Breast Implants - Options for Very Small Slightly Saggy Breasts

YOur posted photos show flattened out breasts with nipples above the level of the under breast skin folds. There does not appear to be any excess skin so it is unlikely that you would need any lifting procedure. Since the upper half of the breasts has very little tissue an under the muscle position is probably your best bet even is you use silicone instead of saline. The breasts are not symmetric in shape so perfect symmetry after surgery is not possible.

You should pick a breast implant size by trying out different sized implant samples under your bra. The surgeon would then pick the implant base diameter based on your breast measurements.

You currently have no cleavage and that cannot be created by breast implants. Most importantly your nipples point off to the sides, right more so than left. You will need nipple repositioning at the time of surgery because if you just put the implants in the nipples will diverge even more from the midline. This can usually be accomplished by removing a small crescent of skin beside the areola in the direction you want to move the nipple. Since you would need that it is probably best to place the implants through that skin incision. You can see an example case in the referenced web page.

I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Although a in-person consultation is always necessary before making any strong recommendations, it appears as though a silicone implant (exact size to be determined) would best suit you.  This would provide the most natural look and feel given that your breast skin and substance has been thinned out from the three pregnancies.  Best of luck...RAS

It's not unusual for plastic surgeons to encounter patients who have breast hypoplasia associated with mild breast sag. These patients want larger breasts, but don't want the scarring that's frequently seen with breast lift surgery.Under these circumstances, dual plane breast augmentation offers significant advantages. The procedure creates a pocket beneath the pectoralis muscle as well as a separation between the muscle and the overlying breast tissue. This results in the implant having muscle coverage superiorly and breast tissue covering the implant inferiorly.This configuration allows the breast tissue to cover the implants in a more natural way. It avoids the need for a breast lift and avoids a snoop dog deformity. In addition, patients continue to have the advantages of sub muscular implant placement including a decreased risk of capsular contracture.It's important to realize that everyone's idea of a C cup is different. For this reason, we utilize the 3D Vectra imaging system and external sizers before surgery. We find that this approach minimizes confusion regarding implant size.If you're considering breast augmentation and have mild breast sag, you may be an excellent candidate for this procedure. Under these circumstances, it's important to consult a board certified plastic surgeon.

You may be able to lift your breasts with implants of a firmer texture and narrower base width, however the lift would probably not be able to achieve as perky a contour as you'd like. You don't have to get a lift, but you should understand that your results may be like a "ball in a sock". However, please see an experienced board certified plastic surgeon for a physical examination. Best of luck.

Based on your photos, I would recommend a breast augmentation using a silicone implant in the dual-plane position using an infra-mammary approach. Seek a board certified plastic surgeon for recommendations.

If you choose to have breast augmentation without the lift, you risk having results that will only exaggerate the sagging you have currently. If you don't mind, then you don't have to have a lift. Implants will do. However, I would be hesitant because you might be unhappy with results.

Depending on your stated goals and your willingness to accept some sagging, then augmentation without a lift is an option.

I do not think a lift is necessary.  In order to make an accurate size recommendation, I would need to assess your chest wall and breast mound measurements and characteristics.  Unfortunately, there is not a general rule of thumb or objective criteria to implant selection.

Your plastic surgeon will perform several measurements of your chest wall and breast anatomy and determine a range of implants that both fit your chest wall and reach your desired goals.
The next step is to try on this range of implants in the office with your doctor.   The key to this success is showing your surgeon the body proportion you desire with a bra sizer and allowing your surgeon to guide you to the right implant.   It will be much easier to communicate in implant cc's than cup size when determining the appropriate implant for you.
I wish you a safe recovery and fantastic result.
Dr. Gill

When the nipple is in a good position and the breast is deflated breast augmentation can be performed without a breast lift (mastopexy) procedure.  In the deflated breast it is beneficial to place the implants beneath the muscle to reduce palpable, visible implant rippling.

Based on the photos you provided, you appear to be a good candidate for brest augmentation. I agree, a breast lift is not necessary. Clear communication with your plastic surgeon is important in achieving the desired goals of the patient.  I like to communicate with patients with “goal” pictures.  During surgery, I use temporary sizers to determine the size/profile that will give the patient the look she is looking for. Trying to predict the size of the implant preoperatively is not ideal.  I think it is too much responsibility for the patient to choose the size of the implant.  Ideally, the surgeon would make that determination once he/she is in the operating room with sizers in and examining the patient in the upright and supine position.  There are many variables that come into play when choosing the correct implant size (how much breast tissue the patient currently has, the shape of the chest wall (concave vs. convex), etc.. 
 On this site, I do my best to give advice without a physical examination but I want you to know that a physical examination by a certified physician is always the best way to get the most accurate information.