“Fashion boobs” is how one Los Angeles designer describes her implants, the smallest currently available in the U.S. She’s part of a new wave of women looking for implants that are “undetectable—cute little breasts that have very soft cleavage and a nice shape when there’s no bra there,” says the designer’s surgeon, Dr. Kamakshi R. Zeidler.
Fashion implants, yoga boobs, ballerina breasts—they’re all current descriptions for this tasteful size. Even exotic dancers are going for smaller breasts now, according to one plastic surgeon. This aesthetic fits neatly into the current wellness culture and the clothes that go along with it. Some women are flying to New York for augmentations with “an east coast aesthetic, more sotto voce and not screaming through a megaphone,” says Dr. Adam R. Kolker, a double board-certified plastic surgeon in New York City, who specializes in breast augmentation.
A new breast augmentation procedure, called Preservé, is a sign of this changing attitude. It allows surgeons to use smaller silicone implants (up to about 350 cc’s) to “put the volume where you need it,” says Juan José Chacon-Quirós, founder and CEO of Preservé’s parent company, Establishment Labs. Instead of cutting ligaments to make room for it, doctors slip a compressible silicone implant through a small incision under the breast and then through a narrow tunnel up to its destination without disturbing the ligaments.
“It is a very different way of thinking about the operation—smaller implants, higher placement of implants, less dissection [cutting], so the recovery should have less swelling,” says Dr. Melissa Doft, a board-certified plastic surgeon in New York City. The placement is “really, really important,” says Dr. Steven Teitelbaum, a board-certified plastic surgeon in Los Angeles, who owns stock in Establishment Labs. First, it prevents the shortening effect that traditional implants can sometimes have on the torso. “When the torso looks longer, and the implant is higher, the same-size breast looks bigger.” He adds, “Patients, particularly women who have had kids, so often just want to be filled in the upper breast and say, I don’t really want to be that much bigger. I’m just empty on the top.”
Olea Gillis, 38, who recently got a breast augmentation with Preservé from Dr. Zeidler, a board-certified plastic surgeon in Silicon Valley, after following her on social media, says, “I’ve wanted boobs ever since my teenage years, when everybody’s came, and mine didn’t. At my sizing appointment, Dr. Zeidler measured the circumference around my padded bra. Then I took it off, put on a sports bra, and started putting in different sizes of implants… I’m honestly so, so happy.”
For decades, the dominant point of view about breast implants was the bigger, the better. Now, plastic surgeons are finessing their techniques to create a “subtle slope,” says Dr. Bob Basu, a board-certified plastic surgeon in Houston and president of the American Society of Plastic Surgeons (ASPS).
“Ten years ago, patients were often going up several cup sizes and using words like ‘full’ or ‘very round.’ They wanted people to see the results,” says Dr. Basu. “Today, more patients are asking for a softer, more athletic, proportionate shape that fits their frame… This [shift] has made its way down to Texas, where, as they say, ‘everything is bigger in Texas’.”
It’s not often that the ideal body shape changes significantly, but a few developments are contributing to the shift: The GLP-1s of it all, which have put skinniness within reach like never before. There’s the fact that wellness is a prevailing ethos, with people working out and living in leggings and sports bras.
“When I first started in practice in 2004, we always used to say [to patients], If you’re on the fence between two different sizes, go with the larger size. You don’t want to have buyer’s remorse,” says Dr. Mark Mofid, a board-certified plastic surgeon in San Diego. Now he has seen some long-term effects of large implants—including strain on the neck, inability to exercise properly, and increased likelihood of revision surgery to reposition implants that have moved. He encourages patients to think carefully before surgery about the consequences of large implants. “You could be buying into a lifetime of surgery,” he says. For every implant he places now, Dr. Mofid estimates he removes five, often from patients in their 40s and 50s who believe large implants make them look matronly.
Some doctors are enhancing small implants by liposuctioning fat from the hips or thighs and transferring it to the breasts to create a soft cleavage. And sometimes they replace the implants altogether with this technique. A breast lift can also change the shape without adding volume.
Breast augmentation remains the second most commonly performed plastic surgery procedure after liposuction, according to the most recent report from the ASPS. “Instead of forcing the breast to accommodate a large implant, the goal is to work with the existing anatomy and add volume in a balanced way,” says Dr. Basu.
It can seem peculiar to talk about cup size as a trend—Bs are the news Ds?—and to be sure, there have always been patients and surgeons who want smaller breasts. But “looking ahead, approaches like Preservé may push our concept of the ideal result even further toward harmony with the original natural breast,” says Dr. Basu. “Proportionate, sustainable”— and something we’ve never really associated with implants before—”refined.”
Elizabeth Siegel writes about skin care, makeup, plastic surgery, and more for Allure, Oprah Daily, W, Elle, WWD, and the American Society of Plastic Surgeons. Previously, she was the deputy beauty director of Allure.
