Breasts certainly do change after pregnancy, so just know that you're not alone. Depending on how much your actual breast tissue has enlarged, you may not need your implants at all. Or you may get by with smaller implants. Either way, it sounds like you'll need a lift. I'm guessing you might do well with a short-scar option for your lift (a "lollipop" scar, for instance).
Breast tissue, the supportive ligaments and even the skin are subjected to serious stress during pregnancy as well as weight gain and loss. Loss of elasticity of the tissue, ligaments and skin leads to southward migration and a less than youthful appearance. Breast surgeon hear, see and treat this often.
Sounds to me like you will need at least a breast lift or mastopexy. I prefer a vertical or lollipop fashioned scar to preform the lift....I think it provides great projection and contour to the breast and I also think it maintains the shape of the breast better over a longer period of time...remember we are able to reset the clock, but the clock keeps ticking and gravity keeps pulling.
As far as your implant, a couple of quick thoughts..A breast lift without implant removal can remove as much as 1/2 of a bra cup size and possibly more depending on your anatomy and your goals. Removal of the implant without replacement will definitely downsize your bra cup, depending on the implant volume, but in combination with a lift will leave the upper breast pole less full both in and out of a bra. Down sizing to a smaller implant in combination with a lift will both reduce the cup size, rejuvenate and fill out the breat both in and out of a bra.
The options are patient specific and you need to discuss then all with a Board Certified Plastic Surgeon...Check out their before and after photos to get a feel for all the options I discussed above!
I hope this helps!
Dr. C
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