What would be the best implants to achieve upper pole fullness and great projection? (Photo)

I have developed a technique I term "Reductive Augmentation" for those patients with significant drooping (ptosis) and want an much higher full round breast. This technique combines breast augmentation with a breast reduction primarily from the bottom of the breast so the fullness remains in the top of the breast. Brest wishes.

Based on your photos alone, it does appear that you would need a full breast lift in addition to a breast augmentation. The lift will help with improving symmetry and giving your breasts a perkier look. A high profile implant would likely be the implant that would give you the most superior pole fullness and projection.  Although saline implants are a fine option, there is a new, much thicker silicone gel in a high profile implant which is designed to give the most fullness over the top of the breast. It is called the smooth, round, highly cohesive full profile implant. This may be the best option for you. We have a 3D imaging system called the Vectra that can simulate what you can expect your results to look like post surgery with your selected implants and the lift. I highly recommend that you schedule a consultation with a board certified plastic surgeon to determine what procedure and implants would be best for giving you your desired result and to discuss your goals and what is achievable.

There are so many considerations when combining a breast lift and augmentation.  One of the most important technical concerns is that the operation combines two entirely opposite forces:1.  addition of volume        2.  subtraction of skin and tissueWhen an implant is too large, these opposing forces can have a negative impact on the blood supply to the tissue.  In addition, the tension on the incisions can cause them to widen.  It's wise to keep this in mind when choosing.The combined procedure is based on raising your nipple and shortening the distance from your fold to the nipple.  The nipple position is typically placed at or slightly above your natural crease/fold.  The distance from your nipple to your fold is shortened to 7-8 cm.  These maneuvers allow for centering the implant in the most natural location.  The implant is then centered behind the nipple.  For these reasons, it is truly difficult to achieve the amount of upper pole fill that you see in your wish list pics.  Those ladies most likely had implants only and 2 of them are wearing garments to push them up a bit.  If you visit them in 5-10 years, their implants will have dropped considerably...sorry to disappoint you.Sounds like your doc is on the right track and maybe it's worth meeting with him again so that he can share more of his perspective.  Also, think about the long term result just as much as the short term.  This is an investment for a long period and you want to be happy with your choice for years to come- choosing an implant that would get you to DDD+ is also selecting a long term matronly look... you do want sexy, right??As for an implant to choose, take a look at the saline IDEAL Implant!  It's the best of gel and saline and will give you the projection you desire!  Click on the link below.Take care!In good health,Ellen Mahony, MD

I would lean closer towards the 400 cc moderate profile implant. Maybe even a little larger CC. Intraoperative sizing will help determine the best size. 

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a breast lift. Your nipple sits below the
inframammary fold and without a lift in addition to the implant, this will not
have a natural shape.  A breast lift with an implant can result in a very
nice shape if good technique is used.  The size, profile, and shape of
the implant is based on your desired breast size/shape, your chest wall
measurements, and soft tissue quality.  This decision should
be based on a detailed discussion with equal input from both you
and your surgeon.   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.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Thank you for sharing your question and photographs.  Though sizing can only be recommended with an in-person examination of your tissues I would favor a higher profile implant to maximize your desired upper pole fullness and projection.  Hope this helps.

Thank you for your question. "Tissue based planning" relies on your chest and breast measurements and is the safest way to ensure good long term results. Your surgeon should determine what size and projection are necessary to give you your desired result based on your body's measurements. The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic breast surgery. Hope this helps and good luck with your surgery.

I think that the first thing you should do is have a formal breast lift. The implants can always be added at a later time. 

My experience leads me to approach decisions on implant size at the time of the surgical procedure when an uplift can be performed and the final implant chosen for you. I'd suggest that you meet with as many ABPS Bd Certified plastic surgeons as necessary until you are comfortable and confident with your choice based upon rapport and a review of many before and after pictures. 
I feel that it is very important to have your surgeon take responsibility for the final implant selection based on your goals, goal photos, and the actual appearance of your breasts during surgery when "sizers" or test implants are positioned with you asleep but in a semi-upright position.  I believe that seeing the actual results using different volumes gives me important aesthetic flexibility and accuracy in matching my patients' goals rather than placing the burden of decision on them based on stuffing a bra, etc....

Also keep in mind that the women shown in your "goal photos" probably had very different anatomy than you have so your results will be somewhat different.  I'd also suggest that you consider cohesive silicone implants to reduce the risk that your large implants will have bothersome rippling and waviness after your procedure or in the future.  
Best wishes,
Jon A. Perlman, M.D. FACS

Certified, American Board of Plastic Surgery

Member, American Society for Aesthetic Plastic Surgery (ASAPS)

Beverly Hills, Ca.

Congratulations on your plans to have breast augmentation and lift surgery.  The breast lift is definitely needed and will help provide fullness.  Considering the size that she wants to be and the fact that she only have 11.5 cm base width he will most likely need a high profile implant to achieve her goals.  To learn more about profile please read below: