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Breast augmentation has always been one of the most frequently requested procedures at Bellissimo Plastic Surgery, and this remains the case today. The thing that has changed is not the demand for breast augmentation in Pittsburgh, but rather what patients are asking for, what current implant technology can provide, and, in some instances, what I recommend.
I have been performing breast augmentation long enough that I have witnessed the discussions change more than once. The implants themselves have improved, and so has the research into how the body reacts to them. Whenever the evidence changes, my recommendations change as well. This is where things stand as I see them in 2026.
What Patients Are Asking About Right Now
The biggest shift I have seen over the last several years is in what women actually expect from breast augmentation. The idea that bigger is better has mostly disappeared. Instead, women are looking for balance and want a result that is proportional to the rest of their body rather than one based solely on a particular size. When I’m sizing a patient, the discussion seldom focuses on a specific cup size; rather, it’s about how the breasts relate to the rest of her body. This is often what people mean when they look for breast enhancement in Pittsburgh rather than breast augmentation, even though both expressions refer to the same procedure.
I am also seeing a new patient profile walk into consultations: women who have lost significant weight through GLP-1 medications and are now thinking about having augmentation or re-augmentation. The way in which this group is different from an ordinary patient seeking primary augmentation is quite specific. A number of these women are not consuming enough protein as they lose weight, and this is reflected in their tissue. Skin and soft tissues do not have the same tone after extreme weight loss as in a patient at a stable weight who has not experienced rapid weight change. Before proceeding with this group, I need to assess their nutrition, not merely their weight history, since both affect their suitability for the procedure and the healing process.
For me, silicone implants have always been the better choice over saline implants. Saline implants carry inherent problems with rippling, and many patients can feel the implant edge, particularly along the sides of the breast. Silicone behaves more like natural tissue. It has the consistency of a soft gel, and if it were ever to rupture, the silicone stays contained within the surrounding capsule rather than migrating into breast tissue.
Within silicone implants, I have moved toward Motiva implants over the traditional manufacturers I have used for most of my career. Motiva’s gel is more pliable and holds its shape more naturally, and after using them for close to a year and a half, I have come to prefer them for the difference I see in how the body accepts them.
The difference is not due to marketing terminology; it is because of the shell. The implant shell produced by Motiva has a surface texture composed of micron-level variations, which is smooth to the touch but structurally distinct from a conventional smooth shell. This structural difference affects the way the body reacts to the implant as a foreign body. In particular, it reduces the thickness of the scar capsule that forms around the implant, as this thickening can cause capsular contracture, the most common complication associated with breast augmentation. Therefore, the body’s more favorable reaction indicates that the implant is more biocompatible.
As for who is a good candidate for Motiva versus a traditional silicone implant, there are no distinct criteria; if a patient is a good candidate for breast augmentation, then they are also a good candidate for Motiva. Traditional silicone implants remain an option and are still offered when they are the right fit for a patient’s goals or anatomy. Motiva is my preference, but it is not the only implant available at Bellissimo Plastic Surgery and Medi Spa.
Preservé Breast Augmentation: What It Is and Who It's For
Preservé is a technique developed by Motiva for a specific group of women. These are patients who have adequate breast tissue along the lower portion of the breast but have lost some volume higher up, closer to the collarbone, where the breast can appear slightly hollowed or concave. These women are usually not looking to become significantly larger. They want that upper-pole volume restored without changing their overall size.
Preservé can be performed under IV sedation rather than general anesthesia. The implant is placed above the muscle using a tunneling device and a temporary balloon to create the pocket. Rather than surgically creating space for the implant in the traditional sense, this approach recruits the patient’s own breast tissue to form a supportive nest around a smaller, softer implant. The result is a well-balanced breast, with the implant positioned exactly where volume is needed.
Candidacy comes down to where the volume loss is concentrated. If a woman has lost volume broadly, across the entire breast, from weight loss or from pregnancy and breastfeeding, a traditional implant is usually the better option. If the loss is specifically in the upper pole while the lower breast still has good tissue, Preservé may be the right fit.
Breast Implant Placement: Above vs. Below the Muscle
This is a topic where my position has changed the most.
For most of my career, I recommended submuscular breast augmentation, which means placing the implant under the muscle, and I had two specific reasons for that. First, capsular contracture, the hardening of scar tissue around an implant, was significantly more common with implants placed above the muscle. With traditional implants, the risk was roughly 12 percent above the muscle compared to about 5 percent below it. That gap was significant enough that I steered patients toward submuscular placement as the default. Second, radiologists at the time told me that implants placed under the muscle allowed for clearer mammogram visibility of the surrounding breast tissue, which mattered for long-term cancer surveillance.
Both of those reasons have changed.
The risk of capsular contracture has now been reduced to about 0.6 percent with the Motiva implant and its special shell, whether the implant is placed above or below the muscle. Moreover, modern mammography, together with ultrasound and MRI, now enables similar monitoring of breast tissue, regardless of whether the implant is positioned above or below the muscle. The two clinical reasons that influenced my recommendation throughout most of my career no longer divide the two options as they did in the past.
Today, implant placement in my practice is not limited to below the muscle. I discuss with each patient the risks, benefits, and lifestyle factors relevant to her, and she decides what is appropriate for her body and goals.
Lifestyle plays a real role in that decision. Women who lift weights regularly often prefer an implant placed above the muscle, allowing for more natural muscle movement. Women who run rather than lift may benefit from a submuscular placement, where the muscle helps hold the implant in place during running or jumping. These are not universal rules. They are part of a conversation I have with every patient about how she uses her body day to day.
Breast Augmentation Candidacy: Timing After Pregnancy and Weight Loss
Timing matters for breast augmentation, particularly after pregnancy or significant weight change. After pregnancy and breastfeeding, I typically recommend waiting at least six months before evaluation, so the breast tissue has returned to a stable baseline. If a woman is still experiencing milk letdown, I may recommend waiting a bit longer. After weight loss, I want to see a stable weight maintained for three to six months before moving forward, since tissue that is still actively changing does not give us an accurate picture of the final result.
Frequently Asked Questions About Breast Augmentation in Pittsburgh
What's the difference between breast augmentation and breast enhancement?
What is the Preservé technique, and who is a candidate?
Why has Dr. Antimarino's view on implant placement changed?
How much does breast augmentation cost in Pittsburgh?
Can breast augmentation be combined with other procedures?
Schedule a Breast Augmentation Consultation in Pittsburgh
If you are considering breast augmentation in Pittsburgh, whether it is your first procedure or a re-augmentation, I encourage you to start with a consultation. Every recommendation I make, including which implant and which placement, is built around your anatomy and how you actually live your life, not a standard answer applied to every patient. To learn more or schedule a consultation with Dr. Antimarino, contact Bellissimo Plastic Surgery today. We see patients at our Pittsburgh and Monroeville locations.
