Terry Zimmerman, MD

When determining if a lift is necessary, we evaluate the position of the nipple and areola on the breast mound. I do not think you will need a repeat lift, even with downsizing, but your surgeon may want to "tighten the bottom side of your left breast which seems a little stretched out as compared to your right. That could be done when making the incision to replace your implants.

The answer to your question depends on the result you're looking for. If, as you say, you want a more natural result, the High Profile may send you over the top and the moderate to moderate plus would give you more the result you're looking for. If you're looking for a lull breast size but still a little mystery, I would choose the moderate plus.

Your photos show you are borderline and it is difficult to tell if your nipples and areola are below the crease beneath your breast. The other deciding factor is the plane in which the implant is placed. If the implant is placed above your chest wall muscle, you will fill out your skin envelope and get by without a lift. If the implant is placed beneath your muscle, you will get more fullness superiorly but may require lifting the nipple and areola as well. I prefer a vertical style lift for longer lasting support.

While your question is straightforward the answer can be a bit complex. There is a new trend of placing implants above the muscle rather than bellow. Both techniques have some positives and negatives. Then some surgeons now placing their implants above the muscle distinguish between beneath the breast gland (sub-glandular), and beneath the gland and pectoralis muscle fascia (subfascial). The Preserve' technique tries to preserve supportive breast ligaments but is sub-glandular in placement. Its advantage may be less postoperative pain from less dissection but takes a bit longer for the implant to settle and round out. If you're sold on above the muscle, I would trust your surgeon's judgement and preference, as you should get a nice result either way.

Describing your anatomy, you are very slender, with a wide 'cleavage' and A cup natural breast. I would suggest staying with the same size implant for both sides as I think different implants would accentuate any small difference you have in your rib cage. The challenge with your anatomy is if the implants are positioned closer together to give you better cleavage, your nipples & areola will be positioned further out to the sides on your breast mound. You may want to consider Motiva Ergonomix implants verses anatomically shaped.

I do not believe you have tuberous breasts based on the photo you provided. A true tuberous breast has a very narrow base and appears 'herniated' into the areola. You have an attractive breast, but just somewhat 'settled' in appearance.

Taylor,  All experienced and skilled breast surgeons use some type of measurements or formula to determine appropriate implant size. Don't be afraid to ask your surgeon what he is basing his implant size recommendation on. By your listed height and weight you sound fairly petite. If you have a shorter chest, the 400 round may give you too much superior fullness to your breast. Make sure they explain the differences between round and shaped implants and review photos of patients of similar size to your own to be sure your surgeon understands what you are considering a natural full C. Lastly, if there are still questions, you can try on various 'sizers' to get a better idea. 

Your profile view shows a moderate amount of abdominal distention, but only through exam can your plastic surgeon determine if that is entirely fat or separation of your abdominal muscles. If it is primarily fat and you have good skin tone then liposuction would be appropriate. Otherwise and tummy tuck would be your best choice.

• You state that your pannus has been previously removed, but you are unhappy with your "huge stomach". Your pictures do not reveal your current situation, but it sounds like a combination of fat and separation of your abdominal muscles (diastasis recti). Liposuction can reduce the fat volume, but if you are after a 'smaller' abdomen, you will probably require tightening of the abdominal muscles, which is done with a tummy tuck.

You are going for a fairly large size implant. If it is going to be placed beneath your pectoralis muscle I believe you will definitely need a breast lift to centralize your nipple on your breast mound.  If the implant is being placed above your muscle (which I do not recommend) you may get away with not needing a lift.