I have saline implants. My breast seem to be getting lower and further apart. Can this can be fixed and how? (photos)

The answer depends on what you want and what you will accept.  Your nipple location is asymmetric (as it was preoperatively) and if you want to fix this you will need to move one of the nipples to match the other. If you don't want to fix this you will not need to move the nipples.  The inframammary creases of your breasts have descended the same distance which has magnified your preoperative nipple asymmetry.  Additionally,  the lateral creases of your breasts have migrated laterally.  Ideally you will need a crescent of tissue removed from the right inframammary crease, the right nipple lowered with another around the nipple incision and material such as  ADM or Seri placed laterally in the breast cavity to push your implants more towards the center. 

Your implants have bottomed out.  Absolutely no need to re-position your nipples.  I would not characterize this as normal.  This could be fixed by tightening up your implant pockets by a procedure called capsulorrhaphy or "internal bra."  Find a surgeon well versed in revision breast surgery.Ary Krau MD FACS

You most likely had the most common type of sub muscular implant placement, the dual plane technique. I have a problem with this in that over time, the pectoralis muscle pushes the implants down and laterally. I have seen this time and time again. The pectoralis muscle also tends to ride upwards, so that eventually very little of the implant is actually covered by muscle. My preference is the full muscle coverage technique, where a pocket is created under both the pectoralis muscle and the anterior serrated muscle laterally. The lateral muscular support keeps the implant centralized. The vast majority of my patients (though certainly not all) have remained centralized over many years with this technique. Fortunately, your condition can be corrected to a large extent by closing down the lateral pocket, preferably reinforcing the report with dermal matrix or the new silk mesh that has been developed for this purpose.

In your before photograph, your breasts were too
low.At surgery you apparently had a mastopexy
with implants.Your implants are too big
and heavy for your body to support.I
recommend a new technique called Implant Exchange with Mini Ultimate Breast
Lift™.Using only a circumareola
incision it is possible to reshape your breast tissue creating upper pole
fullness, elevate them higher on the chest wall and more medial to increase
your cleavage.At the same time, your
implants will be exchanged for smaller ones and the pockets plicated inferiorly
and laterally to keep the implants high and medial so they do not bottom
out.Your results are typical of
patients who had over augmentation without an adequate lift.Best Wishes,Gary Horndeski, M.D.

Saline implants are frequently smooth and do not adhere well to tissue.  The chest is curved and so a smooth implant moves with gravity out and down.  By tightening the pocket and changing the implant to textured gel implants will remedy your concern. Many women in my practice travel to see us because we specialize in revision implant work.  Seek a BCPS that specializes in breast surgery as we do.

Thank you for your pictures. I think your presentation for almost an actual form and shape of your breast prior to surgery. As far as your breast falling toward your armpits, that's going to be what they do because they are fuller than your natural breasts so they will enhance on your armpits. In order not to have that volume you probably would need to have smaller implants and a lift.

Your implants appear to have "bottomed out" over time. This can be repaired by sewing the breast capsule to itself and reinforcing the lower portion of the breast capsule (capsulorraphy). You do not need to move your nipples. Sometimes patients may also benefit from a synthetic skin or what we term an acellular dermal matrix (ADM) to support the bottom of the implant to keep it in it's proper place. Consult with a few plastic surgeons in your area for a second opinion and a thorough examination.Best wishes,Dr.Bruno

There is asymmetry between the two breasts and it really depends upon what you are a looking for. An exam in person would be helpful. Best of luck.

Posted photos appears as a good result. But only IN PERSON opinions count, seek these with boarded Plastic Surgeons... 

I am sorry to hear about your concerns after breast augmentation surgery. Based on your description and photographs (which demonstrate your concerns nicely), it is likely that you are dealing with a breast implant displacement issue;  the breast implants are moving too inferiorly when you stand and off to the sides when you lie down. The procedure that will likely improve your situation is called capsulorrhaphy;  this procedure involves the use of sutures internally along the breast implant capsule, surrounding the breast implants. It involves decreasing the space surrounding the breast implants, by removing some of the capsule tissue and re-suturing the excised edges. In other words, the "volume" of the  capsule (scar) tissue space surrounding the breast implant is decreased in size. This procedure is commonly performed to treat breast implant displacement or malposition concerns such as lateral displacement (breast implants “falling” off to the sides), bottoming out of breast implants, and/or symmastia. The procedure may also be helpful when patients are downsizing breast implants.   I hope this, and the attached link (dedicated to revisionary breast surgery concerns, helps. Best wishes.