I am bottoming out. Will internal sutures fix this even though I want to go up in size? (photo)

Tough call, sutures work but they are not a guaranteed solution and now you want to add a weight on the sutures. It is possible but is somewhat risky, decide what is most important to you and work with your PS to make the best possible decision, GOOD LUCK

I wouldn't recommend going up in size for the very reason you've indicated - higher chance of them bottoming out again. Not to mention, your size looks good already.Best,

I am sorry to hear about/see the problems you are having after breast augmentation surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with breast implant displacement ("bottoming out”).
It is probable that you are feeling the implants significantly along the lower poles of the breasts. Patients in your situation often complain of discomfort in the area of implant malposition. Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low. 
I think you will benefit from revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes and any visibility of the inframmammary fold scars should improve with this operation.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with revisionary breast surgery.
I hope this, and the attached link, helps.

The problem with "bottoming out" relates to a lack of sufficient support for the weight of the implant. There are internal ligaments (Coopers ligaments) that are woven throughout your breast gland that act like a "cargo net" to support the weight of the implant. If this support is compromised then your implant will drop due to a lack of support. The internal sutures are placed to repair the support, but going larger will stress your ligaments and repair even more and I fear that the problem will return.

Yes I see the "bottoming out... Best to either internal suture cappsularraphy or ACDM implantation or both. Increasing size could cause the issue to return...

If you have bottoming out, then sometimes it is advised to actually place smaller implants back in with the capsule repair. I would refrain from going bigger.

Based on your information, this does not seem like a good solution. Internal sutures do work but placing larger implants may have the opposite result.

When an implant bottoms out it means that the normal lower skin fold does not hold and the implant descends. It then makes the nipple and areola look like they are riding too high on the breast. Sometimes all that is necessary is to recreate the lower fold with sutures. That doesn't always work and there are a few other choices. One technique is to use some of the old capsule to support the new implant. Another technique uses a material called acellular dermal matrix. This works well but is very expensive. Your plastic surgeon would be able to explain what techniques is preferred and why.The one thing to be concerned about is increasing the size. You will be adding more downward force with the bigger implant and that may still create bottoming out over time even with a perfect repair. Discuss this carefully with your surgeon. Best of luck to you.