Patients on GLP-1 drugs are losing 20 to 30 pounds, and the weight loss is hitting them in the breast — driving a surge in lift requests at the Beverly Hills practice of Lisa Cassileth, MD, the first female chief of plastic surgery at Cedars-Sinai Medical Center.

"[Patients] are losing 20, 30 pounds," Dr. Cassileth says in the fourth episode of Allure's Perspectives podcast, hosted by editor in chief Jessica Cruel. "And it's hitting them in the breast."

The shift has flipped her caseload. Requests for breast reductions have gone down while lifts are on the rise. After extreme weight loss, a patient's breasts may be the size she wants, "but [the volume] is in the wrong place," Dr. Cassileth says. "You'll have no breast [tissue] on the upper half and all the breast [tissue] is on the lower half."

The technique itself has changed too. Stretched-out skin can no longer do the structural work of a lift. "The lifts used to rely on the skin being tightened," she says. "If you have skin that's been stretched out… why would we rely on that skin? It's already failed."

Absorbable mesh now fills that gap. "The mesh holds the breast in position, but over time it dissolves and leaves scar tissue and collagen tissue where the body is replacing the mesh," Dr. Cassileth says. The material also lets her shape the breast to the patient's preference.

The pendulum between fear and excitement

Dr. Cassileth, known for repairing botched augmentations and for minimally invasive post-mastectomy reconstructions, says public sentiment about implants swings in cycles. Fear spikes when stories circulate about breast implant-associated ALCL (anaplastic large cell lymphoma). "People hear about it, and they're afraid, and so everyone starts to remove their implant," she says. "Then, suddenly, Kylie Jenner gets a breast aug with 445 CCs and everyone's like, 'I want a breast aug with 445 CCs.' The pendulum swings. We've gone through now, in my career, the third cycle of removal and excitement."

Right now, the cycle sits firmly on the side of excitement.

"Ballerina boob" and "yoga boob"

Small, perky breasts dominate current requests, Dr. Cassileth says. Two shapes patients ask for by name: the ballerina boob ("a tiny bit of tissue just under the areola") and the yoga boob ("a scoop with a droop" — no fullness at the top of the breast).

She pushes back during consultations when these shapes won't suit a patient's frame. "That size on you may not look like that size does on a celebrity or someone else," she tells patients.

Implant technology: the Motiva shift

The Motiva implant, winner of an Allure Best of Beauty Breakthrough Award in 2025, has a far lower rate of capsular contracture — the scar tissue formation around an implant that can make it feel hard or look unnatural. Dr. Cassileth credits what she calls a "nano texture" that reduces the risk of the body recognizing the implant as foreign and rejecting it.

Durability numbers have changed the conversation in her office. "We used to tell people, 'In 20 years, half the implants will be ruptured and in 10 years, at least 10 percent are ruptured,'" she says. Motivas have been available in Europe for over a decade with less than 1% rupture at 10 years, she says. Surgeons no longer tell patients to come back in 10 years; the guidance now is to "start to watch the implant and see if it does anything."

AI in the consultation room

Many of her patients now consult AI chatbots before appointments. "It's making a better experience for them," Dr. Cassileth says, because they arrive with informed questions. But the technology cuts both ways. She uses AI-powered tools to realistically approximate surgical outcomes — yet advises patients against trying the same at home.

"Patients used to bring in [inspiration] pictures that were, at worst, airbrushed," she says. "Now they're AI. You just say, 'This is so far off from a realistic picture of what I can give you.'"

The full interview also covers the risks of fat transfer procedures like Alloclae, how mastectomy and reconstructive surgeons can collaborate for breast cancer patients, and the high satisfaction rates among breast reduction patients. New episodes of Perspectives drop weekly.

Source: Allure (https://www.allure.com/story/lisa-cassileth-perspectives-podcast) / Source: podcasts.apple.com (https://podcasts.apple.com/us/podcast/allure-perspectives/id6806327289)