I want perkier breasts and upper pole fullness without getting any bigger.

Realistically it may be difficult to increase the volume in the upper pole area without getting implants which would increase the overall volume of the breasts at least a little bit. With a very skilled and experienced surgeon however, you could possibly achieve the look you are going for with very minimal increase in size. As for perkiness, a breast lift could accomplish that! I recommend scheduling an in person consultation with a board certified plastic surgeon and discussing your goals. Hope this helps.

Thanks so much for reaching out.  You can have your breasts lifted with internal sling or pexy sutures.  This is accomplished in a similar fashion to your first surgery, but adding additional support to your breast tissue. It is unusual for you to have gotten keloids. Did your wounds have any problems while healing?  Those could likely be corrected with your second surgery.I hope this helps :)

You don't have quite enough sagging or excess tissue to simply do a lift using the same scars.  At least a small implant is needed here to get the result you are seeking.  You don't have to make the breasts greatly larger though, and some tissue can be removed from the lower pole.  The areolar scars can be re-done and they look more hypertrophic in spots, rather than true keloids.  They should heal well with good scar care afterwards.  

There only one way to give you upper pole fullness without increasing your breast size. You would need a breast lift using the same scars that you have with a small implant placed under the muscle to increase your upper pole fullness and removing the same volume as the implant from the lower pole tissues. 

Hello,Thank you for your question and photos. A breast lift may be enough for you to remove excess tissue and create perkier breasts but it is very difficult to achieve "upper pole fullness" without the addition of at least a small silicone gel implant. I recommend that you meet with a board certified Plastic Surgeon in person to talk about your goals. They will examine you and offer suggestions.All the best

You really have 2 options:1.  revise the lift and get perkier, or2. add an implant to the lift and get perkier plus a little upper pole fullnessAn implant adds volumesA lift shapes the breast and snugs it up.I don't see any keloids.Keep in mind that adding an implant to the mix will ultimately add more weight to your breast and contribute to its future dropping.  So, think both long and short term! In good health,Ellen Mahony, MD

Hello and thank you for your question. Based on your photograph, you are a
candidate for another breast lift.  This can be designed to result in an
improved shape and contour of your breasts while minimizing scar
appearance.  Make sure you specifically look at before and after
pictures of real patients who have had this surgery performed by your surgeon
and evaluate their results.  The most important aspect is to find a
surgeon you are comfortable with. I recommend that you seek consultation with a
qualified board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

A revision of your reduction/ lift can also address areolar scars and restore perkier appearance. More upper fullness can be added with either fat grafting or small implants at the same surgery. Size would be determined during consultation.An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Thank you for sharing your question and photographs.  It appears that your breast reduction results are still doing well and without placement of an implant your best options would be pursuing fat grafting to the upper portion of each breast.  This will add volume and fullness without adding substantial size to your breast.  Hope this helps.

It sounds like you would like more volume in your upper pole.  if you are not willing to consider implants, the your only remaining option at this time is to consider fat grafting from other parts of your body (love handles, abdomen, thighs, etc.).  This is a two-for-one type of operation since it'll let you have liposuction in those "donor" areas.  Be sure to discuss your goals and concerns with your board certified plastic surgeon and consider the pros and the cons. Be certain your surgeon is properly certified.  I've attached a link where you can start your search.