The thing you need to understand about sizing of implants is that, in my opinion, THE most important thing is the diameter of the implant. I size the implants based on this principle. Essentially, you want fullness in all quadrants.
Additionally, as implants get larger the diameter goes up while the projection may not change, or change very little. Therefore, you should see how the various sizes of implant look on your chest wall- be sure there is nice cleavage, nice lateral fullness, nice round full lower pole fullness, and not too much or too little upper pole fullness.
Your doctor was wise to discuss a pexy with you. Depending on how you heal, you may or may not need the lift. One option would be to wait about 9 months to see how the breasts look and then decide on a lift at that time. This is something olny you can decide in consultation with your surgeon, who has the benefit of exam.
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