Barbara L. Davies, MD, FACS

You are right - you will be pushed well past a D if you go for the implant.  Without seeing you it is hard to make a decision, but if you are droopy, you need a lift.  The 455 cc implants will add approximately a pound to each breast, and I personally think your breasts will be bigger and droopier with an augmentation.  I also think the ultra high profile will give you a great deal of projection but will not fill out the superior pole (top) of the breast, and that is where most people lose a lot of volume when they start to droop.   It’s only my opinion but I think you will be unhappy with just an augmentation and you need a lift (with or without a small implant).  Yes, there are scars on the front of the breast with a lift but they tend to blend in well over time.  In doing the lift, the skin is tightened, so it may seem that you have a slightly smaller breast, although it will be tighter and higher (although perky is very hard to achieve!).  Sometimes the top of the breast is still hard to fill out even with a lift so you may want to add a modest implant - but I would go with a slightly flatter one to fill out the top without giving you overly full roundness at the top (‘boob job’ look).  Good luck!

All lifts can relax to some extent, but the donut lift has a little more tendency for the nipple to splay out (stretch out/enlarge) over time.  I didn’t totally understand when you said ‘2x my areola’ but i’m guessing that is what happened to you - the nipple stretched out.   Adding the vertical incision makes the closure more secure and gives far less of that stretching out phenomenon.  Scars on the front of the breast are, indeed, permanent, but those scars tend to blend in quite well over time.  I suspect that you will be back for a fourth time if you go with a donut lift this time around.  Good luck!

It can be awkward and very uncomfortable to have asymmetric breasts, as you already know.  Breasts can be reduced quite small, but the limiting factor is when the blood supply to the nipple gets compromised.  One thought would be to make the larger breast a B-/A+ cup (rather than AA) and do a small bit of fat injection to the smaller side.  This would give the smallest bit of rounding out to the smaller breast but would also help create the appearance of a border of pectoral muscle which you are likely missing due to the Poland’s.   And you wouldn’t have to enhance the smaller breast if you didn’t want to.  With Poland’s syndrome you have a fair chance of having your surgery covered by insurance (no guarantees!).  Good luck!

Hi there!    You have great eyes!  I think your changes bother you more than other people notice .. . that being said:  it looks like you have two things going on - at rest, you have a mild tear trough deformity (in the picture, it seems to show more on your right than your left, but that could be lighting .. .).  If that is what's happening, a judicious bit of filler would help fill the small hollow and lessen the shadow (my favorite is Restylane, . . . just don't let anyone do Juvederm near your eyes - causes very very prolonged swelling).  With animation (when you smile) you get a bit of bunching up of the lower lid - this is most likely from hypertrophic or thick muscle.  You could try a very careful bit of botox to see if you could decrease some of the activity of the muscle or you could do a blepharoplasty to actually remove (debulk) some of the muscle.  This would need to be done with an incision on the outside of the lid just under your lashes - this incision can hide very nicely.  A strip of muscle - just a few millimeters - can be removed to debulk the area and decrease the activity.  I would probably separate the skin from the muscle and might not remove any skin.  One has to be very cautious with lower lids to not cause increased scleral show (too much of the white of the eye showing) or outright ectropion (the lid pulls away from the globe) - those can happen inredibly quickly with overly aggressive tissue removal.  Now - a transconjunctival bleph keeps the incision inside BUT it only addresses the fat pad, and that's not your major issue and it would NOT fix the bunchiness.  As most surgeons will say, it is very hard to evaluate photos on the web, and you WILL need a personal evaluation before you can make final plans, but these are all my thoughts based on your pictures and questions.  Good luck!

As others here said, it is too early for a revision.  You should wait six months to let swelling settle and to let your tissues drape out a bit - if your swelling goes down enough, you might even want to go beyond 350 c.c.s!  A general 'rule of thumb' is that 100 ccs is approximately one bra cup size, so you can figure it from there AFTER your swelling settles.  And as for revising it under local, it might be possible to do it if your implants are over the muscle, but under the muscle is often too uncomfortable to do under local anesthesia.  Figure this - you wil most likely need some muscle work to open the pocket a bit more to accommodate a bigger prosthesis, and, again, that's more uncomfortable.  As for style:  If you increase size enough, the larger HP would be wider and give you a bit more cleavage, but if you really want to be sure, you might want to change profiles to a moderate plus style.  This has a little less projection, but gives you more width, which would add more cleavage and more volume up top.  When it comes time for revision, you could sit down with your surgeon and look at the various widths/heights.  Don't overthink it, though - it's just a few millimeters in any given direction.  My personal preference is Mentor, but each company has similar shape and size variations.   Good luck!