What if breast surgery could work with your body instead of against it?
Breast augmentation is one of the most commonly performed cosmetic procedures in the world. Yet for decades, the standard approach has relied on techniques that, while effective at adding volume, can alter the natural tissue, muscle, and structure that the body spent years building.
A new scientific framework published in Clinics in Plastic Surgery is challenging that model — not with a new implant or a different incision, but with a completely different philosophy about what surgery should preserve.
It’s called Breast Tissue Preservation (BTP), introduced by Dr. Manuel Chacón-Quirós of the European Center of Surgery in San José, Costa Rica.
THE CORE IDEA
Why preservation matters in augmentation surgery
Traditional breast augmentation tends to focus on the end result: a new shape, a larger size. But to achieve that, conventional techniques often cut through ligaments, manipulate muscle, and disrupt the very tissue that gives the breast its natural support and feel.
“BTP doesn’t just aim to add volume — it aims to protect everything that makes the breast function and feel natural, both today and years from now.”
The BTP framework is built around three guiding principles: understanding each patient’s unique anatomy before making a single incision, using surgical tools designed to move through tissue rather than cut it, and placing the implant in a way that supports — rather than overrides — the breast’s natural structure.
THE FRAMEWORK
Four levels of tissue preservation
Dr. Chacón organizes the BTP concept into four distinct levels, each addressing a different layer of the breast’s biology and function.
| Level 1 Cellular | Implants with a 4-micron surface texture trigger the lowest inflammatory response of any surface type — helping the body accept the implant more naturally and reducing the risk of capsular contracture over time. |
| Level 2 Structural | A key anatomical structure called the Circummammary Ligament (CML) acts as a natural boundary for the breast. BTP respects this boundary, keeping the implant within the breast’s own support framework rather than forcing a new shape onto the body. |
| Level 3 Dynamic | Using a concept called Breast Topography, the surgeon maps each patient’s natural volume distribution before surgery — enabling precise, targeted enhancement that fills areas of deficiency rather than uniformly adding bulk. |
| Level 4 Functional | Sensation, muscle movement, and daily activities are preserved. BTP protects the nerves responsible for nipple sensation, avoids cutting the pectoralis major muscle, and is designed for recovery within days rather than weeks. |
HOW IT WORKS
The technology behind BTP
Four specialized tools allow surgeons to perform BTP with minimal disruption to surrounding tissue.
Tunneling instrument
Instead of opening a large surgical pocket, this instrument creates a narrow, guided path through the breast tissue — navigating precisely through the CML without cutting the ligaments or fascial layers along the way.
Inflatable balloon system
Once the tunnel is created, a small balloon is inserted and gradually inflated. This gentle expansion creates a three-dimensional space matching the implant’s exact dimensions — without the thermal damage associated with traditional electrocautery dissection.
Sterile implant insertion system
The implant is placed using a no-touch technique — either a funnel sleeve (for incisions along the breast fold) or a pneumatic injector (for the underarm approach), minimizing handling and reducing contamination risk.
Biocompatible implants
BTP uses implants with a 4-micron surface designed to reduce the foreign body response. Their gel composition mimics natural breast tissue, moving with the body rather than sitting rigidly within it.
NEW IDEAS
Concepts introduced by this approach
Nesting
Rather than carving out a space for the implant, BTP “nests” it — the balloon creates a pocket that the implant settles into naturally, supported by the surrounding tissue architecture. The result is an implant that stays in position without relying on muscle compression or textured surfaces that carry long-term risks.
Breast tissue recruitment
In most patients, there is natural breast tissue in the upper portion of the breast that is often ignored during planning. BTP identifies and repositions this tissue to contribute to the final result — sometimes accounting for up to 30% of total breast volume. This means smaller implants can achieve the same visual outcome, with less tension and a more natural feel.
The Tent Effect
A specific implant geometry can create vertical lift and upper pole fullness without increasing the implant’s base width. This allows for a more projected, defined look while using a smaller overall implant — reducing strain on the lower breast and preserving the natural fold.
Implant positioning
Clinical observations show that implants placed using BTP tend to sit approximately 1 cm higher than those placed with conventional techniques. This elevation brings the implant into alignment with the area of greatest volume deficiency — the upper pole — improving coverage and reducing the risk of visible implant edges.
FOR PATIENTS
Two procedures — one philosophy
BTP is offered through two distinct techniques, adapted to different patient goals and anatomy
Mia Femtech™ — Transaxillary (underarm) approach
- No incisions on the breast
- Local anesthesia, outpatient procedure
- 1–2 cup size enhancement
- Return to daily life in 24–48 hours
- Implants: 95–195 cc range
- Lentiform geometry for consistent projection
Preservé™ — Inframammary fold (under-breast) approach
- Incision along the natural breast fold
- Local anesthesia with sedation or general anesthesia
- Up to 4 cup size enhancement
- Return to daily activities within 1 week
- Implants: 95–330 cc range
- Compatible with hybrid fat transfer approache
CLINICAL EVIDENC
What the data shows
The BTP technique was evaluated in a prospective study of 100 consecutive patients who underwent the Mia Femtech procedure. The results, tracked over three years, point to a meaningful improvement in safety outcomes compared to conventional approaches.
| 3.2% Overall complication rate | 0% Loss of nipple sensation at 3-year follow-up | 0% Inferior malposition at 3 years |
No patient experienced loss of nipple sensation — a common concern with many augmentation techniques — and implant position remained stable throughout the entire follow-up period. These outcomes reflect the core promise of BTP: that a gentler approach to surgery can produce both safer and more lasting results.
Source: This post is based on a scientific publication by Dr. Manuel Chacón-Quirós, published in Clinics in Plastic Surgery (2025). Full article: https://www.sciencedirect.com/science/article/abs/pii/S0094129825001075. This content is for informational purposes only and does not constitute medical advice.
