Hey thanks for your question. Upper pole fullness of the breasts broadly just refers to how much of the breast volume is situated above the nipple-areolar complex (NAC) when you are in an upright posture, compared with the breast volume below the NAC. A concave shape to the breast above the NAC implies a loss of upper pole fullness. This may be due to atrophy ( loss of breast tissue) or due to descent (dropping, or ptosis) of the breast tissue into a position below the NAC. Sometimes this lack of upper pole fullness is present from the very beginning of a woman's breast development, but (commonly) it occurs with ageing, and especially after childbirth and breastfeeding. To correct a lack of upper pole fullness, it is important to figure out what exactly the problem is first. i.e is the breast too low/ does the lower pole have adequate fullness etc. Secondly, the surgeon needs to find out from the patient what they consider to be their preferred shape to the upper pole of the breast. Most women prefer a "natural" look. This would tend to have a straight line profile to the upper pole of the breast, best visible in the quarter-view and lateral view on photographs. But occasionally we (the surgeon) will be specifically asked to give a "rounded, operated-look" that make it obvious that a patient has breast implants. This gives a rounded or convex shape to the breast above the NAC, and is best visualised in the quarter view and lateral view on photos. The shape and size of the breast implant, as well as the position of placement under the breast will all have a major role in determining the degree of upper pole fullness. The problem is, that the larger the breast implant, the more the breast will take on a "augmented" look, despite all good intentions of making the breasts look natural. Especially if the patient has minimal breast tissue to begin with. Your surgeon is able to make an assessment on what size is going to look natural. Anything above that, and you will start to get the augmented look. This varies enormously between patients. So, you may want to have, say, 500cc implants, but your Dr may tell you that anything above 325cc is going to start to have a rounded, augmented look. Then you (the patient) have to make a decision about what is the most important thing for you to achieve: size, or a natural shape. A large implant will help to fill the upper pole of the breast, but if there is minimal existing breast volume, the upper edge of that implant will be very visible if the implant is larger than recommended for you. I hope this helps