What is the suggested procedure for minimal upper breast tissue? (Photos)

Question

41 yo, 5’5”, 120-125 lb I have very little upper breast tissue, making my chest bones quite prominent and protruding. It feels like my breasts are being pulled down by the weight of the lower breast tissue. This has been the shape of my breasts since I developed them. The issue has become more pronounced due to weight loss and the volume loss that comes with breastfeeding two babies. Increased laxity and volume loss have been worsened by weight loss, age, and breastfeeding two children.

Daniel Barrett, MD · Answer

Dear Mkf122,

determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Ira H. Rex III, MD · Answer

Since you do not have enough fat to consider fat grafting, which would take multiple sessions anyway, the only other option is a breast implant.  I would choose to put it under the muscle for best result.  It seems like your chest wall is fairly long from your collarbone to your breast fold, so an implant will not cover all of the bony effect, but I suspect you would have an excellent result!

Mehmet Ozdemir, MD · Answer

I can certainly see why you feel that way, and honestly, what you’re describing that "pulled down" look&mdash;is a very common result of the combination of weight loss and breastfeeding, which essentially leaves the upper part of the breast deflated while the skin and remaining tissue settle lower. Because your chest bones are prominent and you have very little "padding" on top, a standard implant alone might look a bit unnatural or show visible edges. To really address your concerns, the most effective approach would likely be a **breast lift (mastopexy)** to reposition your natural tissue higher on the chest wall, combined with a **small implant or fat grafting** to soften those bony contours and restore that missing upper fullness. This wouldn't just be about size; it’s about "resetting" the anatomy to a more youthful position so that your breasts sit where they should, rather than feeling like they are working against gravity.

Leila Kasrai, MD, FRCSC · Answer

A breast lift reshapes the breasts to be rounder and fuller in the upper pole. Implants can be added to increase fullness.

Kadir Berat Oyur, MD · Answer

Based on your description and photos, the concern is primarily related to loss of upper pole fullness combined with breast ptosis (sagging), which is common after weight loss, aging, and breastfeeding. The appearance of the breasts being “pulled downward” is due to reduced skin elasticity and volume in the upper breast, while the lower pole retains more tissue. In such cases, the most effective solution is typically a breast lift (mastopexy) to reposition the tissue and restore a more youthful contour. If additional fullness in the upper breast is desired, this can be combined with an implant or, in selected cases, fat grafting. The treatment plan should be tailored to your goals, whether you prefer a natural look without implants or enhanced upper fullness, and a detailed in-person evaluation will help determine the most appropriate approach.

James N. Romanelli, MD, FACS · Answer

Dear Friend:

Looking at your photos, I can see the significant upper pole volume loss and the weight distribution you're describing. Your breast tissue has settled into the lower pole, creating that "pulled down" sensation you mention. A breast lift (mastopexy) would redistribute your existing tissue upward and tighten the skin envelope to restore upper pole fullness a bit and lift the breast mound. You might also consider a small implant or fat transfer to replace the volume lost from breastfeeding....this would address both the shape and fullness concerns simultaneously.

Best of Luck, Dr. Jim Romanelli

Warren Schutte, MD · Answer

A breast augmentation would give you a fuller upper pole and simply more fullness to the entire breast. I would recommend starting with an implant. I do not recommend lifts and augmentations at the same time.

Safa Sharabi, MD · Answer

Hi there,
Thanks for your question. If you want more fullness, I would suggest a submuscular (dual plane) augmentation. This would provide more coverage of the implant at the upper aspect, and a more gentle slope of the upper chest, as opposed to a more stuck-on appearance that may happen with an above-the-muscle approach. A lollipop breast lift (where you would have a scar around the areola and also from the areola down the base of the breast) would also help shift some of your volume from the lower aspect to the central aspect of your breast. I hope that helps!
Sincerely,
Dr. Safa Sharabi

Gary M. Horndeski, MD · Answer

You are an excellent candidate for a breast lift using the Bellesoma. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Best Wishes,

Gary Horndeski, M.D.

Paul E. Chasan, MD, FACS · Answer

Thank you for your question.  I have been in practice for over 30 years and breast surgery and revisionary breast surgery is a large portion of my practice.  You are an excellent candidate for augmentation with a silicone implant in the subpectoral location and lift-mastopexy.  You should be able to have an excellent result.  Best wishes to you.

What is the suggested procedure for minimal upper breast tissue? (Photos)

Answers (18)

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