I want to replace my natrelle 68hp. What would you suggest for me to gain upper pole fullness? (photos)

Based on your photos and history and without the benefit of an examination I would say that it looks like you may have some degree of contracture on your right side which would need to be addressed. It is also important to note that your breasts in the current photo with your arms elevated look about like they did a year ago with your arms by the side. Taking that into account with your preop photo I would say that in order to get upper pole fullness and a nicely shaped breast you will need a lift on both sides.  As far as implant profile, size, shape and placement, that would be a decision for you to make after a consultation with an experienced plastic surgeon who is certified by the American Board of Plastic Surgery. 

Thank you for you question.  I would recommend switching to high profile silicone implants and a lift at least on the left side.  You would need an in person consultation in order t b able to give you a definitive recommendation.

Thank you for your question and pictures.  Based on photos alone you would need some internal pocket tightening (capsulorraphy) and probably some modified lift (especially on the left breast) to achieve your desired look.  An in office consultation is the only true way to answer your question however.  Seek a consultation with a Board Certified Plastic Surgeon who performs a lot of breast surgery to help you.  Best of luck to you

Best to obtain ONLY in person opinions. I refer to Dr John O'Brien in St Pete. You will need revision of lift and exchange in sizes... 

Thank you for the question and pictures. Base on your photographs, I think that you will benefit from revision breast surgery. As mentioned in a question you posted earlier, you may benefit from adjustment of the breast implant pockets and/or additional breast lifting to improve your breast symmetry.  
Ultimately, careful measurements (dimensional planning) will be an important part of the preoperative and intraoperative planning process.    Generally speaking, the best online advice I can give to ladies who are considering  revisionary breast augmentation/ lifting surgery ( regarding breast implant size/profile selection) is:
 1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your   desired goals  with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" or " upper pole fullness with a good deal of projection” etc  means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.   
3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.  I find that the use of temporary  intraoperative sizers ( with the patient in the upright position)  allows for accurate selection of breast implant size/profile to achieve patient's goals as precisely as possible.
I hope this, and the attached link, helps.

I would recommend you use a high-profile style 20 or style 45 implant. I would also recommend you consider a breast lift depending on the distance from your sternal notch to your nipple. It is advisable that you seek a plastic surgeon who is experienced in all types of breast surgery. Best wishes!

Most
women who want a lot of fullness through the upper pole, as you do, opt for
high profile implants. I realize that’s the profile you already have, but it
seems like the volume is there, just the position isn’t quite right for your
goals. You may want to consider a breast lift as part of your breast surgery
revision to give both breasts a higher, perkier look that will also help fill
out the upper poles better. Be sure to do your homework, and schedule a few
consultations with board certified plastic surgeons who specialize in implant
revision to see which one you like best. I also recommend bringing lots of
photos of your ideal look, so your surgeon has a reference to work from.