Breast Implants and Sizing
The first thing that I see is that you have a tuberous breast deformity on the right side and this needs to be addressed during surgery.
Second, anatomic implants that you are talking about are probably the formed silicone that is available in Europe. You should go with silicone implants and the anatomic sound like a good choice as they have less rippling that the regular silicone round implants that are available.
I recommend round breast implants.
1) I would definitely use round breast implants for you. I don't think your ribs are a big problem.
2) The sizes should not be decided in advance. You need disposable implant SIZERS to be put in your breasts during surgery, before opening the permanent implants. This way your surgeon can tell exactly what the difference is between one breast and the other, and choose the correct implants.
3) The fold under your right breast needs to be lowered significantly.
SEE VIDEO BELOW FOR CORRECTION OF ASYMMETRY
Your condition requires a great deal of attention.
In my opinion, I would perform radial relaxing incisions with possible biplanar approach on the right with possible right crescent mastopexy and use of silicone gel implants possibly differential projection (this depends on chest wall projection).
Of course, your surgeon may have experience that recommends a different approach.
Atypical and asymmetric chest wall and breast correction with subfascially placed silicone implants
I would suggest that having true subfascial placement using a lower profile silicone implant would be your best option. Your right breast requires defined shaping to look natural. I consistently get beautiful results that I could not achieve with any other technique using what I call 'cold-subfascial augmentation.' I simply take care to preserve all of the living fascia that allows me to create breasts custom tailored to the patients chest wall and create a true projecting teardrop appearance out of a non projection round implant. I suggest you look at the results of local surgeons doing similar treatments. I do believe the cohesive anatomical will give you a great resultmif executed well but the technique is vastly more important then the implant in your case. I hope this helps! All the best, Rian A. Maercks M.D.
Anatomical implants vs. round implants
I think you have done a good job getting several opinions and are a good candidate for breast augmentation. You do have a constricted breast fold on the right but that should be correctable at surgery. I do not feel that you need anatomic implants and should do fine with round implants. However, look at both in the surgeons office. Most feel that the anatomic silicone implants are too firm for their liking, but you should be the judge. Good luck!
Choosing styles of breast implants
As you know, you have a slightly challenging starting point for breast augmentation. A round implant of proper base dimension will give you the best result in my opinion. Then choose the profile to finalize the "look" you want.
I prefer round implants over anatomic. In additon, you have a mild tuberous deformity of the right breast which may need scoring and a suture placed all they way around the areola to improve its look.
You do have a size difference that can be improved with different size implants. You can use round implants and get quite an acceptable result. You do not need to use anatomic or shaped implants. You will need a little work on the right breast to open up the lower part. This is done internally at the time of surgery.
Round Breast implants for asymmetry and chest prominence
You have a large asymmetry between your Left and right breasts. The right breast is a constricted / tuberous breast with very little breast tissue availability to cover any of the implants you mentioned.
In my opinion, you would need to go with silicone gel filled implants because they ripple less than saline filled implants. In your case, you will not have enough breast tissue to cover the implants (and hide the ripples) so a softer, less ripply implant is crucial. The right breast should be approached through a periareolar (around the areola) approach which would allow the release of the breast and better enable it to conform to and cover the implant below it.
I would vote for MENTOR high profile (round) gel implants (which are close in dimensions to its Moderate Profile Plus, series 2000 saline filled breast implants). I would pick the implants based on the base of the left ("normal") breast. But, preform the operation on the right breast with a temporary sizer implant (AFTER augmenting the left side). Based on the dimension the sizer provides, I would open the appropriate implant.
Hope this helps.
Implant type with a prominent chest
The choice of implant type to be used has multiple variable. It depends on how large you would like to be as well as the dimensions of your chest/breast and tissue tightness. You have a mild tuberous or constricted breast on the right which is, as you know, a little smaller. I would need to see you but I almost exclusively use smooth round implants so you could have either a moderate profile or high profile implant as long as it fits your frame. I hope this helps.