Small Implants - How can I avoid paying anymore consultation fees and find a doctor that supports my aesthetic goal?

The technique I recommend is The Bellesoma Method. The breast tissue is reshaped creating upper pole fullness without implants, elevated higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Dear Thriving329947,

breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient.
When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.


Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Patients who would benefit from a breast lift don't ever 'need' an implant. Combining implant based breast augmentation with a breast lift only serves to increase size, upper pole fulness, and projection. Without an implant, your breasts will be high, tight, and with an optimized nipple position. So, if you want a small implant that's great. No one should be insisting on a large one, but what's important is choosing an implant of sufficient diameter; to approximate your breast width or 'footprint'. It can still be a low projecting device and give you a great result.

Your vision is clear and entirely achievable. Many active women seek the same balance, a youthful, lifted look that feels light, natural, and in harmony with their physique. Wanting smaller, perky breasts that fit your frame and lifestyle is not only reasonable, but a beautiful aesthetic goal.
A breast lift with a small, natural implant is often the ideal approach. The implant’s purpose is not to increase size, but to restore gentle fullness and structure, allowing the breast to maintain shape and projection over time. The outcome is elegant, proportionate, and long-lasting, with soft, natural movement and a result that feels completely your own.
At our clinic, every procedure is custom-designed to align with your anatomy, lifestyle, and personal preferences. We take time to truly listen, understanding what you envision, how you live, and how you want to feel in your body. Every plan is crafted with precision and intention to achieve a refined, timeless enhancement.
To make your journey easier, we offer complimentary virtual consultations for patients who wish to discuss their goals before traveling or committing to in-person appointments. This allows us to assess your needs, answer your questions, and recommend a personalized treatment plan, without the stress of additional consultation fees.
You deserve care that listens, respects your wishes, and reflects your unique sense of beauty. We would be delighted to help you design a result that feels natural, confident, and perfectly you.
Dr. Sibel Atalay, MDBoard-Certified Plastic Surgeon & Destination Doctor

It is important to remember that you are seeking a partner during consultation. Our job as surgeons is to guide not dictate. We can offer insights and opinions. However, the patient has the final say.

Disagreements can occur. As a surgeon, while difficult, when visions do not align it is often for the best to decline to operate.

With regards to your specific question, it is best to limit yourself to 3 consults ("Too many cooks in the kitchen can spoil the broth"). This can allow for 2 different visions and a tie-breaking vote.

Small breasts are always an option. The tendency to go larger stems from experience (the most common patient regret post op is not having gone larger). However, if you cannot come to an agreement, repeat consultation is recommended.

As always, discuss your concerns with a board certified plastic surgeon (ABPS).

I am very surprised that you cannot find a plastic surgeon who would accommodate your choice for a small implant/lift. Most surgeons, once they have had the opportunity to provide you with all of the information about their recommendations for the proper size implants that they feel is best, are happy to put the patients choice 1st, as long as the patient understands what that choice would deliver to them. As most surgeons charge a consultation fee for their time, you may try canvassing your area with phone calls and asking if you could get a firm commitment from the surgeon to agree to a certain size implant prior to being seen. You may still have to pay the consultation fee for that surgeon, but it will save you from going to multiple other surgeons. I hope this helps.

In person evaluation needed for definitive answer; Do I need a breast lift? You might not need one. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

There are many experienced board certified plastic surgeons that can help you achieve a natural look that matches your frame with conservative sized breasts. Visit the ASPS website to look for surgeons near you. You can review before/after photos to see photos of patients that are similar to you. You can also review qualifications to determine who you want to have consultations with.