August 17, 2026 | Breast Augmentation
She sat in my consultation room last week and one of the first things she tells me: “Get them done, but nobody has to know.”
Ten years ago it was unusual for patients to ask this. Today, I would say it accounts for about half of my patients. “Ballerina breasts” is a phrase some use to describe this look: still functioning breasts that retain a nice shape but are overall smaller and more similar to what they looked like prior to implants. The remaining 50 percent of my patients still desire large breast implants and I am able to achieve that for them, too. The smaller half warrants its own section, because achieving a natural-looking result does not entail simply a miniaturized version of the operation I described earlier.
What “Smaller” Actually Means
Here is the surprising number: 150-200ccs added to your implants can move you up an entire cup size. Small volume can lead to huge changes in projection, fullness, and cleavage.
Small does not mean subtle. It means more particular. The implant still needs to cover the width of the breast; what changes is the amount of volume behind it.
When selecting an implant for these patients, I turn to the Motiva Ergonomix. It is shaped to adapt with your movement and has a teardrop shape when you stand, similar to a natural breast. While round when lying on your back, it appears in a teardrop shape when upright.
Fuller Results From Smaller Implants
There are two ways I place these implants.
The first is a traditional breast augmentation, simply sized down.
Second is the Motiva Preserve technique, which involves putting the implant inside the breast ligaments. Ligaments work the way they are intended, holding everything in place. It works to protect the nerves, arteries, and breast tissue. Because the breast itself takes on much of the work of fullness the implant would normally have to achieve with volume, a patient looks fuller with the implant in the ligaments than with the same implant placed the standard way.
The Internal Bra
In fact, once your goal is a size that will sit and keep its shape year after year, support matters even more.
In a standard location, I love to put in something I call the internal pushup bra. It is a supportive internal mesh, often DuraSorb or GalaFLEX, that holds the implant up and in the space in which it was put. That sort of support lowers the chance that the implant will shift out laterally or inferiorly over time and it also lowers the risk of capsular contracture.
Motiva Preserve relies on your own ligaments for support, so mesh is not required. But no matter the road chosen, you end up in the same location, with extra support, gained by a different approach.
Downsizing: The Fastest-Growing Request
Yes. A great number of women are finding their large implants just too big as time goes by. Women in their fifties and sixties are sometimes ready to trade out their overblown look for a more understated style. Other factors are women wanting smaller, more natural breasts, following fashion trends, and even self-drive to make this change.
How we downsize depends on how far we are going.
Removing about 100 cc to 200 cc, which is about a cup size, may take only an implant exchange. With more, you may need an implant exchange with a donut lift around the areola to remove excess skin. If there is a lot of loose skin or if the breasts have dropped a lot, then you want an implant exchange with a full breast lift, which would be an anchor pattern breast lift with a circumareolar incision, vertical incision and a horizontal incision.
When you shrink an implant, you shrink its pocket too. Then I stitch the pocket down with GalaFLEX or DuraSorb mesh so the new, smaller implant cannot drift away. People end up with revisions when this step gets skipped.
The Long Game
When implants fit accurately to one’s body, breast enhancement will hold results better in the long term. A smaller implant adds less weight, which will help to maintain the form. This is contingent on not experiencing future pregnancies and maintaining a steady weight.
There will be no need for lift in the foreseeable future. This method has many potential benefits, including a much lighter breast for women of all sizes, an aspect of which many have found comforting. But, in the end, every patient is a suitable candidate as long as the results produce satisfaction and confidence. There is no ideal candidate. Anyone whose goal is a change within about a cup size qualifies.
Seeing It Before Choosing It
“Natural” means something different to every patient. “Small” does too. I have had patients whose mental picture of natural was not natural at all, and patients whose small was anything but.
This is what the consult appointment is for: closing the gap. Photos have value. More valuable is 3D breast implant visualization software like Crisalix or VECTRA 3D, which allows me to overlay various implant sizes and types onto your body, also showing what a lift may look like, whether a donut or full mastopexy.
In the middle phase of the consultation, the patient wears breast implant sizers fitted with their own bra while dressed in regular clothing to allow them to get the look of augmentation and feel how it weighs before making any commitment. Our transparent fees are laid out on our fees page, so the figure is not disguised in any form.
Why Choose Dr. Agullo
I have double board certification, fellowship-trained at Mayo Clinic, and a 13-year run of Castle Connolly Top Doctor selection. I offer both traditional and Motiva Preserve breast augmentation options and have zero issue giving you frank feedback about which direction and size are best for your unique body structure and expectations.
Ready to Talk?
Come see what 150 cc looks like on you, not on a screen model. Simulation, sizers, and straight answers.
Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com/appointments. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
Cross-links
- Editorial version on drworldwide.com: “Ballerina Breasts: Why Half My Patients Now Ask for Smaller Implants” (link once live)
- Med spa side on swplasticsurgery.com: “Trying On Your New Size: How Southwest Plastic Surgery Plans a Smaller Breast Augmentation” (link once live)
