Southwest Plastic Surgery

A decade ago, most patients who came to Southwest Plastic Surgery about their breasts wanted to go bigger. Today, a striking number want the reverse. They have carried their implants ten or twelve years, they have read something online, and they want a clear answer about whether to remove, exchange, or simply go smaller.

Dr. Frank Agullo walks each of them through the same honest framework. What follows is that conversation, offered as education rather than a verdict on any one case.

What Dr. Agullo Tells Patients About Breast Implant Illness

If you have lived with your implants for years and felt fine, Dr. Agullo says, you are most likely never going to develop a problem. It is uncommon. Across the thousands of augmentations he has performed, only ten or twelve women have asked to have them removed because they felt the implants were affecting them, and most of those women did feel better afterward.

He is candid about the uncertainty. A lot of the time, he explains, it is hard to know whether the implants caused it or whether ordinary aging did, since aches and fatigue arrive on their own as the years pass. The science is still developing, so he will not hand a patient a certainty the evidence does not support, and he will not talk anyone out of removal who genuinely wants it.

Why Textured Implants Get a Closer Look

Textured implants have been linked in a small number of patients to a specific type of lymphoma. The risk is low, on the order of one in a few thousand, and it is tied to the textured surface rather than to smooth implants.

For that reason, Dr. Agullo tells patients with textured implants that exchanging them for smooth ones is reasonable even when everything feels fine. If a risk can be sidestepped, he would rather sidestep it.

What Removal Does to the Shape

This is the part that surprises patients most. Remove an implant of any real size, Dr. Agullo explains, and the breast drops a cup size or more and tends to sag, because the implant was holding up volume the skin had stretched to accommodate.

That is why removal alone is rarely the full plan. Most patients get a better result with a breast lift at the same time, which raises and tightens everything. If a patient still wants a little fullness on top, fat grafting can be added a few months later, once the pocket has closed off.

The Options at Southwest Plastic Surgery

What the Patient Wants	The Path at the Practice
Implants out, simplest plan	Removal, often paired with a lift
Smaller but still shaped	Remove, lift, small implant
Soft, natural fullness	Lift now, fat grafting later
Textured shell, no symptoms	Exchange to a newer implant
Touch-ups over time	Injectables and follow-up at the Med Spa

Going Smaller, on Purpose

Many patients choose the middle path. Dr. Agullo removes the large old implant, performs the lift, and places a small one, sometimes only 150 or 200 cc, mostly to hold a little cleavage and shape. A small implant is more predictable than fat, gives a reliable size, and does not change when a patient’s weight goes up and down.

The Motiva implants Dr. Agullo places now carry a very low rupture rate, under half a percent, and a very low rate of capsular contracture, also around half a percent, compared with ten to fifteen percent for some older implants. Because of that, he no longer tells patients they must swap every ten years, and he often adds an internal mesh to hold the result in place.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is 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. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years. Removal and exchange is more involved than a first-time augmentation, which is why he examines each patient, reviews imaging, and is honest about how the shape will change before making a plan.

Ready to Talk?

If you are weighing whether to remove, exchange, or downsize your implants, the team at Southwest Plastic Surgery will help you build a plan around what you actually want.

For the surgeon’s editorial take on this topic, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing version, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

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

This entry was posted on Wednesday, July 15th, 2026 at 8:00 am and is filed under Breast Surgery, Plastic Surgery News. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.

At Southwest Plastic Surgery, the mommy makeover consult often starts with Dr. Frank Agullo subtracting from the patient’s list rather than adding to it. “Mommy makeover” is a marketing name, he explains, not a single operation. His first job is to figure out which procedures actually serve a patient’s goals, and which ones they can skip. Sometimes the most useful thing he does is talk someone out of part of it.

Here is how Dr. Agullo walks patients through the decision.

What the Mommy Makeover Bundles

It is a list of procedures combined into one plan, not a fixed package. It can include a breast augmentation or whatever the breasts need, liposuction 360, a BBL (fat injections to the buttocks), and a tummy tuck. The team picks from that menu based on the individual. No one has to do all of it. The full overview lives on the practice’s mommy makeover page.

Being Unsure Is Normal

Dr. Agullo tells patients that walking in certain about one part and nervous about another is completely normal. Many are sure about the tummy tuck and anxious about implants, or the reverse. Being scared is not a reason to rush or to skip. It is a reason to slow down and go through each piece, one at a time, and patients are allowed to leave undecided.

Implant, Lift, or Both?

What Dropped	What Dr. Agullo Considers
Mostly lost volume	An implant may be enough
Nipple and tissue descended	A lift, often with a modest implant
Somewhere in between	A donut lift plus a modest implant

It depends on what dropped. If it is mostly lost volume, an implant can be enough. If the nipple and tissue have descended, an implant alone can make it look worse, and a lift enters the conversation. A donut lift, a small circle of skin around the areola, raises the nipple about an inch and re-centers it, and Dr. Agullo can place a modest implant through that same incision for upper fullness. The result is perkier and natural, with the scar hidden at the edge of the areola.

Liposuction or Tummy Tuck?

This is the conversation Dr. Agullo never lets a patient skip. Liposuction removes the fat that can be pinched. But if the abdominal muscles separated during pregnancy, a bulge remains when the muscles relax, and the only thing that repairs it is a tummy tuck. A tummy tuck flattens and tightens the abdomen and repairs the muscle, like a built-in corset. It is a bigger improvement than lipo alone, and it comes with a scar, a trade-off he lays out clearly.

Should a Patient Lose Weight First?

Stable matters more than low. If weight is still swinging, settling it first usually gives a better, longer-lasting contour. But a tummy tuck removes loose skin and repairs separated muscle, and dieting fixes neither, so the answer depends on what is actually bothering the patient. The team sorts that out at the exam.

One Surgery or Several?

Often it can be done in one, and that is usually the smarter choice: one anesthesia, one recovery, one block of time off. When planning combined surgery, Dr. Agullo weighs overall health and total operative time rather than stacking a wish list. If a list runs past the safe ceiling on operative time, he stages it into two calmer surgeries rather than one marathon, and he tells patients plainly when that is the safer route.

What Recovery Looks Like

At Southwest Plastic Surgery, patients are coached to expect the tummy tuck to drive the recovery in most mommy makeovers. It asks the most, with a real adjustment in the first week or two as the repaired muscle settles. The breast and liposuction portions ride alongside it without adding much.

The practice builds recovery support into the plan. In-house post-surgical massage keeps fibrosis from setting in, two Marena compression garments are provided and sized down as swelling drops, and a nurse helps with the first shower the next day. Most patients return to normal daily life sooner than they feared, with full exercise later. The advantage of combining procedures is doing this recovery once.

When Is the Right Time?

There is no universal answer, but there are good signals. A patient is done having children, or confident they are. Weight is stable. Help is lined up at home for the first week. And the reasons are the patient’s own, not a deadline someone else set. Dr. Agullo never wants a patient rushing a permanent decision to make an event, and he will say so if the timing is not right.

Recovery and Med Spa Support

Beyond the operating room, the practice’s Med Spa rounds out the mommy makeover journey, from skin care that complements the body work to maintenance treatments once healing is complete. The goal is a result that lasts, supported well after surgery day.

Talking Patients Out of What They Do Not Need

One thing that distinguishes Dr. Agullo’s approach is his willingness to remove items from a patient’s list. If liposuction alone will address a concern, he does not add a tummy tuck. If an implant will restore volume without a lift, he does not recommend longer scars. The practice measures a successful consult not by how many procedures get booked, but by how well the plan fits the patient. For many, the most reassuring part of the visit is hearing what they can safely skip.

About Dr. Frank Agullo

Dr. Frank Agullo is the founder of Southwest Plastic Surgery in El Paso, Texas. He is 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 completed his plastic surgery fellowship at the Mayo Clinic. He is a Clinical Associate Professor of Plastic Surgery at Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and has been named a Castle Connolly Top Doctor for thirteen consecutive years.

Ready to Talk?

Let the team build the plan that fits you, not a template. For the surgeon’s editorial take, see Dr. Agullo’s essay on drworldwide.com. For the patient-facing walkthrough, see the companion post on agulloplasticsurgery.com.

Call (915) 590-7900, text 1-866-814-0038, or book online at swplasticsurgery.com. #StayBeautiful.

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

This entry was posted on Friday, July 3rd, 2026 at 8:00 am and is filed under Body Contouring, Med Spa. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.