49, female - How can I achieve smaller breasts with upper pole fullness?

Question

I am struggling to explain what I am wanting during my consultations. I am currently a DD and would prefer to be a C cup. However, I would also like fullness in the upper breast and don’t want to have to rely on a bra for cleavage. So, I want to be approximately a C—but I don’t want the deflated upper-pole appearance I see in many reductions. I want noticeable upper-pole fullness and projection, while still having a natural breast position and contour. I don’t want them sitting excessively high or looking large or obviously implanted. Is this even a possibility? Many consults have told me that a lift with implants defeats the purpose and I 100% understand that too. I am 49 yo, healthy female. Please help!

Michael D. Baratta, MD · Answer

Hello,
That is a great question that I get from many of my patients. A breast reduction is performed to decrease the overall breast size. During this operation a lift is also performed as part of it which will give a more youthful looking breast in terms of shape and nipple position. You are correct that just performing this operation will not give the full upper pole look of say an augmentation with an implant. This is often why we perform what is called an augmentation-mastopexy which increases the breast size and lifts the breast at the same time. I try to tailor these various operations to the patient's goals. For example, some patients want a larger breast reduction and some want a smaller one which helps me to understand how much tissue I should plan to remove. This is the same when performing an augmentation-mastopexy in regards to choosing an implant size and how much tissue to remove. There is another option that can be great for some patients called an autoaugmentation. I often perform this in breast reductions or lifts for patient's who don't want an implant but still want to try and improve their upper pole and maintain more of their natural breast tissue. The autoaugmentation component involves maintaining some of your natural breast tissue to its blood supply and using it essentially as an implant. This could likely get you down to the cup size you want without being too small. To know if you are a good candidate for this versus other options like using an implant would require an exam but this may very much be a good option from the concerns and desired outcome you have stated. I think you may have multiple options to decide from at the end of the day. Hope this is helpful!
Michale Baratta, MD

49, female - How can I achieve smaller breasts with upper pole fullness?

Answers (1)

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