In the right patient upper pole fullness can be achieved with use of specialized techniques. All conventional techniques fail miserably at supporting the upper pole. The only technique that worls, and it works very well, is called the pectoral sling mammoplasty designed originally by Dr. Ruth Graf. The pectoral sling technique utilizes a sling made of the inferior superficial pectoralis major muscle and uses it to suspend the tissue that most surgeons throw away when performing a lift. This tissue is transposed and supported in the superior pole. There is no other techinique that I am aware of that is this effective. Companies have developed products designed to offer similar support such as stratice, but these are doomed to failure.
The only other way to achieve superior pole fullness without an implant is fat grafting to the superior pole.
With implants it is easier, but still not simple. The commonly used submuscular or dual-plane technique assures that true superior pole fullness is never achieved. Surgeons try to achieve this by using larger higher profile implants, however when the superior pole of the implant is under functioning contractile muscle the superior pole always flattens and the implant decends. Some still consider the round full look to be "superior pole fullness" even though it is way too low to tmruthfully be referred to as superior pole. This is one of the many reasons I use the Cold-Subfascial Breast AugmentationTM exclusively in my practice. It allows my to customize each detail of the breast's form and achieve a nice gently sloped natural appearing superior pole that is supported and has longevity.
I hope this helps!
All the best,
Rian A. Maercks M.D.