Was told “this is the best I can get”. What are my options?

Your photos exhibit an implant that is in good position relative to your soft tissue envelope. They are not dropped out or sagging; you have plenty of upper pole fullness form the implant. Although your nipple to fold distance is slightly inadequate for this size implant, you look good. What will likely make you happier is a larger device, which is now obtainable due to pre-stretch from the current implants. Two words of caution: 1. Going to 400 cc will barely be perceptible, so if you are truly considering a revision surgery, you'll need to think bigger and sizers (either homemade rice sizers or in office purpose built ones) would be appropriate to determine the implant size. 2. Going bigger is going to stretch your soft tissue envelope out further, putting you at risk for rippling, malposition, and capsular contracture, the latter you are already higher risk for because your implants are over the muscle. You need to really think about the long game here. Bigger implants create bigger problems, especially years and decades later.

You may consider a breast lift if you are worried about breast ptosis (sag/drop). With larger implants you may experience further breast ptosis due to the weight of these devices.

The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, your implants can be exchanged for smaller ones.

Best Wishes,

Gary Horndeski, M.D.