Need Orthodontics. But Do I Need Orthognathic Surgery? (photo)

I've become incredibly self-conscious about my side profile. I've recently been to an orthodontist who has said that I need 4 teeth removing (because they protrude) and genioplasty. What would you recommend? I have previously had braces and also a retainer that was meant to move my lower jaw forward. I feel like I should have something done regarding my jaw. My voice is nasally (but less so when I move my jaw forward) and I am a mouth-breather at night. What would you advise? Thanks.