The source of your problems right now is an implant that is too wide for your native breast footprint. In your preoperative photo (very helpful!) you can appreciate that the breast itself is narrow, with 3-4 cm of separation. Your first augmentation was done with an implant that suited your breast well. Unfortunately, you were left with more distance between your breasts than you wanted. At the revision augmentation an implant much too wide for your breast was used in an effort to get you cleavage, giving you symmastia and a double bubble. A correction would involve closing off the pocket medially to reestablish natural breast contour and placing a narrower implant. I believe you could maintain most or all of your current implant volume, you would just need a higher profile implant. A lift would be helpful to reduce your areolar diameter and tighten the lower pole of the breast, and I feel that the resultant improvement in breast shape would justify the additional cost and scars.
Though I classify you as a minor "implant cripple", your result is not bad. I recommend using fat grafting to correct the double bubble effect and the rippling issues. As for the closeness cleavage I might leave well enough alone in your case.. Good Luck.
Thank you for your pictures. If you downsize your implant You will have excess skin. The breast lift will help tighten the skin improve shape and give you fullness. I think this is a good plan. Good luck.
thx for the question and the pics. I agree with the other responses. Fat grafting will help correct the minor rippling as you are thin. if you want more separation, i would suggest a narrower implant. Perhaps a high profile. this will give you projection, mild lifting, and more separation.
If you press the implants together, does the cleavage disappear?
I don't recommend a lift. You have mild sagging that still looks normal. Perhaps a mini lift or short vertical in the future.
Best to you.
Thank you for your question and photos.
You have several issues going on. However, if you wish to keep your volume you can forgo the 400 - 450cc implants once your tissue is aligned properly with your implants. I have found that larger implants are not necessary when your breast tissue is properly aligned with the implants. Smaller implants will require less maintenance and will often have less complications than larger ones.
Tissue realignment is essential. A breast lift is required.
Hope this helps.
Gary Horndeski M.D.