Bigger implant or lift for more fullness at top & reduce saggy look? (Photos)

Your limited photos suggest you have very attractive breasts. Based on these I would personally not recommend additional surgery. Although the appearance can always be improved, the anticipated benefits do not always justify additional surgery.

Thank you for your pictures and questions. Let me start by saying that you have a completely reasonable result, but that does not mean you have to be happy with it. If you want more fullness, you either need to reposition your current implant (aka revision lift with internal mesh support) or increased the size of the implant. However, increasing the implant size may fix the problem short term but will likely result in further stretching of the tissue over time and at some point you will likely require a revision lift with more soft tissue support.
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Dear MommyMakeoverJourney12,
breast revision surgery is the most difficult plastic surgery procedure performed. Botched breast surgery alters normal tissue planes and laxity, the ability of breasts to heal properly, and leaves scar tissue that dramatically affects the level of difficulty of the corrective surgery.Many patients come in to correct poor outcomes from their initial surgeries. The most common problems are due to implant malposition, bottoming out of the implant, poor scarring, and incorrect implant size.While the type of revision required will depend on the result of the previous surgery and the desired result of the patient, some revisions involve extensive pocket repair that may or may not need specialized external bras.If you are considering breast surgery revision, you should speak with a board certified plastic surgeon and have yourself properly assessed. Only after a thorough examination you will get more information and recommendations. Also, you have to make sure that your surgeon understands your breast augmentation goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Although your photos are limited, I would suggest just enjoy what you have. If you go larger, your implants will sag more from the weight and you still won't have upper breast fullness. Your breasts sit somewhat low on your chest and that cannot be changed.

There are several options available. First, if you do not care for larger breasts then do not consider larger implants (you would need a significant increase in size and possibly change in implant shape to fill the upper poles).
A revision mastopexy would tighten the pocket and lift the breasts significantly.
Best wishes.
Dr. Taranow

Based on the posted photos I might offer increasing volume to 500-600 cc HP implants first. If after 3-4 months you still think saggy then revision lift indicated. Best to in person or virtual consult with...

Your result looks nice as it is but a high profile style implant would give more fullness. BUT as someone who needed a lift, your tissues are stretchy and won't hold up the kind of upper pole fullness you can see in some tight skinned folks who didn't need lifts.