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.