Tissue-preserving Inframammary Fold Breast Augmentation: A Three-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 three-year period.

[METHODS] This two-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 pre-pectoral pocket via balloon expansion. Complications were assessed by monitoring cumulative incidence during follow-up visits at 2 weeks, 6-, 12-, 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 (grade 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 via the IMF, performed under general or local anesthesia. It preserves stabilization structures, features a short learning curve, and carries a low risk of complications.