Hello and thank you for the question and the photos. The main issue to discuss is the difference between sagging and deflation. A sagging breast has too much stretched out skin, where the nipple hangs well below the breast crease and there is too much breast skin. In this case, a breast lift or mastopexy is needed. NO implant, regardless of how large, will fix sagging. A deflated breast has a normal skin envelope, the nipple points forward, and either sits at or just below the breast fold. In deflation, an implant is all that is needed. Some patients need both. That is, they have both sagging and deflation. In this case, I would recommend doing both. You have components of both sagging and deflation. The stretch marks on the upper breast will remain. They will look red and inflamed right after surgery, but subside afterwards. Unfortunately, there are no great options to hide / remove stretchmarks right now. Doing both procedures together is a common procedure and will help your shape, size, projection and loose skin. I think it will address the wrinkles you mentioned. For some examples of my patients, please follow me on instagram: @bennettyangmd As always, be healthy, no smoking, and make sure any health conditions are being managed by your primary care MD Best to you.