Breast Implants - Options for Very Small Slightly Saggy Breasts

A breast lift (mastopexy) is recommended by plastic surgeons when the skin envelope is larger than  the volume of the breast.  If a lift is not done when indicated, extra skin may drape abnormally over the lower pole of the breast and the nipple may be too low on the breast mound.  From your photographs, I am sure that a lift could be avoided if you chose a large enough implant.  It would be a mistake to pick a size you are uncomfortable with simply to avoid a lift.  I would recommend you try on sizers with your surgeon's help to decide the approximate size you would be most comfortable with. You want to make sure that your idea of an appropriate size is in keeping with your surgeon's recommendation. A small peri-areolar lift (sometimes called a mini-lift) might enhance your result if you select a smaller size implant.  Occasionally I let a woman choose to have an augmentation  and wait a few months to see whether or not a lift is required. This two step process works for some, though it is obviously better to complete the plan at one procedure. This is a decision that is important for you, so talk with your plastic surgeon and keep an open mind about the options.

YOur posted photos show flattened out breasts with nipples above the level of the under breast skin folds. There does not appear to be any excess skin so it is unlikely that you would need any lifting procedure. Since the upper half of the breasts has very little tissue an under the muscle position is probably your best bet even is you use silicone instead of saline. The breasts are not symmetric in shape so perfect symmetry after surgery is not possible.

You should pick a breast implant size by trying out different sized implant samples under your bra. The surgeon would then pick the implant base diameter based on your breast measurements.

You currently have no cleavage and that cannot be created by breast implants. Most importantly your nipples point off to the sides, right more so than left. You will need nipple repositioning at the time of surgery because if you just put the implants in the nipples will diverge even more from the midline. This can usually be accomplished by removing a small crescent of skin beside the areola in the direction you want to move the nipple. Since you would need that it is probably best to place the implants through that skin incision. You can see an example case in the referenced web page.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.