36 years old, 170 lbs and 5’10, what is the best way to get more breast projection at the top? (Photos)

Thanks for your inquiry and excellent pictures. I agree volume is at the heart of creating more upper pole fullness for you, also choose a more "cohesive" form stable implant. Finally I agree no lift of the nipple areolar complex, good luck.

There are a number of considerations when one is attempting to increase fullness in the upper part of the breast. If one has already undergone breast augmentation and lifting, a good physical exam and measurements may determine if exchanging for a larger implant with more superior fullness will achieve the result one wants. On the other hand at consultation one can determine if there is too much room in the bottom part of the breast implant pocket that may prohibit this. Also there may be excessive skin in the lower part of the breast. Second or even third mastopexies do increase the risk for necrosis of the nipple. However, if the nipple is in the correct position, sometimes the bottom part of the mastopexy can be corrected, in other words one can tighten and remove skin at the bottom part of the breast without changing the nipple position. This would markedly reduce the risk of nipple necrosis. This could be combined with implants with more superior fullness. For sure a larger implant in general will have a larger diameter to help improve superior fullness. Saline implants have the advantage that if overfilled, the extra saline within any model of implant will increase the superior fullness. There are also some gel implants, for example the mentor high-profile extra series that can achieve significant fullness. In the photos provided, one suspects that a combination of internal pocket tightening and removal of extra skin on the lower breast may help along with possibly new implants.

Your implants have extruded inferior and laterally. Adding larger implants will make the situation even worse. Your skin envelope does not have the mechanical strength to hold up the load of large implants. You have some alternatives. One is to remove the implants, place smaller implants submuscularly and plicate the inferior capsule and possible augment it with artificial materials. Two is to remove the implants, wait 6 months and then place smaller implants submuscular. Your surgeon is correct with a 3rd lift there is a higher instance for nipple necrosis.

Best Wishes,

Gary Horndeski, M.D.

Thank you for sharing your question. With your tendency to bottom out I would advocate for an internal bra using mesh support to maintain greater upper breast fullness.

Dear manicorgnaic,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Please do not go bigger or you will just sag even more from the excess weight. Your large heavy implant is sagging your breast down from the weight. I would suggest going down in size so your lower pocket can be tightened and help lift you breast back. Fat transfers to the upper breast can also be added. Look at your before photos to tell, but I suspect your natural breast sits somewhat low on your chest and the base cannot be lifted.