Tissue-Preserving Inframammary Fold Breast Augmentation: A 3-Year Clinical Experience

BACKGROUND: Breast surgery often compromises structures, potentially leading to complications that affect aesthetic outcomes, lactation, breast tissue health, and the patient experience. Tissue-Preserving Breast Augmentation (TPBA) is a novel concept designed to enhance breast and implant stability by preserving the breast's stabilization system, including the circummammary ligament and Cooper's suspensory ligaments. OBJECTIVES: This study presents the TPBA approach, performed in a minimally invasive manner to minimize surgical stimuli and protect the parenchymal breast tissue, along with outcomes observed over a 3-year period. METHODS: This 2-center, multi-surgeon retrospective observational study included consecutive female patients undergoing primary breast augmentation or primary augmentation-mastopexy using TPBA between December 2022 and June 2025. All procedures involved an inframammary incision and creation of a prepectoral pocket through balloon expansion. Complications were assessed by monitoring cumulative incidence during follow-up visits at 2 weeks, 6 months, 12 months, and 24 months. RESULTS: A total of 330 procedures were performed. At a mean follow-up of 18 months, the complication rate was 0.9%. No cases of acute complications, including seroma, wound breakdown, or infection, were observed. Follow-up evaluations revealed no capsular contracture (Grades III and IV), implant rupture, lateralization, or inferior malposition. Superior malposition occurred in 2 patients (0.6%), and bleeding was observed in 1 patient (0.3%). Implant rippling was reported by 3 patients (0.9%). CONCLUSIONS: TPBA offers a standardized, reproducible approach to breast enhancement through the inframammary fold, performed under general or local anesthesia. It preserves stabilization structures, features a short learning curve, and carries a low risk of complications. LEVEL OF EVIDENCE: 4 (THERAPEUTIC): For image description, please refer to the figure legend and surrounding text.