Podcaster Bobbi Althoff, 29, says she is getting implants in January after breastfeeding her two daughters for six years straight. She considered a lift and decided to wait, because she plans to have more children, and she told her followers she likes “a little bit of a sag.” People reported it on October 29 via Yahoo, and The Blast added a hair transplant to her list. She did not name a surgeon.
Dr. Frank Agullo has not examined her and does not diagnose anyone from a video. But the request she described, fuller again after nursing, natural, not too high, is one of the most common consults at Southwest Plastic Surgery. Here is how that hour actually goes in our El Paso office.
Step One: The Tape Measure
The first thing Dr. Agullo does is measure, because the measurement decides whether a lift is optional.
“The ideal sternal notch to nipple areola distance is anywhere from 19 to 22 centimeters. Any number greater than that should consider some type of lift.”
He also checks where the nipple sits against the fold under the breast. Above it, an implant alone is usually enough. At it, a small donut lift may help. Below it, skipping the lift shows.
Step Two: What Do You Actually Want?
For moms after nursing, the answer is almost never “bigger.” It is “back.” One patient, a mother of three who had breastfed for years, told him:
“I want it to be almost not noticeable. Not noticeable to anyone I know.”
That goal changes the plan. If the shape is still good, Dr. Agullo sometimes skips the implant entirely:
“If the patient is already happy with their breast shape and they just want a little bit more fullness, then this can be achieved with fat transfer alone. It usually gives you at least a cup size, preserves the current breast shape, and just augments the volume by 100 to 200 cc, which is a cup size.”
Step Three: See It Before Surgery
Nobody has to imagine “a little sag.” The team builds it on a screen.
“One of the advantages in my practice is that we can simulate the results using the Vectra 3D system and the Crisalix system to visualize the results even before the surgery.”
On that same mom’s simulation, the implant did some lifting by itself:
“The nipples are a little bit low. With the implant, it does lift up a little bit, without having to do any lift per se.”
“From the top, you get a nice cleavage, but it’s still, we call it ballerina breast, because it’s not obvious that there’s an implant there. It definitely makes everything look younger.”
Then she tries sizers under a shirt. Size is her call.
Step Four: The Technique That Keeps It Soft
For a natural slope, Dr. Agullo often uses Motiva Preserve, where the implant sits above the muscle and behind the breast gland with no muscle release:
“To achieve the ballerina look, we often use the Motiva Preserve technique, which preserves the arteries, the nerves, and the ligaments of the breast without performing any cutting, and the implant is placed just under the gland, above the muscle.”
Patients who plan more babies ask about nursing, and he answers carefully:
“Well, because we’re not cutting anything, everything you were born with will be the same. There’s a higher likelihood that you’ll be able to breastfeed and not have any issues with it. And sensation as well.”
For larger implants, or tissue that has been stretched hard by pregnancy, a traditional pocket with an internal mesh bra is the better tool:
“Because your tissues have been stretched out before, I always recommend using a special reinforcement. It is like an internal bra, which is a mesh. And it kind of is gonna hold everything up and in, so we’re not relying on your skin.”
Step Five: The Day Of and the Day After
Preserve is done under sedation, without a breathing tube.
“It’s a conscious sedation. So you’re breathing by yourself. You will be talking at some points. You probably won’t remember anything.”
“So it’s one day versus one week. Right after surgery, you can raise your arms. Most patients can.”
“I think the sweet spot is six months. But this does tend to get there a lot faster. They’re not gonna drop as much as with the regular breast augs, and they’re not gonna be as high up as with the regular breast aug.”
Who the Natural Slope Suits
Dr. Agullo is direct about body type, because the same implant reads differently on different frames:
“The ballerina look is very appropriate for patients that already have a ballerina type structure. These are patients that are usually thin and athletic, so a ballerina breast is very proportionate in these cases. The ballerina breast can look disproportionate in heavier set patients, or those with wider bony structures. But in all reality, it really just depends on what the patient wants and what they will be happy with.”
If a Lift Comes Later
When the family is complete, a lift may make sense, and Dr. Agullo is clear about what that trades:
“If a patient just wants to have a breast lift, then they have to understand that they may be the same size or slightly smaller, maybe half a cup size to a cup size, because we are removing that excess skin. The breast will be perkier, but it’ll also be tighter, and it may appear smaller.”
The full lift-versus-implant decision after nursing is on Agullo Plastic Surgery, along with the Motiva Preserve technique. His read on the celebrity plan itself is on drworldwide.com.
Why Southwest Plastic Surgery
Dr. Agullo is double board-certified by the American Board of Plastic Surgery and the American Board of Surgery, completed his plastic surgery fellowship at Mayo Clinic, and is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center. He trained in Motiva Preserve with Motiva in Costa Rica as one of about 30 selected US surgeons, and he has been a Castle Connolly Top Doctor for 13 consecutive years.
Book Your Consultation
Come in with your wish photos and leave with a 3D preview. (915) 590-7900, text 1-866-814-0038, or book at agulloplasticsurgery.com/appointments. #StayBeautiful
@RealDrWorldWide on Instagram, TikTok, and Snapchat, @Agullo on X, or @AgulloPlasticSurgery on Facebook.
