation, Breast Implants
In August, Forbes ran a headline about an operation I perform: Is Motiva Preservé The Rolls-Royce Of Breast Implants?
I was one of the first surgeons in the United States doing it. So I get to answer.
Here is what the brand question sounds like in my consult room. A patient sat down last summer, I asked whether she had heard of the Preserve procedure, and she said no. Then I described it.
Patient: “Oh, the Motiva.”
Dr. Agullo: “The Motiva Preserve. Yes. So that’s the one where you can go back to work the next day.”
She knew the name before she knew the operation. Forbes heard the same thing from Motiva itself.
What Forbes Reported
Contributor Emma Sandler’s main points, paraphrased:
- Motiva, made by Establishment Labs, launched Preservé in the US in March 2026.
- It is a minimally invasive technique that preserves the native breast tissue, through an incision of about 2.5 cm under the breast.
- Recovery is described as a few days instead of four to six weeks, and the implant can sit above the muscle.
- It pairs with Motiva’s Ergonomix implants, which have a teardrop-like shape that moves with the body and a SmoothSilk surface. Forbes cites a capsular contracture rate of 0.5 percent at five years.
- Malavika William, Motiva’s VP of global communications and marketing, told Forbes that patients now ask for an implant brand by name, which historically did not happen. CEO Peter Caldini said the category had seen no real innovation since the late 1990s. Founder Juan José Chacón Quirós described treating regulatory milestones as a starting point.
- Dr. Adam Kolker, a double board-certified plastic surgeon in New York, said placement matters more than which implant you choose. He advised finding a surgeon experienced in more than one technique, and called Preservé a thoughtful addition.
I agree with Dr. Kolker more than with the headline.
What the Name Means
I will not re-teach the whole operation here; my technique post, the patient Q&A and the Preservé page do that. The short version is the implant sits in front of the pectoralis, behind the breast tissue. The muscle is never cut or released.
“It is called Preserve because we’re not cutting any nerves, arteries, or breast tissue. All of those structures are preserved, and the most important ones are the natural breast ligaments, which will now act like a mesh and keep the implant in that pocket.”
That is a technique. The implant matters, but the plane matters more. It is the same idea I wrote about in Preservation, Not Minimalism.
My Verdict
Is it the Rolls-Royce? For the right patient, yes. For the wrong patient it is the wrong car, however nice the badge is.
A Rolls-Royce is a car you could put anyone in. Preservé is not like that. It has a size ceiling, a body type it suits and a body type it does not. And most of what makes it feel natural (the implant over the muscle, a soft cohesive gel, no animation when you flex) I already give patients who choose a traditional augmentation:
“Really, we’re mostly doing everything over the muscle with the Motiva implants because you get the benefit of them being a little bit closer, your muscle’s not pushing them to the side, and when you exercise, they don’t move like if you were flexing. So they’re a lot more natural.”
So the luxury is not the brand. It is the speed.
Who It Is Right For
“Patients who are looking for a natural result are the ideal candidates.”
The patient who does best with Preservé wants to look like herself, a little fuller. Often she has lost volume after pregnancy, breastfeeding or weight loss. Often she wants smaller, too: most of my augmentations still land between 300 and 400cc, but more patients now ask for under 300cc, and some of them get there through Preservé. (More on that in my post on smaller breast implants.)
And she cannot afford to be down for weeks. “Most of the patients who seek Motiva Preserve breast augmentation are really interested in the ultrafast recovery and getting back to the gym within weeks.”
Who It Is Not Right For
This is the part a headline leaves out.
“So if a patient desires more than a two cup size increase in their breast, we need to go to a traditional breast augmentation over the muscle, or dual plane. This procedure by itself is not ideal for patients who have significant breast ptosis. They will actually require a breast lift, or a mastopexy, at the same time.”
There is also a size limit, and I want patients to hear it early. I show patients both on the 3D simulator: “With Preserve, the maximum is 315 cc’s, versus 400 with the traditional approach, but the result can look very similar because with this technique there’s no cutting of nerves or arteries, we’re just making a space and relying on the breast’s own ligaments to hold the implant, which pulls the breast up more and gives you more visible size than the same cc’s would with the traditional technique.”
That consult was from earlier this year. Today I put the Preservé limit at about 325cc, and in some cases we can go a little larger.
Some anatomy needs a different plan entirely. A tuberous breast is one: “And because you have the tuberous breast, we put it over the muscle, because it fills in the breast better and it expands that tissue.” That case gets a lift through the areola and internal mesh support, not a balloon pocket.
Days, Not Weeks: The Actual Recovery
Forbes says a few days. Here is what that looks like in my practice, in the words I use with patients.
| When | What happens |
|---|---|
| Surgery day | Light IV sedation, about a 2.5 cm incision in the fold, home the same day |
| First three days | Exparel block numbs the breast; most patients feel pressure, not pain |
| Next day | FaceTime check, shower, back to work |
| First two weeks | Breasts look tight at first, then settle |
| Two weeks | Back to the gym |
| Four weeks | Out of the surgical bra |
The day itself is short. “We usually come in an hour before, we do the surgery, and then you go out about an hour later.”
Pain is planned for before it starts. “So we’re going to do an Exparel block, which is a long acting anesthetic that lasts three days. If we beat the pain early on, you usually don’t get pain. So most people don’t have pain. They feel more like pressure.”
Patients notice something right away: “Patients notice immediately after surgery that they’re able to raise their hands above their head without any discomfort or pain.”
Then the follow-up. “We’ll do like a FaceTime follow up the next day, make sure everything’s okay.” When a patient asked me about showering, my answer was two words: “The next day.”
And a warning I give everyone, so nobody panics in the mirror: “With this procedure, the breasts look a little funny right in the beginning, because we kind of put them in tight. And then the implant slowly expands into the breast. So in the beginning they can look a little tight, and then over the first two weeks everything goes to where it starts looking nice.”
Now the honest comparison. Forbes contrasts Preservé with four to six weeks. My traditional augmentation, over the muscle with a mesh, is not that slow: “Recovery with the 400 and mesh is about five to seven days, and then we wait four weeks before the gym.” The gap is real. It is just smaller than the headline when the traditional operation is done over the muscle.
What About the Price?
Forbes reported that surgeons charge a 30 to 50 percent premium for Preservé over a traditional augmentation. That is Forbes’ reporting on the market, not my fee schedule. My starting prices are on my fees page, and you get an exact quote after your consultation, once we know which operation actually fits you.
Why I Was Early
“I was one of the very early adopters of this technology.”
Motiva trained me directly, as one of a select group of about 30 US surgeons, and I traveled to Costa Rica twice to train on the technique. My practice announced it in August 2025, in a PR Newswire release picked up by Yahoo Finance. I am also an investigator on the national Motiva post-approval study (ClinicalTrials.gov NCT06938399), which follows patients for ten years and is still ongoing.
Being early also meant learning the limits early.
Why Choose Dr. Agullo
Double board-certified, by the American Board of Plastic Surgery and the American Board of Surgery. Mayo Clinic plastic surgery fellowship. Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. Castle Connolly Top Doctor for 13 consecutive years. Trained by Motiva on Preservé, and I perform both Preservé and traditional augmentation, which is the kind of surgeon Dr. Kolker told Forbes readers to look for.
Ready to Talk?
If you read the Forbes piece and want to know whether you are a Preservé patient or a traditional one, come in. We will measure, run the 3D simulation, and pick the operation before we pick the implant.
Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at agulloplasticsurgery.com/appointments. #StayBeautiful
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