Will I Need a Second Breast Lift (Nipples Still Low, Implants Might Be Too Big)?

Thank you for the question in pictures.

I agree with you that your nipple/areola are too low  and that additional breast lifting is indicated. Additional breast lifting will require more incisions ( vertical)  and more scarring. This is the classic trade-off that should be considered by all patients undergoing breast lifting surgery.

In regards to achieving your breast size goals communication with your plastic surgeon will be key to achieving the results you are looking for. Unfortunately, the use of words such as  "natural look" or C cup means different things to different people.  Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.

In my practice I use goal pictures to communicate with patients.  With this technique patients are able to demonstrate what they are trying to achieve and what type of looks they do not like as well. 
I also use  intraoperative sizers and place the patient in the upright position to evaluate breast size. Use of these sizers also allow me to select the breast implant profile (low, moderate, moderate plus, high-profile) that would most likely achieve the patient's goals. The patient's goal pictures are hanging on the wall, and allow for direct comparison. 
I have found that this system is very helpful in improving the chances of achieving the patient's goals as consistently as possible. 


I hope this helps.

         In the context of
baseline asymmetry and efforts to minimize scarring this isn’t an unreasonable
result. Review of your pictures demonstrates pre-operative asymmetry with breast
sag which is worse on the left side than the right side. Post-operatively,
there’s significant improvement, but there’s still minimal residual breast sag
and asymmetry present. In addition, you continue to have concerns about your
breast size and would like to have smaller breasts.

 

         Reducing your breast
implant size will result in loss of support of the overlying breast tissue with
accentuated breast sag. Correction of your sag and residual asymmetry will
require a more extensive breast lift. This will require either a lollipop or
anchor incision with increased scarring.

 

         It’s important to
have good communication with your surgeon to avoid confusion about important
issues like breast size. It’s always difficult to determine breast size by
utilizing cup size because it means different things to different people.

 

         Obvious trade offs
between increased scarring and “perkier breasts” will need to be made. Going
forward, it’s important to have realistic expectations about what, revisionable
surgery can accomplish. When expectations are realistic, patients are usually
satisfied with their surgical result.

I do not think your interval result is bad.  You had low set breast and you still do.  Getting breast isuue to stay up and add volume is difficult and will not last despite what any surgeons tries to tell you.