I have to agree with your surgeon and say that you need a lift to correct the shape of your breasts. Unfortunately there are no effective alternative options to a breast lift when it comes to correcting breast ptosis, and I would recommend in particular to avoid falling for the trap of getting bigger implants to 'fill' and lift the breast (a solution that never works).
Do I need a lift?
Hi! You are right in the range where I might consider a mastopexy. It also depends on what shape you are looking for. If you want your nipple/areola to be in the center of the breast mound then you definitely need one. If you want a more mature, natural look then I think just adding the appropriate amount of volume could lift the nipple/areola complex up. An in person consultation with a board certified plastic surgeon is key. Make sure you look at before and after photos of similar body types to see what kind of result the surgeon can produce. Good luck to you!
No one wants a lift, but unfortuantely some woman need them
I believe you will benefit from mastopexy with implants. I would not offer implants alone due to degree and asymmetric ptosis, lateral nipple position and wide cleavage. An implant alone will not deliver the result you're expecting. Seek another in person consult. Best of luck.
Surgical Options for Sagging Breasts
Breasts usually sag due to there being too much loose skin surrounding the breast gland itself. Essentially, the amount of skin is out of balance with the amount of breast tissue. Therefore, there are two general methods of lifting saggy breasts--1) Adding volume with an implant, which will fill up the loose skin (Think of a partially deflated balloon that lifts up and becomes rounder and firmer when inflated.), or 2) Removing some of the excess skin in various patterns to reshape and lift the breast. However, depending on the degree of sagging and the amount of loose skin, there is a limit to how much lifting effect can be achieved just by adding a breast implant. The larger the implant, the more lifting effect, but sometimes it isn't enough to correct the sagging and the patient ends up with a very full upper breast from the implant, but the remaining breast is still too low. It is really up to your surgeon's experience and judgement to explain if he or she thinks just an augment will lift your breasts and give you a nice result, or whether you would need a lift, either periareolar or vertical, to contour the skin and lift the nipples up into a central position on your enlarged breasts. And it also depends on what breast shape and position will make you happiest. Some women are happy with a more mature feminine shape with the nipples lower and the bottom of the breast slightly below the fold, while others prefer a younger, more rounded shape. Finally, it is possible to correct sagging just with the skin contouring of a breast lift without changing your size, but a lift by itself usually doesn't increase any fullness in the cleavage area. Hence, the frequent addition of a breast implant. From your photos and considering that you wish to be larger, I think you could reasonably choose either approach, depending on the shape you desire.
Sometimes Breast Augmentation Gives the Illusion of a Lift
I agree that you may have lost some elasticity from weight change, causing some of the droopiness that you have. But if your goal is to be larger and fuller, you don't absolutely have to have a lift.
Since your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness with a more natural look. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher.
You're right that you're breast will likely change after childbirth and at that point you might need a lift. For more information on this topic, I'd recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."
Breast augmentation alone? Breast lift? Or both?
Thank you for your questions and for the photos. Although an examination would be necessary to give you the most accurate or definitive answer, it would appear from your pictures that implants alone would not be appropriate due to the degree of sagging or ptosis that your breasts exhibit. There are different incisions that can be used for a lift depending on the degree of lift required. I hope this forum is useful for you and good luck!
Breast Lift with Implants
Unfortunately the sagging of your breasts leaves you with little choice but to have a vertical breast lift. Implants alone will only exacerbate your breast sagging problem.
Lift later if needed
You are correct to question the need for a lift.
In our new modern era, we have extra high profile implants to treat challenges such as yours. If you were my patient I would tell you to give them a try. If you decided later that you wanted a little more, it would be very minor.
In this modern era we have implants that allow us to think in three dimensions.
Why not get an opinion for someone with experience with Allergan 410 X profile implants?
Breast Implants Plus Uplift
If you're indicating the crease line below your breasts in your photos then it appears to me that placement of modest sized implants without an uplift is feasible. I would have you consider a periareolar lift since the scars are only around your areolae but even without I think simple augmentation alone is an option. This won't produce perfection but I think you understand that it would be a compromise procedure allowing for future uplift when/if necessary. Be certain to not go too large since overly enhanced or excess upper pole fullness will make your nipples appear to be more droopy-a bad aesthetic!
Good luck with your decisions.
Is it possible that I can get an augmentation without a breast lift?
With the location of your breasts at present, I think an implant alone would need to be placed lower so that it lies directly behind your nipple. Because of that, little to no implant will lie underneath the muscle. That will lead to future faster sagging. Might want to wait until you have had your children before moving forward