Insufficient upper pole fullness after teardrop implants. Would exchanging for round implants or fat grafting be better? (photo)

Dear Honest6785,
Upper pole fullness is achieved with appropriate implant selection but more importantly, submuscular placement, and precise pocket dissection. The submuscular placement allows the muscle to cover the top part of the implant which allows the upper pole to appear more full. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side. 
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Achieving upper pole fullness with breast augmentation is best obtained using a cohesive extra full implant.  The cohesive gel is firmer and won't drop as much with gravitational forces.  Alternatively you could fat graft on top of your anatomic implants but you need viable vascularized breast tissue over the implant to support the fat graft which is likely not present after a mastectomy.

Dear Honest6785,thank you for your question.  There is a soft tissue deficit after a mastectomy.  To give your the fullness yo want I would consider staging the revision with fat grafting  to the upper chest and then, assuming adequate take of the fat graft I would change to a round implant with ADM support of the lower pole.  Good luck & hope this helps.James Sheridan,MD

I am sorry to hear about the complications you have experienced. Increased upper pole fullness may necessitate the use of larger and/or more projecting breast implants. In my experience, these types (rounder, more projecting, "augmented" look) of outcomes are best achieved with higher projecting (for example Mentors ultrahigh profile) silicone gel breast implants or the use of overfilled saline breast implants. Of course, there are pros/cons associated with the use of each type of breast implant. I hope this helps.

Since you are Honest6785 I will be Honest 78910: You don't need anything! You have a nice result following the terrible diagnosis of BRCA2, but you are alive well.....and beautiful. The teardrop, round ....blablablabla is nothing but a side show, a distraction from the unfortunate diagnosis and considerable anxiety you have experienced. No one can blame you, but we have the obligation to protect you. Five surgeries are telling us something: It is your way of feeling alive and fighting. You don't need additional trauma, you are more than beautiful in your present state. Best of luck.