Third breast augmentation, from 520cc to at least 800cc —would you suggest round or tear drop? (Photos)

Thank you for the question and pictures.   You will find that online consultants will not be able to provide you with specific advice in regards to selection of specific breast implant size/profile. Ultimately, careful communication of your goals will be critical.Anatomical breast implants were designed to better simulate the natural breast  shape;  the problem with these implants is that if they shift or rotate,  the entire breast will change shape as well.  This change in breast shape may require further surgery to correct. Round implants, on the other hand, can shift or rotate without changing the shape of the breasts.  I personally prefer the use of smooth round implants for most patients.I agree with you that either the largest silicone gel breast implants or overfilled saline breast implants may be necessary to achieve your desired outcome.   Sometimes, in my practice  this is a decision that is made during surgery (after careful preoperative communication and intraoperative evaluation of the patient's breast with temporary sizers in place).
Generally speaking, the best online advice I can give to ladies who are considering revisionary breast augmentation 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. Have a full discussion and communication regarding your desired goals  with your plastic surgeon. This communication will be critical in determining  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 "D or DD cup” or "extra large" 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.   
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 ( after the use of temporary intraoperative sizers).  Viewing the patient's chest wall in the upright and supine positions, with temporary sizes in place, help select  the best breast implant size/profile for the specific patient.
I hope this helps. Best wishes.

Dear NC,   Thanks for posting your pictures. From observing your pictures and your goal pictures you appear to have the following problems:1. Your breasts size is full C and your goal size is DD. If you are currently 34 full C cup size , you will need 750 cc implants to get to your goal.2. Severe capsule contracture. You will need complete capsulotomy (scar release) to a more natural looking breasts and make room for the bigger implants.3. Skin laxity and nipples asymmetry. Peri areola skin tightening (donut, Benelli) and right breast mini lift will improve your breasts attractiveness and youthfulness.   In my practice I use exclusively smooth, round, moderate profile implants made by Mentor for over 32 years and thousands of breasts augmentation patients. The entry approach is via sub areola incision which allows for better outcome due to easier technical dissection of the pockets.   Always, consult with experienced board certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and have  natural look.                           Best of luck,                                          Dr Widder

Dear nc2019,
I use both tear drop (shaped) implants and round implants in my practice. One has to understand the dimensions of the breast to determine which implant would work best. A shaped implant looks like a tear drop and like a natural breast shape. This may sound like it makes the most sense for breast augmentation but if a patient has breast tissue already, this tends to push out or project the bottom part of the breast more so than what is natural. Two things that look like a breast don't necessarily make for a more natural looking breast. A round implant often times has a more natural look than a shaped implant because it increases the breast size more evenly. I still use shaped implants in a few circumstances when patients have no breast tissue. Patients that are very flat or have had a mastectomy. Shaped implants also have the increased risk, up to 30%, of rotation so I'm very careful when using or recommending them. The bottom line is that one should consult with a board certified plastic surgeon who does a lot of breast surgery to determine the best implant for each patient. All of my breast augmentations are designer breast augmentations which means that one size does not fit all. I customize the surgery and implant based on the characteristics of the patient and their goals.
Daniel Barrett, MD