Do I need an uplift? I would like a 650cc implant so with that in mind can I avoid any uplift? (Photo)

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

I appreciate your question.

From your photos, yes, it appears that you would benefit from both a lift along with augmentation to achieve your desired results.
I perform a liposuction breast lift that removes tissue from the areas you don't want such as near the armpit and the lower portion hanging near your stomach. Once I use this to shape the breast I then remove the skin to tighten the breast and create a better shape with nice cleavage. Since I perform this less invasively the recovery time is faster and drains are not necessary. The size would depend on the proportion with your body versus going for a cup size. It works very well if there are asymmetries. I can also use the removed fat as a natural breast augmentation by grafting the fat back into the breast to create more projection or into the top to create more cleavage. This procedure can also be combined with an implant if needed or wanted.  It should not affect nipple sensation, mammograms, cancer risk or breast-feeding. If you gain or lose weight, the transferred fat can do the same.

The best way to assess and give true advice would be an in-person exam.  Please see a board-certified plastic surgeon that specializes in aesthetic plastic surgery.  

Best of luck!    

Dr. Schwartz 

Board Certified Plastic Surgeon

#RealSelf100Surgeon 

#RealSelfCORESurgeon

I'm sorry to tell you, you definitely need a lift. As a breast revisionary specialist, I see this situation way too often. Think of it this way. If you are drooping without an implant, what will happen when you disconnect the breast tissue from the chest wall and place a big, heavy implant. You don't have to be plastic surgeon to know that gravity will always win. Please see link below to the paper I wrote about this very topic. On the other hand, you are an excellent candidate for and augmentation and lift. If performed appropriately and meticulously, the scarring associated with the lift can be almost imperceptible. Please do not be victim to the "let's just put in big implants and you won't need a lift" sales pitch. It never works out well. Best of luck to you.

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a breast lift. A breast lift with an implant can
result in a very nice shape if good technique is used.  The size,
profile, and shape of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their
results.   The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Hello,It looks as though you would benefit from a lift. However, if you are getting really large implants (650 cc), then it's likely best to stage it. You can get the augmentation first. It might be that you are happy with that appearance but if not, you could then undergo a lift. When performing a lift along with very large implants, your end result can be a little unpredictable since the large implants may stretch your lifted breasts, causing the scars to stretch and for your areolas to stretch. All the best!Dr. BlaggAustin, TX

Thanks for sharing your images and goals.You definitely need a lift.An implant alone will leave you with low and heavy breasts that look great in a bra but horrible naked.I hope this helpsGood luck

Thank you for your question and photo.  From what I can see, you would benefit from an implant for upper pole fullness and a lift to reshape and reposition the breast higher over the implants.  A lift will also reduce the size of your areolas as well.  Best to get an in-person exam by a board certified plastic surgeon.  Good luck.  

Thank you for the question and picture.  
 Although definitive advice would require in-person evaluation, I think that it is likely that you will benefit from breast lifting as well as breast augmentation surgery.  Based on your photograph, I would be concerned that you will not be pleased with the long-term outcome (breast shape, position, and symmetry) achieved with breast augmentation surgery only.  
 
 Generally, I do not suggest that you utilize larger breast implants (than you will feel comparable with physically or psychosocially) in the attempt to avoid the need for breast lifting.   I also think that there are many advantages, which you will read about on this website, with breast implants placed in the sub muscular (dual plane) position.
Of course, breast augmentation/lifting surgery is a more complicated procedure (and more complication prone);  careful selection of plastic surgeon and careful communication of goals will be key.  Furthermore, you will need to carefully consider the trade-offs (such as additional scarring) associated with breast lifting versus the upsides briefly discussed above.
Generally speaking, patients undergoing this combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with will a significantly higher risk of complications and need for additional surgery.  Again, it will be important that you educate yourself regarding the pros/cons/risks/complications associated with breast augmentation/lifting surgery. Only after doing so can you make an informed decision whether or not to proceed. You will find a lot of information on this website and on the attached link.
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting surgery ( regarding breast implant size/profile selection) is:
1. Concentrate on choosing your plastic surgeon carefully. Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you are looking for. ***Ask to see lots of examples of his/her work. 
2. Again, have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals. In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural or huge” or "D or DD cup" etc means different things to different people and therefore prove unhelpful. Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup size may also be inaccurate. The use of computer imaging may be very helpful during this communication phase.
3. Once you feel you have communicated your goals clearly, allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals. Again, in my practice, this decision is usually made during surgery. The use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
I hope this, and the attached link, helps. Best wishes.