I will say that based on the pics and your stats, you should have no problem on the size. The implant sizes available should be able to get you what you want there.
I understand your desire to avoid a lift, but your nipples are low and the added weight of the implants acting on the already low structures will only cause more ptosis. What things will look like right after surgery will be a bit hard to predict, and guessing what things will be like it 10 years impossible.
I have put a link to some of my lifts for you to peruse. I do so for you to really just look at the scars. These by and large are patients who do not have "mature" scars, and therefore, the scars will only look better over time. I find in my practice that people who resist even considering a lift, object to the scars. Perhaps if you see what they actually look like, you may change your mind. Maybe not.
Thanks for the question regarding realistic expectations. All too often we have to deal with very unrealistic expectations during consultations. First of all, you can achieve a very acceptable augmentation result without a lift, but you will need either on top of the muscle (not usually the best idea) or under the muscle using the dual plane technique, which is commonly done by many surgeons. But if you were to take a picture of that patient with your desired result in 10 years, it would most likely be very undesireable as gravity attacks that very large weight of implant which is supported by not very strong breast tissues. As to how many ccs would be necessary on your particular frame to get that result, the question can only be answered after a physical exam. You may first want to take two baggies, fill each with 600-800 ccs of water, hanging the baggies inside your bra to get an idea of the actual weight you are considering.
What happens to large implants over time?
You ask some tough questions. While it is quite possible that over time your breasts will either sag a lot more or "bottom out" with large implants, I have a couple of patients that have 600-800cc implants that I have been able to follow for 5-10 years and so far they continue to be happy with the result. I don't know for sure what size would be necessary to achieve your goal look, but it will probably be the largest available. Using sizers in your PS's office can help sort that out. You might want to consider a textured implant, which has the possibility of tissue ingrowth to hold the implant in place over time.
It sounds as if your PS wants to do a lift and you don't want that. They should accept that as long as you have made it clear that you are happy with the nipple position. If not, see someone else.
I'm not sure these goals are realistic. While you may be able to have implants large enough (or nearly so) to look like your goal photo, and while you do not (obviously) have to have a lift if you don't want one, the concern is that implants that large will, over time, drop into the skin you have and eventually produce a bottomed-out look. No one can guarantee that that will happen, but it is a concern. That being said, if you don't do the lift now you can always keep that as an option for the future, so as long as you understand that, you can proceed with the implants alone. The larger the implant, though, the more it is likely to drop (sag) with time.
I hope that this helps and good luck,
I am located in Williamsville. You can probably go with very large implants if you want. But this may not be the best decision long term. Over time the weight of large implants will stretch out the ligaments and skin envelope and the breasts will fall or sag. You need to be realistic as far as your goals and the long term consequences of your decision. Good luck.
Should do fine with augmentation only. High profile not wide enough base diameter for you but moderate plus profile a better fit. Good Luck! PLease see a board certified plastic surgeon.
Choices for implants and avoiding a breast lift
Your nipples appear to be just below the infra mammary crease. It appears that a standard sub muscular breast augmentation would give you a nice result and you should not need to use a huge implant to accomplish your goal
The choice of implants has gotten more interesting since we now have shaped gel implants available, depending on your degree of skin laxity this may be a nice choice since the implant can help shape the breast and push out the lower pole.
there are two choices now for shaped implants sientra and Allegran style 410 .
Breast Implants and sagging
Breast Implants can make a woman quite large breasted, even as large as the photo which was posted. There are many factors involved with getting you to your desired look. Breast base diameter is a very important factor and will indicate to the physician whether a midrange or high profile implant would be best. Keep in mind that when someone uses very large implants there are more risks of sagging (ptosis), back, rippling and stretching over time. If a physician does not seem like he is trying to get to the same result you have in mind then perhaps you should listen to his advice but find another physician that you will trust more to give you the desired result.
Breast augmentation and 'realistic goals'
You appear to be a good candidate for breast augmentation alone, without the need for a breast lift. As concerns size, most surgeons will measure the breast dimensions to ascertain which implant size will fit most naturally given your specific anatomy. Beyond that, implant sizers can give a further indication of how you would look with any given implant size. If your overriding goal is to be 'huge' then some surgeons will probably decline to operate. Others will offer surgery but make it very clear that there would likely be a higher rate of long term problems related to implants that are too large for your chest wall. Usually a compromise between your goals and the surgeon's goals can be reached. Best of Luck Dr Harrell
Breast Lift With Implants
Sara. By looking at your side view photo, your nipples ar above the breast fold so you don't need a lift. If your doctor insists on a lift, consider finding another surgeon. As far as the size goes, it is possible to make you the size that you show in the picture, but with such a large size, there are added risks such as stretch marks, loss of nipple sensation, future drooping, back and neck pain, etc.