natural breast augmentation Archives

August 17, 2026

Ballerina Breasts: Why Half My Patients Now Ask for Smaller Implants

Greyscale editorial photograph for a smaller breast implants essay by Frank Agullo, MD, FACS.

Trends hit my field like 12 months after they came to the runway. This one came early.

Patients started picking up a description I had never put into their mouths, the phrase “ballerina breasts.” They were “working breasts,” they had a nice shape to them. Smaller. Lighter. The size the breast would be on its own. Not flat. Not androgynous. Just quiet.

Let me be precise about the numbers, because the internet is not. In my practice, approximately half of my patients still desire the largest sizes and they are getting amazing outcomes. The other half has moved, and moved decisively.

The Cup Size Secret

The single math lesson that informs how every size conversation I have ever been in ever unfolds is that 150-200cc implants equate to one full cup size.

The patient arrives saying some version of “a small implant will not change my appearance much.” Then, on the 3D simulation of their own body, I show what 150 cc of change does and ask for comments. You can hear crickets. Even that little volume dramatically impacts projection and cleavage. 150 cc is not a minor change.

I often turn to Motiva Ergonomix when addressing these situations. It mimics the movement and contour of breast tissue: It is rounder while flat and takes a teardrop shape when standing, which appears more natural in motion for its size.

Getting More From Less

Placement of the implant is key: Traditionally placed, it leads to a standard augmentation with a size difference that makes sense relative to the individual’s natural breast size. Under ligaments using the Motiva Preserve approach, it causes the ligaments to support the implant and not cause a “hang” or “unnatural feeling” because nerves, vessels and breast tissue are all left alone; a size is chosen that yields a breast size higher than what might be expected just from the cc count itself.

When I place implants the traditional way, I often add a DuraSorb or GalaFLEX mesh that essentially acts like an internal push-up bra. That placement is secure and lowers the risk of capsular contracture and migration. With Preserve, the breast’s own ligaments achieve this same purpose, for free.

I cover the full surgical walkthrough, along with the downsizing pathways, in the complete smaller implants guide on the practice side.

The Downsizing Wave

These ladies are more interesting because they are not fresh to cosmetic surgery. They are 50- and 60-something women who chose large implants decades ago and now feel they are simply too big to wear.

It is serious surgery with real planning involved. If you plan on dropping only one cup size, you might be fine just taking out the old implant and inserting the new, smaller one. If you are dropping larger sizes, the skin will likely be too saggy and would have to be worked with. This usually takes a shape similar to a “donut lift” or an “anchor lift.” Finally, the now empty space/pocket from the old larger implant needs to be pulled tighter, closed up with some mesh to keep the new, smaller implant from moving out of place or shifting. Skipping it is what turns a downsize into a future revision.

What It Costs to Go Small

That smaller size does not result in a smaller bill, and I would prefer to say so plainly rather than mislead anybody. It is still the same surgery and the same amount of carefulness in that surgery. I went over all the details and costs in my breast augmentation cost read.

Going small might buy some time, as there is much less weight pulling your breasts down as you age and maybe a result that never needs a lift at all. It will also, as many patients say, be much more comfortable to get around.

My Honest Take

Two major waves of breast augmentation fashion have rolled through my professional life. The choice of size should be the patient’s, not the surgeon’s dictation. The physician’s role is to inform the patient of realistic tissue constraints, outline available alternatives via a 3D visual model and then allow them to hold implant samples in their own bra to estimate weight before they go under the knife.

Ballerinas are not even close to a downgrade. If done right with the right type of implant and support, they are honestly some of the most detailed cases that I can do. One recent example is in the 315 cc Motiva Preserve case study.

Ready to Talk?

Bring your version of “natural” and we will find out together what it looks like on you.

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

Full surgical guide on agulloplasticsurgery.com: “Smaller Breast Implants in El Paso: The Ballerina Breast Trend, Downsizing, and the Preservation Approach” (canonical)
Consultation-experience version on swplasticsurgery.com: “Trying On Your New Size: How Southwest Plastic Surgery Plans a Smaller Breast Augmentation” (link once live)

August 9, 2026

One Cup Size, Honestly: Fat Transfer to the Breast and Where Its Ceiling Sits

Black and white editorial still life for fat transfer to the breast commentary by Dr. Frank Agullo, MD, FACS.

A lot of women who come to see me about their breasts open with the same disclaimer: no implants.

They do not want the look. They are worried about sensation because a friend told them a story. And so they ask the obvious question, the one the internet has primed them to ask: can we just use my own fat?

Yes. We can. It works, it looks natural, and you get a little liposuction out of the deal. But it has a ceiling, and I would rather tell you exactly where that ceiling sits now than have you discover it at six months.

The Honest Number Is One Cup Size

With fat, we usually cannot get more than a cup size. Anybody promising you two is either overfilling dangerously or overselling.

What you get along with that cup is shape. Most women asking about fat are empty in the upper pole, and filling that hollow changes the breast in a way an implant finds hard to fake: a taper instead of a dip, natural fullness with a little more projection. It is a natural look, not an implant look. For the right woman, that is precisely the point.

You Will Lose Some Fat, by Design

Not all transferred fat survives, and that is not a complication. That is the procedure. Most of my patients keep at least fifty percent, with retention running fifty to seventy.

I plan for it two ways. I overfill, placing roughly two cup sizes knowing about one will stay. And I process and wash the fat before injecting it, so I am not putting in fluid and debris that were never going to survive. That processing step measurably improves retention.

The Two-for-One

The fat comes from wherever you have extra, most commonly the abdomen and lower back together, sometimes the sides, upper back, or inner thighs. On the abdomen I use Renuvion J-Plasma during the liposuction to tighten the skin so it does not sag after the volume leaves.

That is the trade patients love about this operation: volume taken from where you do not want it, placed where you do, and a slimmer, tighter torso as the receipt.

The Mammogram Question, Answered Straight

No. Mammograms and screening stay the same after fat transfer. This is the question I am asked most, and it deserves a flat answer.

The nuance: some absorbed fat can form a small nodule or an oil cyst. Both are very easy for a radiologist to identify, neither mimics anything worrisome, and the chance of forming them at all is under five percent.

On sensation, the fear that drives many women toward fat in the first place: loss is possible but not what I see. Most patients are actually hypersensitive for a while from the inflammation, and that fades.

Small Incisions, Strict Rules

The liposuction enters through small stab incisions at the waistline and along the same line on the back. The breast gets two incisions in the fold underneath, small enough that you should not feel them at all. No long scar anywhere.

The operation runs about two and a half hours under general anesthesia, outpatient. The soreness is gym-after-a-layoff, not real pain, and most people are back to light activity and driving in five to seven days.

Then the rules that protect your result. No exercise for four weeks, because transferred fat needs stress-free time to re-establish blood supply. A special bra for four weeks, no underwire, no push-up. The principle underneath: squeeze the fat and you lose the fat.

And because it is live fat, it behaves like fat forever. Gain weight and the breast grows. Lose weight and it shrinks. Maintain, and you keep your result.

Where I Get Less Romantic About Fat

Asymmetry is where fat stops being my first recommendation. Fat is wonderful, but it is a little unpredictable: I never know precisely how much will stay, which is why I overfill, and a touch-up is sometimes needed.

Implants are predictable. They do not change size, and for a true asymmetry I can measure the difference in cc’s on 3D imaging and place a different size on each side, correcting it exactly.

	Fat Transfer	Implant (Preserve technique)
Size gain	About one cup	Chosen precisely
Predictability	Fifty to seventy percent retention	Exact
Asymmetry correction	Approximate	Measured in cc’s per side
Bonus	Liposuction of the torso	Thirty-minute operation, next-day return to work
Feel and look	Completely natural	Natural with the nano-surface Ergonomix

For the woman who wants small and natural but rules out implants on instinct, the Preserve technique deserves a hearing before the decision. Nothing is cut: a balloon creates the pocket above the muscle and behind the gland, your own ligaments hold the implant, and a smaller implant reads larger with a little lift. Three-centimeter incision, thirty minutes, IV sedation, back at work the next day. And screening survives implants too: when a mammogram cannot see an area, ultrasound answers, and MRI sees everything. The implants I use have a rupture rate under half a percent, and we replace them only if imaging shows a reason.

Why I Offer Both and Push Neither

I am double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, a Fellow of the American College of Surgeons, and a Mayo Clinic plastic surgery fellowship alum. My whole approach is preservation-based: add what is missing and damage as little as possible getting there.

Fat transfer and Preserve are two routes to that same destination. Fat is your own tissue and slims your torso. An implant is predictable and corrects asymmetry exactly. Which trade-off you can live with is a conversation, not a sales pitch, and I will not have it any other way.

For the patient-facing version, see the companion post on agulloplasticsurgery.com. The practice team covers it at swplasticsurgery.com.

Ready to Talk?

If you want more fullness but the word implant makes you flinch, fat transfer may be exactly right for you, and it may not be. Come in, let me examine you, and I will tell you what your own fat can realistically deliver. Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. #StayBeautiful

@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.

May 13, 2026May 31, 2026

Back to the Gym in Two Weeks: Motiva Preservé and What Preservation Surgery Actually Means

Editorial frontal before and after view of a Motiva Preserve breast augmentation with 315cc Motiva Ergonomix Full implants on a slim athletic young woman patient wearing a Dr. Worldwide bikini, breast augmentation by Dr. Frank Agullo, MD, FACS, double board-certified plastic surgeon at Southwest Plastic Surgery in El Paso, Texas.

The patient in the photos on this page walked back into her office the day after surgery. Two weeks later she was lifting weights again. Four weeks later she was running. The compression bra came off at three. None of those numbers used to be possible.

For most of my career, the honest answer to “when can I lift my kids” after a breast augmentation was four to six weeks. The honest answer to “when can I lift heavy at the gym” was six to eight. I gave those answers a thousand times. They reflected the real recovery from a traditional submuscular augmentation, where the pectoralis muscle is partially released to make room for the implant. The muscle heals. It just takes the time it takes.

I stopped giving those answers about a year ago. The reason is a technique called Motiva Preservé, and it has changed enough about how I plan a breast augmentation that I owe my patients a longer explanation.

What Preservation Actually Means in the OR

The word “preservation” in Preservé is a commitment. Smaller incision (2.5 to 3 centimeters, inside the natural shadow below the breast). The implant sits in front of the muscle and behind the breast tissue, held by the breast’s own ligaments, so there is no muscle release at all. A no-touch funnel so the implant never contacts skin on its way into the pocket. Less tissue dissection overall. The breast and chest wall handed back to the patient as close to their pre-operative state as the operation allows.

What patients feel is less swelling, less tightness, less of the bruised-rib soreness that traditionally defines the first week. The recovery curve compresses. The day-one experience now looks like the week-three experience used to look.

The case in the photos on this page was completed in under an hour in the operating room, under light sedation rather than general anesthesia. She walked out of the surgical suite the same morning and drove home (with someone else at the wheel) before lunch. That is not a marketing claim either. It is the operative report.

That is not a manufacturer claim. That is what every Preservé patient in my practice has told me, with a logbook that backs them up.

The Implant: Motiva Ergonomix Full

The implant in this case is a 315cc Motiva Ergonomix Full. Sixth-generation silicone gel, ProgressiveGel Ultima inside, SmoothSilk surface outside. The shape is what makes the Ergonomix line different from anything else in my OR.

Upright, the implant drapes into a teardrop that looks like real anatomy. Supine, on the back, it flattens and rounds the way breast tissue does. Nothing about its shape is fixed. The implant moves with the body the way tissue would. Patients describe the result as natural in a way I do not hear with older implant designs. That has shown up in my consult conversations and in the reaction shots my own patients send me a year later.

The Full profile is one of three Ergonomix projection options Motiva offers in the United States (Mini, Demi, and Full). For a slim athletic patient who wants visible projection but a natural silhouette, Full is the right end of the range. The 315cc volume was the result of careful sizing in the office. She did not want a striking change. She wanted proportion. For the full breakdown of the technique itself, the Motiva Preservé breast augmentation page on agulloplasticsurgery.com walks through every step.

Why I Stopped Promising Six-Week Recoveries

The single hardest number to defend in breast augmentation is recovery time, because the standard answer has been wrong for a long time. We told patients six weeks because that was the honest answer for the surgery we were doing. We are not doing that surgery anymore.

The Preservé recovery ladder, for a patient with this body type and this implant choice, looks like this. Day one: back to desk work, off the heaviest pain medication, sleeping upright. Day seven: showering, light walking, sleeping however she wants. Week two: back to lower-body gym work and short runs, with a sports bra. Week three: compression bra off. Week four: full upper-body programming, with the surgeon’s clearance.

None of those numbers come from a brochure. They come from the patients themselves, who tell me what they actually did, day by day, in the months after. I keep notes. I update the table I show in consults. The numbers have not slipped.

A Short Comparison

A simple way to see the difference:

Question	Traditional Submuscular	Motiva Preservé
Incision length	4 to 5 cm	2.5 to 3 cm
Muscle release	Significant	None (implant in front of the muscle)
Implant insertion	Hand placement	No-touch funnel
Back to desk work	5 to 7 days	1 to 2 days
Back to upper-body lifting	6 to 8 weeks	2 to 3 weeks
Compression bra	4 to 6 weeks	2 to 3 weeks
Shape behavior	Round or shaped, fixed	Ergonomic, position-responsive

The table flattens some real surgical detail. The full nuance lives in the clinical version of this post on agulloplasticsurgery.com (linked at the bottom of this post), where I walk through the operating room in more depth.

Who Is the Wrong Candidate

I will tell you who Preservé is not for. A patient with significant ptosis (drooping) needs a breast lift in addition to an augmentation, and the lift drives a different recovery curve. A patient with very thin tissue or a history of capsular contracture needs a more nuanced breast augmentation revision conversation. A patient who wants a dramatic enlargement well beyond what her frame supports is going to be unhappy with any technique, and I will tell her so before we book a date.

The right candidate is a patient with a reasonable skin envelope, a defined inframammary fold, and goals that lean toward proportion. The patient in the photos on this page is one of the easier candidates to plan for. Not every patient is.

Why I Trained on This System

I have placed thousands of breast implants going back to my plastic surgery fellowship at Mayo Clinic. Castle Connolly Top Doctor thirteen consecutive years. Clinical Associate Professor at Texas Tech University Health Sciences Center, where I teach breast augmentation to the residents I am responsible for. I do not adopt new techniques because a rep walks them in. I adopt them when the data and my own results justify the change.

Motiva earned FDA approval for its silicone gel implants in 2024 after years of leading the implant market in Latin America and Europe. I trained on the system directly before I placed an implant in a patient. I do not place a Motiva implant the way I place every other implant in my OR, because the technique is different and the implant rewards the difference.

One More Thing About Volume

Patients always ask about size in cubic centimeters first. The number matters less than the planning around it. A 315cc implant on the patient in these photos reads as proportional. The same 315cc on a different frame might read as dramatic. The same 315cc on a third frame might read as not enough. Size, projection, profile, the elasticity of the skin envelope, the position of the inframammary fold. All of those drive the answer to “what should the number be.”

The right surgeon will spend the consult walking you through that math. If the conversation starts and ends with a single number, you are in the wrong consult.

See the case on social: originally posted to Instagram and TikTok.

Ready to Talk?

If you are reading this on your phone and thinking “two weeks back to the gym sounds too good to be true,” the right next move is a consultation. I will tell you whether Motiva Preservé fits your anatomy and goals, whether 315cc is the right number for your frame, and whether augmentation alone is the right operation or whether you also need a lift. If the answer is “not the right time,” I will tell you that too. The goal is the face and body you recognize in the mirror. #StayBeautiful.

Call (915) 590-7900, text 1-866-814-0038, or book online at agulloplasticsurgery.com. For the longer clinical breakdown, see the agulloplasticsurgery.com post on this same case or the swplasticsurgery.com practice version. Follow along on social at @RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.