Mark D. Ball, MD (retired)

Your existing implants are round, gel-filled, Natrelle implants which have a diameter of 13.1 cm.  The style 10 implant at 240 cc has a diameter of 11.7 cm.  Obviously, the new implant is going to have a diameter significantly smaller than the existing pocket.  This can create problems, and can be challenging to correct.  I usually deal with this by reducing the pocket diameter to about 0.5 cm greater than the implant diameter by removing the edge of the capsule and suturing.  Talk to your surgeon about how he/she plans to deal with the issue so you are comfortable with the plan.

Many women find they are not happy with their appearance after removal of breast implants.  A lift may or may not be the answer.  You might consider replacement of your old implants with new ones if pain relief is your primary concern.  Photos suggest some capsular contracture, which can cause pain.  That may be relieved by capsulectomy and re-augmentation.  This would almost certainly avoid the issue of mastopexy, since your breasts are not sagging.  Ask yourself if you would be happy if your breasts were soft and free of pain.

It is waaaaay too early at 10 days to know what your eyes will look like when you have fully healed.  Give it 6 months before making a final judgment.

From what I can see in your photos it looks like you would benefit from lower lid blepharoplasty via an incision on the inner surface of the eyelid (trans-conjunctival approach) to re-distribute the fat more evenly in the area.  Restylane or Juvederm can camouflage the bags by filling in below, but has to be repeated at intervals, whereas the surgery usually is done only once.  In the long run surgery can be more economical.  If not injected deeply enough fillers can give a bluish color through the thin skin of the eyelid.

I'm guessing from your photos that your implants are under the muscle.  You often hear talk of implants "dropping" after BA, which really makes no sense.  If the pocket has been made to exactly fit the dimensions of your implant, there is no place for the implant to "drop" to.  What I think does happen with sub-muscular BA is noticable swelling of the pectoralis muscle, which rides over the upper half of the implant.  The excessive upper breast fullness caused by this swelling gradually disappears as the swelling of the muscle goes away, and this is misinterpreted is "dropping" of the implants.  I expect that is what will happen in your case.  Patience is all that is required.  I discourage my patients from wearing any type of push-up bra for at least 6 weeks.  Ask your surgeon when you see him/her.