Upper pole fullness is the term plastic surgeons use to describe the desired shape of the upper part of a breast. Many women like the look of some upper pole fullness. The challenge for us is how to make this shape during surgery, and have it stay there.Certainly, breast implants are a proven way to get upper pole fullness. Moderate and high profile implants, whether they are saline or silicone gel filled, clearly create that fullness and roundness. I call this “the implant look”.Fact is, it is a real challenge to get the uplifted “implant look” without using breast implants. Not that surgeons haven’t tried: if you look at the literature on breast lifts and breast reductions, there are literally dozens of strategies that have been tried. There are the “internal bra” methods, the internal suture methods, internal tissue re-arrangments, and many more. These may very well work for the first month or two, especially while the breast is still swollen from surgery – but the real question is, do they last once the swelling has gone?
Dr. Elizabeth Hall-Findlay, the talented plastic surgeon from Canada and author of a textbook on surgery of the breast, did her own experiment on this problem. She tried virtually every sensible method during breast lift surgery to try to solve the mystery of how to get persistent upper pole fullness without an implant. She presented her results at a recent plastic surgery conference. She found that, although the results looked promising initially, by 6-12 months after surgery, the shape of the breast returned to what it was pre-operatively, and that the fullness was lost. Nothing really worked; all of the methods she tried failed to give lasting upper pole fullness.
This month, in PRS, comes a new study reviewing 82 major previous publications in breast lift surgery. Careful photometric analysis was done of the techniques. Once again, it’s a disappoinitment. With the possible exception of fat-grafting to the breast, the author found that upper pole fullness “was not increased by any of the mastopexy / reduction techniques, or by the use of fascial sutures or autoaugmentation techniques”.
In other words, all the methods touted for upper pole fullness failed to work. So put internal lifting sutures, auto-augmentation, and the “internal bra” on the scrap-heap of discredited methods.
What does this mean for patients? Simple: if you want the “implant look”, you have to have an implant. Fat grafting might be an option, too – but we’re still waiting for the studies on that one.
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