Inadequate implant and a sad-looking shape - what are my options?

Hard to tell what's going on, but assuming the first picture is when you had your 295 HP and the second is your 195 MP, your implants are too small. Also there is a strange contour. It should not bulge above and be flat below.
You might consider a pocket change to partial submuscular, start over and use the MP implants. 295 looked good volume wise, maybe it was the HP that caused the problem. Did you try on sizers before your fist aug? Think back to what looked good at that time. If 295 was too big, perhaps something MP in the 230-60 range might suit you.

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery and have written many peer-reviewed papers on this topic. First of all, "subfascial" is a fantasy that some surgeons still cling to. The fascia of the pectoralis major muscle is about the thickness of tissue paper. There is virtually no support with this tissue layer. That means you are essentially subglandular. In your case, you need a lift. You probably needed a lift before your first surgery. Again, another fantasy is that by placing a an implant you will fill out the tissue envelope and not need a lift. My recommendation would be to go to another surgeon who is experienced at revision breast surgery. Best wishes to you.

Hi M_ell,
You actually have a very nice result and the size of the implant looks great. But, I see what you are saying. If you breast is not firm (suggesting capsular contracture, that could be pulling the implant up) then I would suggest a moderate or moderate plus profile implant instead of a high profile. It could be the shape of the implant causing that look. Have you surgeon evaluate and recommend.
Best Regards!

Without an in person examination, no one can speak with certainty to your issue. However, you did mention you had a capsulectomy in your revision and you now present with this unnatural upper pole fullness and waterfall deformity. Given those two pieces of information, it appears that you had with your prior implants and have with your current implants capsular contracture. Dr. Frank Lista, who is located near Toronto, is a world renowned surgeon who advocates for subfascial implant placement and claims that capsular contracture rates are comparable to subpectoral placement despite decades of published evidence that does not support his claim. If he isn't your surgeon, maybe you should get a second opinion from him. If he is your surgeon, maybe it's time to seek out another expert's opinion. If I am correct in my diagnosis, I know what I would do: remove them and create a new subpectoral pocket for implant replacement using a biologic material known as acellular dermal matrix.

Your natural breasts are a little low and you could have benefited from a lift. But that entails scars. You can still have the lift but is it worth the scars? Otherwise your result is pretty good.

I see tow things: First, if the breast size is too small, then go bigger. Second, it seems like the implant is too high in the pocket and your breast tissue hangs off lower. This would require opening of the lower capsule to allow the implant to descend down into the lower breast pocket.
Best wishes,
Dr. Taranow

Based on the posted photos I recommend revision surgery with larger implant in 350-400 cc high profile with inferior open capsule release. Plus bilateral donut or L shaped lift. Fee$10,000. Best to virtual with consult …