Retrospective Validation of a Tissue-Preserving Breast Augmentation Approach: From Native Tissue Geometry to Surgical Practice

BACKGROUND: Breast augmentation has traditionally focused on implant volume and pocket selection, often overlooking the variability of native breast anatomy. OBJECTIVES: Breast tissue preservation (BTP) emphasizes preservation of fascial planes and tissue integrity, enabling prepectoral implant placement within a preserved tissue envelope. When combined with 3-dimensional (3D) imaging and ultrasound-based geometric analysis, BTP supports selective implant positioning tailored to regional deficiencies, potentially improving stability and natural aesthetic outcomes while reducing reliance on larger implant volumes and the need for scaffold support. METHODS: A single center retrospective study analyzed 111 patients undergoing primary breast augmentation or augmentation-mastopexy using tissue preservation techniques, including transaxillary and inframammary approaches. Pre- and 12-month postoperative assessments incorporated 3D imaging and high-resolution ultrasound to evaluate breast geometry, tissue distribution, volumetric and angular changes, and stability. Safety outcomes and patient satisfaction were evaluated over 12 months. RESULTS: Among 111 patients, complication rates were low (4.5%), with no Baker III-IV capsular contracture, no implant ruptures and high satisfaction scores. Geometric analysis demonstrated consistent increases in upper, medial, and lateral angles, procedure specific inferior angle changes, preserved nipple alignment with maximal projection, and improved breast stability, supporting controlled and reproducible volume redistribution. These changes were achieved through targeted regional volume placement. CONCLUSIONS: This study highlights the clinical value of a comprehensive native breast assessment in real-world practice. Integrating volumetric, topographic, and angular analysis enables individualized planning, precise implant positioning, with minimally invasive BTP techniques. This approach supports biomechanical stability, demonstrates a favorable safety profile, and promotes natural outcomes in everyday surgical practice. Level of Evidence: 4 (Therapeutic).