I am 36DD, 158 pounds after massive weight loss, 5'7" tall, 50yo. How would you create big beautiful breasts for me? (Photo)

One of the common problems for women in your situation is that the breast skin is very stretchy after major weight loss - moreso than normal - and stretches out quickly if you put in a big and heavy implant.  Even if you do a breast lift. Some surgeons will try to avoid this stretch-relaxation problem by doing the operation in two stages - a really good lift first, and then the implant later.  Others try to reinforce the lower tissue of the breast with an ADM or some sort of internal support.Currently, the best method is not yet known, but keeping the implant smaller will be less prone to revision surgery in the future.

The goal of breast surgery is to have beautiful
breasts.Since you are already a DD, I
do not think adding 200 cc implants to take you to a DDD will make much
difference.However, what will make a difference
is aligning the areola and breast tissue over the bony prominence of the chest
wall to maximize anterior projection.I
recommend a new technique called The Ultimate Breast LiftTM.Your breast tissue is reshaped creating upper
pole fullness, elevated higher on the chest wall and more medial to increase
your cleavage.You need to change the
shape and position of your breasts and nipples.Best Wishes,Gary Horndeski, M.D.

You need a lift and an implant for volume. The scars you have from a prior lift or reduction ( not sure which you had in the past) can be accessed for the implant placement and lift. You can choose your size with your surgeons guidance.good luck

Appears as a very very conservative lift. I would re do the lift with fat grafting to improve the appearance... 

Breast surgery on a massive weight loss patient can be difficult due to the extreme laxity of the breast tissue.  To meet your expectations you may need a revision of the mastopexy and larger implants.  For every 200 cc of implant volume you will go up about a cup size.  

You definitely need a large implant to get to the size you want to be, but that puts you at risk for bottoming out. Also,It's going to be tough for your surgeon to tighten the skin any more if you put in a larger implant. Would you be willing to tolerate a slightly lower set breast?

I think the most important thing we can do as plastic surgeons is to listen to our patients and help try to pick implants that will achieve their goals.  We would review this in more detail at a consultation, but from what you are describing, I think you should be looking into high or ultra high profile implants (Allergan style 20 or 45) that fit your base width of your chest.  From there, we could determine if you still need additional breast lifting (which it appears from your photographs that you may still need). Many of my patients who have undergone bariatric surgery and come to me for body contouring have different goals from other patients who have not had the dramatic weight loss you have experienced.  I think patients who have experienced massive weight loss should see a plastic surgeon who has a good experience in treating patients after weight loss.  I hope this helps.  

I see many patients with your problem.  Since you want the upper fullness and don't have implants (I assume) I would do probably a vertical lift and use a shaped silicone implant like a FF 410 Allergan.  I also find that the addition of some support like ADM (acellular dermal matrix) or SERI is very beneficial in massive weight loss patients.  I would look more at the dimensions than the cc's to determine an appropriate size.  Good luck, Dr. Schuster from Boca Raton.

Thank you for the question and pictures. Congratulations on your significant weight loss; you should be very proud of this accomplishment!  Based on your photographs, it seems that you will benefit from additional breast lifting along with breast augmentation surgery. Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery (regarding breast implant size/profile selection) is:
 1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your   desired goals  with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "DDD or DDDD" etc or "big, sexy, beautiful breasts” means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  The use of  in bra sizers and computer imaging may be very helpful during this communication phase.
3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.  I find that the use of temporary  intraoperative sizers ( with the patient in the upright position)  allows for accurate selection of breast implant size/profile to achieve the patient's goals as precisely as possible.
I hope this, and the attached link, helps.

Based on your photograph and your history you will need a revision of your breast implant to place the nipple areola higher.  It sounds as though your plastic surgeon is planning on that.To achieve a triple D cup breast will require very large breast implants.  You need to discuss this in detail with your plastic surgeon.  Generally placing implants larger than 400-450 cc at the same time as a breast lift can cause difficulty with blood supply to the nipple and skin around the breast and can lead to serious complications.  Please undergo a breast implant sizing system evaluation and discuss your goals in detail with your plastic surgeon.