speaker
Operator
Conference Operator

Good morning and welcome to Establishment Labs' second quarter 2026 earnings call. At this time, all participants will be in a listen-only mode. At the end of this call, we'll open the line for a question-and-answer session, and instructions will follow at that time. As a reminder, today's call is being recorded. I will now turn the call over to Malavika William, VP, Global Head of Corporate Communications and Marketing. Please go ahead.

speaker
Malavika William
VP, Global Head of Corporate Communications and Marketing

Thank you, Operator, and thank you, everyone, for joining us. With me today is Peter Caldini, our Chief Executive Officer, and Sandra Harris, our Chief Financial Officer. Following our prepared remarks, we'll take your questions. Before we begin, I would like to remind you that comments made by management during this call will include forward-looking statements within the meaning of federal securities law. These include statements on Establishment Labs' financial outlook and the company's plans and timing for product development and sales. These forward-looking statements are based on management's current expectations and involve risks and uncertainties. For a discussion of the principal risk factors and uncertainties that may affect our performance or cause actual results to differ materially from these statements, I encourage you to review our most recent annual and quarterly reports on Form 10-K and Form 10-Q, as well as other SEC filings, which are available on our website at establishmentlabs.com. I'd also like to remind you that our comments may include certain non-GAAP financial measures with respect to our performance, including but not limited to sales results, which can be stated on a constant currency basis or EBITDA, which we disclose on an adjusted EBITDA basis. Reconciliations to comparable GAAP financial measures with non-GAAP measures, if available, may be found in today's press release, which is available on our website. The content of this conference call contains time-sensitive information, accurate only as of the date of this live broadcast, August 6, 2026. Except as required by law, Establishment Labs undertakes no obligation to revise or otherwise update any statement to reflect events or circumstances after the date of this call. With that, it is my pleasure to turn the call over to Peter.

speaker
Peter Caldini
Chief Executive Officer

Good morning, and thank you for joining us. Q2 was another strong quarter for Establishment Labs. We delivered revenue of $67.5 million and adjusted EBITDA of $3.7 million, representing revenue growth of 31.7% over the same period last year. The U.S. business once again outperformed, generating revenue of $24.7 million, an increase of over 140% compared to the same quarter last year and an increase of 26% from Q1. Outside the United States, our business grew steadily at 4.4%, supported by strong execution in our direct markets and steady demand with our distributors. Our minimally invasive platform continued to emerge as an important growth driver globally, generating $12.1 million in revenue during the quarter. We're off to a good start in Q3, which is traditionally the seasonal low point of our industry. As a result of our first half performance, we are raising our full-year revenue guidance to $269 to $271 million, up from our previous range of $266.5 and $268.5 million. Minimally invasive is approaching 15% of our global business, We should transition to free cash flow positive during the second half of 2026 and be free cash flow positive for fiscal 2027. With our recent inclusion in the Russell 2000 Index, we have quite a bit of new interest in our story, and this was the focus of our Q1 call, where we walked through the technological foundation of our business and what makes Establishment Labs different. If you're joining us for the first time, I'd encourage you to read the transcript from that call. It provides a good overview of our product differentiation strategy and a long-term opportunity we see ahead. We aren't just looking to take share from others in breast aesthetics and reconstruction. We're looking to meaningfully expand the market. Breast aesthetics has been heavily under-invested for years. and we remain the only company bringing meaningful improvements and differentiated technologies to the market. Our goal has never been to be another implant company. Our goal is to be a major contributor to women's health. We started with Motiva Implant, a product developed through years of investment in science, engineering and clinical research. It has shown the strongest safety data in the industry This has been the foundation for one of the fastest launches in the U.S. breast aesthetics. Our technology platform allows us to do so much more, and we are already seeing how it enables an entirely new category of procedures through the introduction of minimally invasive. Today, that platform consists of two procedures, MEA and PRESERVEI. A third procedure called GEM is currently in development and represents a potential breakthrough in gluteal augmentation, offering what could be a safer and more predictable alternative to the Brazilian butt lift. Mia and Preserve are built on the tissue-preserving principles that Establishment Labs has pioneered and patented. The surgeries are designed to preserve native breast tissue, sensation, and chest muscles. The focus on preservation delivers clear benefits to the patient. Minimal anesthesia with barely noticeable scars and a significantly reduced recovery time compared to traditional breast augmentation. Preserve accommodates a broader range of patient needs, including larger augmentations and augmentation mastopexy procedures, while maintaining the same principles of tissue preservation and faster recovery. Mia, which is currently available outside the United States, is designed for women seeking a more subtle enhancement, typically one to two cup size increase. The procedure uses our Ergonomics II diamond implant offering a scarless breast with a small incision made in the underarm. The implant is one of the major differences between Mia and Preserve. It is a patented new shape breaking a decades-old dichotomy of round and teardrop implants. The shape, which is symmetrical, has more volume in the middle, creating more projection with a smaller volume implant. This shape is the first of its kind, truly innovative, and has many usage opportunities as we expand our efforts in minimally invasive. The softness and lightweight design allow for an augmentation Thank you for joining us today. of the more challenging parts of the surgery and over time could become a new standard in the industry. As you learn about our technology, it's worth reading the supplement on Preserve that has been accepted and should be published later this year in the Aesthetic Surgery Journal. This is a compendium of peer-reviewed clinical data specifically on breast tissue preservation and the techniques. It focuses on the science, and our hope is that it will become foundational learning for plastic surgeons as they adopt Preserve. Minimally invasive is being very well received by the market, with adoption even at higher price points. Two things are happening here. First, minimally invasive options are bringing new patients into the category that have never previously considered a breast augmentation. Second, patients already considering breast augmentation are opting for this procedure even though it's more expensive. For establishment labs in the United States, Preserve commands a premium of more than two times that of traditional breast augmentation procedure. Not only are we expanding the market, but it appears that women are deciding to get the procedure much faster than they traditionally have. Historically, women could take years between their first thoughts of having a breast augmentation and actually getting a surgery. The appeal of minimally invasive is shortening that consideration time. Since launch, we have seen any number of cases where women take months, and in some cases days, from consideration to surgery. We believe we're still in the very early stages of this opportunity. There is significant potential for market expansion and we expect it to become an increasingly important driver for our growth in the years ahead. Turning to the quarter, the United States continues to be the primary growth engine for our business, now representing 36.6% of total company revenue, up from 20% a year ago. Another milestone, in Q2 we surpassed 100,000 Motiva implants in the U.S. market, We are still early in our U.S. journey, but crossing 100,000 implants is an important reminder of how quickly the market has embraced our technology and how much opportunity remains ahead of us. What continues to stand out is the depth of adoption we're seeing. At the end of the quarter, we had surpassed 2,000 accounts in the United States. Many accounts have multiple surgeons using our implants. While we continue to open new accounts, an increasing percentage of our growth is now being driven by utilization within existing accounts. As surgeons become more familiar with the clinical data products, differentiators, and patient outcomes, we are seeing adoption strengthen, particularly among early adopters in high volume accounts, where Motiva now represents a significant percentage of their practice. One surgeon, who adopted Motiva immediately following FDA approval shared that he has completed approximately 300 Motiva cases in its first year and has now converted nearly his entire augmentation practice. Another surgeon shared that for the first time in his more than 25-year career, patients are actively requesting Motiva by name and that increased demand is translating directly into higher surgery volumes. We're also seeing that even when women have a warranty from another company that offers a free replacement, they are paying for Motiva implants themselves. These experiences seem to be representative of what we're increasingly hearing across our customer base. Late adopters are also beginning to show interest, particularly as patients' demand for Motiva continues to build. In a category where patients historically have rarely asked for a specific implant brand, 75% of surgeons now report that patients are asking, and 93% of the time that brand is Motiva. That level of consumer awareness remains highly unusual in breast aesthetics and continues to be a powerful driver of adoption, making Motiva increasingly difficult for practices to ignore. Preserve is also emerging as an important growth driver in our US business. We ended the quarter with over 300 surgeons trained and certified on the procedure, which is more than 50% above our original expectations for the year. There is no shortage of surgeon interest, and they now have multiple training pathways available, both in the United States and our global innovation hub in Costa Rica. and we continue to see relatively quick adoption following certification. The benefits of Preserve are showing up across both traditional and digital media outlets. In the limited time that Preserve has been on the market, it has been mentioned as the new breast augmentation option commonly discussed on social media platforms and in the media, including in feature articles from People Magazine and Allure as well as the Zill Report and the Washington Post, to name a few. Surgeons report they are charging between 30% to 50% more for preservative procedure than for their traditional breast augmentations, confirming that patients value these benefits and are willing to pay for them. It is increasingly early in the launch to see this kind of market expansion, and our success is suggestive. that we are only in the early innings of something that could fundamentally change the category. Also interesting, we are hearing from some surgeons that because of the very limited downtime with Preserve, they have book surgeries throughout the summer, which is unusual because of the summer months are traditionally slower for breast augmentations. One of our earliest adopters performed five breast augmentations in July and August last year. This year, He's already scheduled for 50 in the same time period. As we have discussed previously, a major focus of our strategy is expanding and strengthening our direct markets outside the U.S., and we are pleased with the progress we continue to make. Over the past year, we have not only strengthened leadership across several of our key markets, but also prioritized resources in those markets, and those investments are translating into stronger growth. Growth was broad-based across many of our regions, driven by strong execution and an increase in the number of accounts. Europe, where we have the most direct markets, delivered 16% growth and was especially strong in Italy, Germany, and the UK. In Latin America, Argentina continued its positive trajectory from Q1, while Brazil maintained its path of stability, driven predominantly by our minimally invasive platforms. Our minimally invasive platform remains an important contributor to growth outside the United States and continues to support adoption across the more than 40 markets worldwide. In general, demand trends remain stable throughout the quarter, despite continued macroeconomic and geopolitical uncertainty across several regions. Our exposure to the most volatile markets remains limited, and we continue to benefit from a highly diversified global business. As we look ahead, we continue to advance our innovation pipeline. This includes our reconstruction submission with the FDA, the expansion of our US product matrix through smaller implant sizes and the continued development of GEM. All of these will help us take market share and expand the market. With that, I'll turn the call over to Sandra to discuss our financial results in more detail.

speaker
Sandra Harris
Chief Financial Officer

Thank you, Peter. The second quarter was another important step forward financially. We continue to deliver strong top-line growth while expanding margins and generating positive adjusted EBITDA with improving cash flow. As our U.S. business and minimally invasive platform continue to scale, we're seeing increasing operating leverage across the organization. Total revenue for the second quarter with $67.5 million, an increase of 31.7% compared to the second quarter of 2025. In the United States, revenue was $24.7 million, representing growth of 140.9% compared to the prior year. The U.S. now represents 36.6% of total company revenue and continues to be our fastest growing region. Growth was driven by continued adoption of Motiva and increasing contribution from our minimally invasive platform. Geographically, our business outside the United States continues to perform well. OUS revenue was 42.8 million during the quarter, representing growth of 4.4% over the second quarter of 2025. Our minimally invasive platform generated 12.1 million in revenue during the quarter, and continues to perform ahead of our original expectations. Gross profit for the second quarter was $47.7 million or 70.6% of revenue compared to 68.8% in the prior year period. Gross margin expansion was primarily driven by the increasing contribution of our higher margin U.S. and OUS direct markets, favorable product mix and the continued growth of our minimally invasive platform. Operating expenses were $52 million for the quarter, including $2.2 million of one-time charges related to restructuring and debt refinancing. Excluding these charges, underlying operating expenses remain well-controlled, increasing modestly despite revenue growth of nearly 32%, reflecting continued operating leverage across the business. adjusted EBITDA improved by $12.2 million to income of $3.7 million compared to a loss of $8.5 million in the prior year period. We ended the quarter with cash and cash equivalents of $71.2 million, a sequential increase of $3.1 million from Q1, and $16.5 million higher than the same quarter last year, and generated positive overall cash flow. This milestone reflects the strong progress we have made improving profitability, expanding margins, and driving greater operating efficiency throughout the organization. Importantly, we have sufficient liquidity to execute our strategy and continue investing in future growth opportunities without the need for future equity raises. Given our strong first half performance and continued momentum across the business, we are increasing our full year revenue guidance to between $269 and $271 million. We expect the U.S. business to be the primary driver of growth, while our OUS business remains healthy and diversified. As we look to the third quarter, I'd like to remind investors it is historically the softest quarter in the industry, reflecting the summer vacation period. We expect the U.S. business to remain strong, and our OUS business should reflect the normal seasonal pattern. As always, we expect our strongest quarter to be the fourth. We remain very encouraged by the performance of the business, the continued momentum in the United States, the growing contribution of our minimally invasive platform, and the increasing profitability profile of establishment labs. Now, I'll turn the call back over to Peter.

speaker
Peter Caldini
Chief Executive Officer

Thank you, Sandra. As you've heard today, we continue to execute well across the business. The U.S. remains a significant growth driver. Our OUS markets continue to perform well. Our minimally invasive platform is gaining momentum globally, and we have a clear path to being free cash flow positive. At the same time, we continue to advance a pipeline that should support growth for many years to come. While we are proud of what we've accomplished so far, we believe the opportunity ahead remains substantially larger than what we've achieved to date. Operator, we're now ready to take questions.

speaker
Operator
Conference Operator

Thank you. Ladies and gentlemen, we will now begin the question and answer session. If you have a question, please press star followed by the number one on your touchstone phone. You will hear a three-tone prompt acknowledging your request. Please limit yourself to one question. If you wish to do a follow-up, please hit a cue. If you would like to cancel your request, please press star 2. One moment, please, for your first question. Your first question comes from the line of Josh Jennings from TD Cowen. Please go ahead.

speaker
Josh Jennings
Analyst, TD Cowen

Hi, good morning, Peter and Sandra. Thanks for taking the questions and answering. Great to see another strong quarter, especially the U.S. momentum. I wanted to appreciate your comments on MEA during the call so far. Our checks have suggested that there's some optimism in U.S. plastic surgeons that MEA ultimately could produce an entire new category in the aesthetic space where you could transition breast augmentation from a surgery to an injectable procedure. I mean, is there any plans to kind of drive that notion and just that segmentation here in the international markets where you've launched and ultimately in the U.S., and how does that all play out?

speaker
Peter Caldini
Chief Executive Officer

Yeah, thank you, Josh. You know, listen, I think what we've always highlighted around the minimally invasive platform, and this is truly an innovation in a category that hasn't Thank you for joining us today. We've seen that through market research in the U.S. It's about 15% with Preserve outside the U.S., similar type of numbers, because it does address a number of the barriers that are preventing women from doing a breast augmentation. When you talk about minimal anesthesia, you talk about also those smaller scars and quicker recovery. So it'll continue to be a key driver for us, and we're just in really the early stages of that development, and we're seeing that impact in the U.S. and also outside the U.S.

speaker
Josh Jennings
Analyst, TD Cowen

Thanks for that. And I know I'm focused on the pipeline here with my questions, but you referenced, Jem, on the call so far. It seems like there's a potential for, I mean, maybe getting too aggressive with our assumptions, but a potential for initial U.S., kind of commercial, OUS, excuse me, commercial launch maybe next year. Any more details you can provide on where that development program stands and and any kind of regulatory or commercial milestones we should have on our catalyst calendar. Thanks for taking the questions.

speaker
Peter Caldini
Chief Executive Officer

Yeah, so Josh, so regarding GEM, you know, we see this as a tremendous opportunity, really leveraging a lot of the technology from the minimally invasive platform in really providing a safer alternative, also with more predictable results to the traditional Brazilian butt lift. So where we are in that process is we're doing a clinical study in Costa Rica. We expect next year in the back half to do an early experience in Latin America. And right now we're really working through what that regulatory pathway is going to be for the U.S. as well as OUS primarily in Europe. But we're very pleased with the progress we've made so far. I mean, it's a very differentiated technology. And we see this as very much an untapped market. But in terms of timing for, let's say, the U.S., we have so many things that we're going to be driving growth over the next couple of years. We don't see that really as a contributor in the U.S. until 2028 and beyond. But we're still working through what that regulatory pathway is going to be.

speaker
Operator
Conference Operator

Your next question comes from the line of Sam Iber from U.S. Bancorp. Please go ahead.

speaker
Sam Iber
Analyst, U.S. Bancorp

Hi, good morning. Thanks for taking the questions here and congrats on the nice quarter. I want to come back to Preserve in the U.S., 300 surgeons now certified. I'm curious what you're hearing from the field in terms of utilization and adoption, their own plans to expand Preserve within their practice. and generally thoughts around the procedure and what it can mean for the U.S. business over the back half of the year.

speaker
Peter Caldini
Chief Executive Officer

Yeah, thanks, Sam. I mean, it's pretty clear we're off to a great start with Prezavay. There's significant demand. I think our original target was around 200 surgeons. We quickly surpassed that. We're really expanding our capacity in terms of training. So there's no shortage of We fully expect that this is going to be a key driver for our growth in the back half of this year. We're targeting to train approximately 500 surgeons for the full year of 2026. and this is really driven by tremendous demand in the marketplace and it is addressing a significant barrier that patients have with doing a breast augmentation and that's really been playing out in what we're seeing in the marketplace.

speaker
Sam Iber
Analyst, U.S. Bancorp

Okay, really helpful. Maybe if I could just squeeze in a quick follow-up. The global minimally invasive revenue for the quarter, 12 million, certainly past our expectations. You know, as I think about the prior 35 million guidance, it seems like you're on pace to, you know, achieve well beyond that. I guess any updated thoughts on how we should be thinking about that number?

speaker
Sandra Harris
Chief Financial Officer

Yeah, Sam, I think we said over 35 million. And, you know, what we've said recently is that we're going to be approaching for the full year about 15% of our revenue. So, you know, I think that Depending on how you look at our guidance, that gives you the guide for minimum and basic going forward.

speaker
Sam Iber
Analyst, U.S. Bancorp

Okay, great. Thanks for taking the questions.

speaker
Operator
Conference Operator

Your next question comes from the line of Mason Carrico from Stephens. Your line is now open.

speaker
Mason Carrico
Analyst, Stephens

Hey, guys. Thanks for taking the questions here. Could you give a sense of Motiva Mix? among Preserve trained surgeons compared to that of an untrained one. Have you seen Preserve certification lift overall Motiva Mix or share it at that account? And I guess, you know, longer term, what percentage of your U.S. volumes do you think could ultimately be Preserve?

speaker
Peter Caldini
Chief Executive Officer

Yeah, so thanks. We are seeing in the accounts, I mean, there's such strong interest in Preserve. It's truly a A unique innovation in the marketplace that's really been starving for innovation. So, you know, there's really, we're seeing strong interest and a number of surgeons are really, once they get trained and accustomed to using Preserve, you know, a lot of them see this as really the future of the industry and it will continue to be a bigger part of the practice. It certainly generates a significant revenue opportunity for them. So we see that over time that will continue to be a bigger part of that market. In terms of the split, I don't know, Sandra.

speaker
Sandra Harris
Chief Financial Officer

Yeah, I mean, in terms of the split, I don't know that we've really talked about the split between the U.S. and the O.U.S., but it's going to be a very important part of our ability to expand the market and to continue to take market share in the U.S.

speaker
Operator
Conference Operator

Your next question comes from the line of Caitlin Roberts from Canaccord Genuity. Please go ahead.

speaker
Caitlin Roberts
Analyst, Canaccord Genuity

Great. Thanks so much for taking the question and congrats on a great quarter. Would love to touch on recon. Have you had any convos with the FDA on the recon indication and updated expectations for this approval timeline? And how many hospitals are you now in this flora? Thank you.

speaker
Peter Caldini
Chief Executive Officer

Thanks, Caitlin. Obviously, recon is a tremendous opportunity for us. It doubles the TAM for us in the U.S., and we fully expect to have the same level of success in recon in the U.S. that we've experienced in augmentation. In terms of the feedback, we have heard back from the FDA. We're in the process of responding to what we consider some routine questions. What I think is very positive, they now started the BMO audits of our clinical study sites, which I think is a normal part of the process. And I think it's a good indication that things are progressing well. In terms of the actual approval timing, I mean, it's really up to the FDA. But what we're seeing, everything is positive, moving in the right direction. And just to remind everybody, we don't really expect from a planning standpoint to achieve material revenue and recon until 2027.

speaker
Operator
Conference Operator

Your next question comes from the line of Joanne Wunsch from City. Your line is now open.

speaker
Jane Marie Lai
Analyst, Citi (on behalf of Joanne Wunsch)

Hello, this is Jane Marie Lai. I'm for Joanne from City. Thanks for the question. At this half-year mark, What are, could you provide more color on your expectations for the second half of the year? And I know it's a bit early, but for 2027, how should we think about that? And do you have any kind of color on that as well?

speaker
Peter Caldini
Chief Executive Officer

Yeah, so I'm not sure I fully heard the question. My understanding is what's our expectation in terms of the back half of the year? You know, listen, I think we're going to continue to see the strong momentum That we've experienced in the first half, especially with the US, but also in terms of how we're driving growth in our direct markets. We expect that momentum to continue in the back half of the year. I think there's significant continued growth opportunities with our platforms and the different initiatives that we're driving. We haven't really set any guidance as it relates to 2027, but I'll pass that over to Sandra.

speaker
Sandra Harris
Chief Financial Officer

Yeah, just as it relates to this year, I'll just remind you of our seasonality, and we do anticipate that our fourth quarter is always the strongest quarter of the year, with the third quarter being impacted by some seasonal impact around the summer and vacation periods in both our OUS business and our U.S. business. What we did is we have raised our guidance to 269 to 271. And then in regard to 2027, the only information we've provided to date is that we do expect that revenue next year would be around the 25% mark.

speaker
Operator
Conference Operator

Your next question comes from the line of Anthony Petrone from Mizuho Financial Group. Please go ahead.

speaker
Anthony Petrone
Analyst, Mizuho Financial Group

Thanks, and congrats on the strong print here. Maybe one on Preservate Competitive Dynamics and then pricing. Just on Preservey, when you think about site adoption in the U.S. specifically, one of the medtech phenomenons, for instance, with DaVinci Surgical, you sort of have DaVinci in your practice in the early days, and it represents a competitive advantage for that site. That site then gains share from its competitors. So to what extent do you think Preservey is going to allow surgeon sites to have competitive advantages versus its competitors. When do you think that tipping point actually happens? And then just on unit economics, can you remind us where Preserve sits per case versus Motiva? And when you think about reconstruction, how pricing will settle out there? Thanks.

speaker
Peter Caldini
Chief Executive Officer

All right. So thanks, Anthony. In terms of Preserve, as we highlighted, we're really in the early innings in the Thank you for joining us today. For us, I think that's going to be the surgeons that are using Preserve. It provides them a significant competitive advantage in the market, and I think that's where such a strong interest is. I mean, we've seen from market research that 15% of women who have done Preserve were not initially considering doing a breast augmentation until they heard about Preserve itself. It really has the potential to be a category driver and bring additional patients to the surgeon. So we see that as a competitive advantage and that's probably why we have such significant demand from different surgeons. In terms of the recon, we highlighted we're making good progress from a regulatory standpoint. This clearly is a significant increase in terms of the ASP and the recon. Your next question comes from the line of Mike Mattson from Needham and Company. Please go ahead.

speaker
Mike Mattson
Analyst, Needham & Company

Yeah, thanks. So, you know, I heard that the growth is kind of 4% outside the U.S., but I'm just curious if you're seeing or saw any sort of impact from the Iran war in either the Middle East or the broader international business in the quarter.

speaker
Peter Caldini
Chief Executive Officer

Yeah, so thanks, Mike. I mean, we've had I think very solid growth outside the U.S., and a lot of that's been driven by our direct markets, in particular in Europe. We've achieved 16% growth this quarter versus the same year, the same quarter last year, so very pleased with that. And that's very important for us because we prioritize those markets. These are our markets. We have better economics. We've made a number of leadership changes. We're also increasing the resources, and it's really reflected In terms of our performance, you know, what we're trying to do is de-emphasize our dependency on the distributors. And I think that's really been, we're really establishing that. And I think we've been very effective in doing it. Specifically, I would say across most of our distributor markets, I think demand has been steady. But the one outlier is what you highlighted is the Middle East, you know, obviously with the conflict there. We have had orders, but it's at a much lower level than what we've experienced in the past. And we don't expect that to change for the remainder of the year. But this is, in terms of the spillover in other markets, we haven't really seen that, but we're going to continue to monitor that very closely and course correct where necessary.

speaker
Sandra Harris
Chief Financial Officer

And Mike, this is a reminder, Middle East is less than 5% of our revenues.

speaker
Operator
Conference Operator

Your next question comes from the line of Alan Gong from JP Morgan. Please go ahead.

speaker
Alan Gong
Analyst, J.P. Morgan

Thanks for the question. I guess just on the cost front, you know, when we look at your operating spend for the quarter, you know, excluding the refinancing costs came in better than expected. But when we look forward, there's clearly a lot to invest into between continued launch of the minimally invasive platform and upcoming reconstruction, not to mention GEMM. So how should we think about the trajectory of, you know, SG&A and R&D spend in the balance of the year?

speaker
Sandra Harris
Chief Financial Officer

Yeah, thanks, Alan, for the question. And as you noted, we are making progress leveraging our operating expenses. As you noted, we had some one-time costs in the quarter that made our overall operating expenses around $52 million, but when you adjust for that, we're seeing that, you have leveraged our operating expense in relation to our sales growth. So single-digit growth in operating expenses with strong double-digit growth in revenue. As we look out, we have had a very healthy investment in our R&D efforts around our innovation pipeline. And I think we've been investing at the right rate to bring that innovation. So to date, we're not anticipating any major increases to what we've previously seen. We think we're pacing our innovation pipeline appropriately. and we continue to look for areas of opportunity to leverage our expenses as we grow the business across the organization.

speaker
Operator
Conference Operator

Your next question comes from the line of Matthew Taylor from Jefferies. Please go ahead.

speaker
Matthew Taylor
Analyst, Jefferies

Good morning. Thanks for taking the question. I wanted to ask a follow-up on recon, and maybe I'll weave that into a 27 question. So I guess my question is, hypothetically, if you got recon approval on January 1st, I'm just interested in how quickly that would start to contribute and how quickly you can launch it. And when you talked about 25% growth-ish next year, does that include a lot of recon contribution, or would you grow 25% without it? Thanks.

speaker
Sandra Harris
Chief Financial Officer

Yeah, in regard to recon, I think what we've said in the past is that we don't anticipate we would grow as rapidly as we have with our launch of our minimally invasive platform. It does take a longer period of time as we work with the hospitals. And as far as what's in our guidance for this year, I think we've said that we don't have any anticipation for recon this year. And as we work toward 2027, we'll provide more color on that based upon what we know from the FDA timing.

speaker
Operator
Conference Operator

There are no further questions at this time. I will now turn the call over to Mr. Peter Maldini for closing comments.

speaker
Peter Caldini
Chief Executive Officer

Thank you, operator, and thank you, everybody, for joining the call today. Really appreciate the time. As you see, we're making a great progress in terms of the growth with Establishment Labs, really applying a lot of financial discipline, but at the same time, making sure we deliver in terms of the revenue expectations. We have a tremendous Portfolio, tremendous opportunity of innovation and we continue to capitalize on that in terms of great execution. So once again, thanks everybody for joining the call today. Look forward to catching up in the follow-up calls as well as upcoming conferences. Thank you.

speaker
Operator
Conference Operator

Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.

Disclaimer

This conference call transcript was computer generated and almost certianly contains errors. This transcript is provided for information purposes only.EarningsCall, LLC makes no representation about the accuracy of the aforementioned transcript, and you are cautioned not to place undue reliance on the information provided by the transcript.

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