Balloon-Assisted Prepectoral Breast Augmentation Using a Hernia Balloon Dissector: Early Clinical Experience in 50 Patients

Abstract Background Breast augmentation remains one of the most performed aesthetic procedures worldwide. While dual-plane subpectoral placement has traditionally been favored, increasing preference for smaller implant volumes and advances in implant technology have renewed interest in prepectoral approaches. Objectives To describe a minimally invasive prepectoral breast augmentation technique using balloon-assisted dissection with a hernia balloon dissector, and to evaluate early clinical outcomes. Methods A retrospective review was conducted of the first 50 consecutive patients undergoing primary prepectoral breast augmentation using a hernia balloon dissector at a single center. Data collected included patient demographics, operative parameters, complications, and secondary procedures. Results One hundred breasts were augmented in 50 women using a hernia balloon dissector between November 2023 and September 2025, with a mean follow-up of 18 months. All patients received Motiva Ergonomix2® implants, with a mean volume of 262 cc (range, 170–425 cc). Mean total operative time was 37 minutes (range, 15–85 minutes). No hematomas, seromas, infections, or wound complications occurred within 30 days. One patient required same-day re-exploration for suspected hematoma; intraoperatively, the implant was found in a subpectoral plane and was successfully repositioned into the prepectoral plane. Secondary procedures were performed in 8 patients, all within the first 20 cases, including revision for superior malposition (n=3), implant exchange for size preference (n=3), mastopexy for ptosis (n=1), and explantation at the patient's request (n=1). Conclusions This study is the first to report the clinical use of a partially reusable, sterilizable hernia balloon system for breast augmentation. Careful patient selection and recognition of the initial learning curve are important when applying this technique. Balloon-assisted prepectoral augmentation may represent an alternative for selected patients seeking modest breast augmentation with minimal surgical trauma. Prospective comparative studies with longer follow-up are needed to define its long-term role in aesthetic breast augmentation.