Hello and thank you for your question. You can definitely switch to round silicone implants, but your breast shape will still not be appealing if you do not get a breast lift. You need to go to a board certified plastic surgeon with expertise in aesthetic breast surgery who is not afraid to do a lift and augmentation at the same time. I have found that some surgeons are not comfortable with lifting techniques and either do not perform a lift, or do not do an aggressive enough lift, and this leads to continued sagging (even though some patients can get recurrent sagging due to gravity/genetics/tissue quality).When I discuss with my patients about breast lifting techniques and also use of implants, I break down the different topics into parts. The easy way to decipher what each procedure produces is that implants increase breast volume and add upper pole fullness. Implants are placed in either a subglandular or subpectoral pocket centered over the left and right chest breast footprint. When you have ptosis/sagging, where the nipple-areola complex is at the fold or lower, your breast will continue to hang off of your chest onto your upper abdomen even after implants. In fact, in patients with such sagging who undergo an augmentation without a lift, their breast tissue hangs off of the implant that is sitting on their chest, creating a shape like Snoopy's nose, hence called a "snoopy" deformity. Implants can not give a therapeutic lift and taking shortcuts will only lead to suboptimal results. In some borderline cases of ptosis, breast augmentation can be performed and if there is unsatisfactory sagging, then a lift can be performed later at a second stage, but in your case, an in person examination with a board certified plastic surgeon will be most instrumental in going over your lifting options in conjunction with implants. Two lifting techniques that are very good ones in the right patient and I use are based on the following: 1) if it is mainly the nipple position that needs lifting, I like the circumareolar approach (also called a donut lift) vs 2) if a large portion of the breast tissue/weight needs to be lifted, a circumvertical and sometimes a full anchor incision is needed as the circumareolar approach in my mind is not strong enough to hold the weight of the breast and results in stretching of the areola and drooping over time. Click on the link referenced below and scroll down and the two examples listed are of patients whom had both mastopexy and augmentation and you can see one patient in whom the circumareolar approach was sufficient whereas the other needed the circumvertical incision. I hope this helps you and do not hesitate to reach out to us if we can be of further assistance to you.Sincerely, Dr. Sean Kelishadi@sskplasticsurg on Instagram