Should I have another reduction on the bottom pole before small implants are put in for upper pole for fullness?

Thank you for the question and pictures. I agree that your breast shape will benefit from additional resection of skin/tissues laterally. In my opinion, it may be possible to place breast implants during the same operation to provide you with superior pole fulness. The other option, as you mentioned, is to to have the resection done first, followed by the breast augmentation procedure.  Best to learn about the pros/cons/risks/complications associated with each option during  thorough conversations with your plastic surgeon.  The attached link, may also be helpful as you learn more about revisionary breast surgery. Best wishes.

First of all, if you had a reduction, this INCLUDES a breast lift. A breast lift only requires the removal of about an ounce or so of (saggy excess breast) skin and little or no breast tissue. If you are now asking about removing more tissue so you can add implants, then perhaps you had "too much" tissue removed in the first place.You said it yourself: "no volume." This means too much was removed in the first place! I suspect that this is sometimes the case in order to achieve minimum tissue removal guidelines for insurance reimbursement. But why in the world would a patient have "too much" tissue removed so insurance would "cover" her breast reduction and then undergo repeat lift, removal of additional tissue, and addition of implant volume (all presumably at HER cost) when she could have simply undergone a (non-insurance covered) breast lift in the first place (better shape and adequate volume), or breast lift plus implants (better shape and increased volume)?I just don't understand the logic of "free" or partially-covered-by-insurance breast reduction that makes a woman's breasts too small so that she can pay for elective breast augmentation (plus additional lift or tissue removal) and a SECOND operation, plus second set of risks, more time off, etc., when she could have simply undergone one proper operation--either breast lift (if size was fine but shape and sagging needed correcting), or breast lift plus implants (if she needed or wanted more youthful, uplifted breasts plus additional size/volume).Volume is volume, and implants replacing breast tissue do NOT give more upper pole fullness--that is the function of a push-up bra (assuming proper volume TO push up). For implants to give upper pole fullness, there must be either too-high placement (giving a "Snoopy-dog" appearance) OR capsular contracture (giving high, round breasts that are hard like croquet balls in your vest pocket)! Otherwise, a soft, natural-feeling breast augmentation with implants will act just like your own tissue, including heaviness and eventual skin stretch and re-sag!I think your shape is not ideal, as you have too much fullness laterally and should have additional skin removed in these areas bilaterally, giving better "fill" in the upper pole as the skin is re-tightened. If you want additional size, then implants will indeed be required, making it a real shame you had that tissue removal with your "reduction" that was not needed.BTW, if you want size/volume to be increased, you WILL have additional fullness and weight, and that will eventually lead to more skin stretch and sag, whether this volume was the original tissue removed, or the implants you are asking about now. If you like your present size and breast weight, I'd consider simply additional skin removal and tightening with the same volume in a perkier package. Removing more tissue and then adding it back in the form of implants is like taking out falsies and switching to chicken cutlets--same volume but now things start to stink! Sorry for the unsavory analogy, but this type of thinking continues to amaze me in its illogic! Think about it and see if you agree. Best wishes! Dr. Tholen

A small implant may give  you the upper pole fullness that you desire, but over time the implants will descend and sit lower in the pocket.