Possible to get upper pole fullness without an implant? (Photo)

I am 24 years old, 138 pounds and 5'3. I am looking to get a breast lift as I have had saggy breasts since I was a teenager. I have been looking through this sight for months but am not super happy with the lift only pictures I am seeing. Is it possible to get a lift and have upper pole fullness without implants? Is fat grafting an option to improve the upper pole?

Doctor Answers 10

Upper Pole Fullness Without an Implant?

There are breast lifts and there are Breast Lifts. There is no question that different types of lifts and different variations of lift techniques which will create varying degrees of upper pole fullness. Older breast lift techniques, which primarily emphasized removal of excess skin, were notable for their inability to create sustained upper pole fullness, and they tended to create a breast that appeared boxy or bottomed out in a short period of time. Newer techniques such as the vertical or lollipop lift which emphasize fewer scars and greater projection also do not create much upper pole fullness and frequently result in a bottomed out appearance.


When I discuss breast lift procedures with a patient, I explain to them that the technique which I primarily use for an isolated breast lift is specifically designed to create as much upper pole fullness as possible, and in fact I intentionally overcorrect initially because I know that the patients breast tissue will settle and that they will loose some of that initial fullness. In some patients, much of that fullness does disappear, and while they are significantly improved overall, they do not end up with a great deal of upper pole fullness. The degree to which the fullness of their upper pole is retained has much to do with what I call the cohesiveness or firmness of their breast tissue. Patients in whom their tissue is not firm or cohesive will most likely loose their upper fullness. These tend to be patients who are older or who have had children. Younger patients who have not had children do tend to have more cohesive breast tissue, so they are much more likely to retain their upper pole fullness. Of course a breast implant, even of modest size, is the most effective way to create long lasting upper pole fullness.


Your photos indicate that in addition to being asymmetric, you do appear to have a good deal of breast tissue, it's just in the wrong place. The appearance of your breasts also suggests that you have nice elastic skin and relatively cohesive breast tissue, so you would be someone who I would anticipate being able to retain the upper fullness that is created with a lift. You are not "low breasted" and while we cannot see the inferior fold of your breast, I do not think that the footprint of your breast is low on your chest wall. You appear to have a heavy breast with an underdeveloped lower pole which creates a dramatic degree of sagging even at a young age. I would expect that when your breast tissue is aggressively transposed upwards, you will in fact have a great deal of upper pole fullness. What is difficult to predict is how well that will be retained.


Autolgous fat grafting is another technique that can be used to add additional volume to the upper pole. I find that fat transfer to the breast is very useful in improving moderate contour deficits, but I haven't been impressed that it works all that great when it is done at the same time as a breast lift. I think the approach that I would take with you would be to do the lift first to achieve as much upper pole fullness as possible, but consider adding fat grafting after about 6 months if we didn't feel that you had achieved enough sustained upper fullness. I have included a reference to some photos so you can see if the degree of upper pole fullness is a much as you were hoping for. Obviously, there will be differences between individuals depending upon the quality of their skin and the cohesivity of their breast tissue.



Autoaugmentation breast lift vs fat grafting

I have a way of doing a breast lift on folks like you in which I keep literally everything you've got except a teaspoon of skin fragments. Photos are on my web site. This additional volume retained vs the usual breast lift in which excess skin is disposed of can give more projection and fullness than standard lifts. Nothing replaces implants though for upper pole fullness, but implants are where most of the complications reside. 


I am not a fan of fat grafting, though it is a big fad procedure these days. The reason is that not all of the fat will survive and what doesn't could possibly turn to scar tissues and confuse breast cancer detection down the road. Just my opinion.

Possible to get upper pole fullness without an implant?

I think that the breast lift can be performed in such a fashion that upper pole fullness can be improved.  Fat transfer can also be used to augment that region, and is a very good use of that technique.

Fullness with a Lift or Natural Breast Lift incluing Fat Grafting

The procedure is done on an outpatient basis under intravenous sedation and local or general anesthesia. As mentioned above there are a variety of techniques for these operations.  Lollipop lift (vertical lift), donut (periareola) lift, Benelli lift, crescent lift, anchor lift (inverted T). Most commonly, we prefer the lollipop or donut lift because of the shape, small scars and easier healing. Although the “anchor-shape” or inverted “T” incision is still more popular in the United States, it represents an older technique with extensive scarring and a less optimal result in many cases. These newer techniques are utilized in the vast majority of cases, the rare exception being extremely large breasts. The nipple-areola complex is repositioned higher, the excess skin is removed, and the breast is reshaped in a pleasing contour and in a more normal position.

The crescent lift removes a small amount of skin at the top of the areola. We find that there is very little lift and the areola becomes oval in shape and distorted with this method.

The Benelli lift as performed by most surgeons is just the donut lift, removing a donut shaped piece of areola and skin then using a #Pursestring or double purse-string suture to tighten the skin.  A true Benelli actually will expose much of the breast through this incision and then the breast itself is shaped and lifted with sutures.  This is a more complex procedure and is often not done as describe by Dr. Benelli.

 The insertion of an implant as well, may be advisable to restore superior fullness, which is lost with aging and after pregnancy despite the rest of the breast being overly large.  Fat grafting can be used instead of implants to improve the contours of the breast. This is the #NaturalBreastLIft or #CaliforniaBreastLift

#AugmentationMastopexy

This involves placing a small implant at the time of the #mastopexy to add volume or contour the upper breast.   Another option is the #NaturalBreastLift or #CaliforniaBreastLift which places fat in the upper breast instead of an implant to help the shape of the breast.

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 96 reviews

Fat Grafting the Upper Poles

Hello,

A breast lift and fat grafting to upper poles would be an excellent way of optimizing your result. Go visit a few ABPS certified/ASAPS member surgeons that specialize in breast surgery. 

Gerald Minniti, MD, FACS
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 79 reviews

Breast lift (mastopexy) and upper pole fullness without breast augmentation?

I am in agreement with the other providers that breast lift (or mastopexy) alone does not create upper pole fullness. I believe that upper pole fullness can be done best with an implant. But patients should understand that by placing an implant, their breasts will be bigger and they may go up in cup size. Breast implants are also not" forever" devices and may need further replacement surgery in the future. So if a patient has adequate breast tissue it may be best to do the mastopexy first, then wait 6 months to see if they want more volume. Your board certified plastic surgeon can help you with this decision.

Best of luck to you and have a great weekend.

Possible to get upper pole fullness without an implant?

Thank you for your question and photo. A breast lift by itself will not give you significant improvement in fullness in the upper poles. The breast has a "footplate", where you see the indentation laterally between the breast and chest wall, that is the superior border of your breast and the inframammary fold is the bottom of the footplate. Some women are "high breasted" and some are "low breasted". You are low breasted, and to give you upper pole fullness you would need a breast implant or fat grafting at the time of your lift. Fat grafting is not as predictable as an implant, but you will do well with grafting to the upper poles of the breasts and the pectoralis muscles. Fat grafting has been done for many decades (face, buttocks, breasts), it is very technique dependent, and not all the fat will survive. The fat that does not survive, will become scar tissue, there might be some calcification (seen on a mammogram) or oil cysts. None of these are clinically significant and the calcifications are not confused with "micro calcifications" which are presentations in some breast cancers. Matter of fact, every time a surgeon cuts into a breast, for an augmentation, lift, reduction, biopsy, etc., scarring and calcifications form. None of these are confused for breast cancer, and no one questions these procedures. See a board certified plastic surgeon with experience in all types of breast surgery for an in person consultation/evaluation. Good luck.

Breast lifts and upper pole fullness

Breast lift surgery does not in itself produce upper pole fullness, although it raises the position of the breasts on the chest wall.  An implant gives a predictable level of volume to the upper pole.  However, you can also undergo fat grafting to this area to improve your fullness without using an implant.  The main disadvantage of fat grafting is that the amount which will be retained is somewhat unpredictable, and therefore you may require a second procedure for additional fat grafting.  This is typically performed a year after the initial procedure if needed.  Best wishes.

Upper pole fullness without an implant?

Thank you for your question. Unfortunately, many women never develop the high, firm breast shape that we associate with youth. In these cases, we want to reshape the breasts into a higher and more youthful shape. This is achieved with either  lift (mastopexy) or cosmetic breast reduction procedure. Fortunately, you have sufficient natural breast tissue volume to reshape with or without further augmentation. I would prefer a reduction procedure, as this technique reshapes the breast from within, and tends to hold well over time. Fat grafting is always an option if more upper pole volume is desired. Other patients would add an implant later for a similar effect. As always, it's important to work with an experienced, board certified plastic surgeon, in your area. Best of luck to you.

Michael F. Bohley, MD
Portland Plastic Surgeon
4.9 out of 5 stars 15 reviews

Fat grafting with mastopexy

Yes, fat grafting would be the best and most effective way to get more upper pole fullness with a mastopexy. These procedures can safely be done at the same time, but your recovery is a little longer because you will also have to recover from the liposuction. 

Tracy Kayan, MD
Minneapolis Plastic Surgeon
5.0 out of 5 stars 10 reviews

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