You may need a breast lift as well
While it's difficult to know what the best procedure is for you without first examining you, keep in mind that you may need a breast lift as well in order to achieve the best cosmetic results. If you have a tremendous amount of excess skin and droop to the breasts, simply performing a breast augmentation will not give you the best results in most cases.
My advice would be to set up a consultation with a Board Certified Plastic Surgeon in your area-- he or she will be able to give you options for achieving the results you desire, options that may include using silicone versus saline implants, with or without a breast lift.
Breast augmentation with lax skin options
If your skin is lax, some of this will be corrected by the volume of the implant. If your skin is VERY lax, a larger implant could be used but then you might feel that you are too big. In this case, a proper sized implant is much better and coupled with a lift to tighten what laxity isn't corrected by the implant. It all depends on your starting point which we haven't seen but there are many options for you.
Sagging of breasts after childbirth
Whether a patient can get by with an implant alone in your situation or may require a lift of some type depends on many factors. The basic question is how the breasts would appear if only an implant were placed. Would the breasts look good? Would the areolae be too large? Would the nipples be too low? Are there asymmetries to be addressed?
Currently, there are few good options to increasing breast size other than breast implants. How much they ripple will be determined by the size of the implant, the type of implant, the placement of the implant (above or below the muscle), and the thickness of the patient's tissues.
Unfortunately, stretch marks don't go away with implants and lifts, but their appearance can be minimized in many patients if the skin is tightened.
Your board certified plastic surgeon should make careful measurements and be able to give you a clear answer to all these questions.
Stretchmarks and lax skin
It sounds like you may need a breast lift, as skin laxity will only be worsened with the additional weight of the implants. However, this depends on a physical examination by an experienced board certified plastic surgeon.
Stretchmarks don't really improve in appearance with implants.
Implants for loose breasts
It is difficult to tell how your breast will respond to implants without formally examining you. As for the stretch marks, they are permanent and may look slightly better or slightly worse after having implants placed.
You need a lift in addition to the implants.
If you have loose skin or ptotic (hanging) breasts, then you will likely need a lift in addition to the implants. This can be done at the same time. If you post a picture, we can give you more specific advice. It would look very unnatural to try to put a very large implant to "fill up" the loose skin. The best approach would be to put in a moderately sized implant and have a concurrent mastopexy (breast lift). Good luck with your procedure.
No particular problems that I see.
Many many many women present with your same concerns, so you are by no means alone!
My bias is for the submuscular implant, as the muscle adds support (like an internal bra), added padding, and decreased risk of capsular contracture. Implants may reduce the appearance of stretch marks, though initially, they may be worse.
The important thing is that you get an evaluation, and determine if you need a lift as well as implants.
Best to you.
Minimizing recurrent sagging
These are only my recommendations anbd some will clearly be debated by other surgeons so here goes:
1) You will likely need a breast lift.
2) Placement of the implants beneath the muscle will provide you with additional support to help minimize long term ptosis of the implant. Implants on top of the muscle in patients with loose parenchyma skin tend to develop the "rock in the sock" appearance whereas implants under the muscle tend more towards a "snoopy" appearance
3) Consider an implant on the smaller side to minimize longterm garavitational effects i.e., less than 300cc
4) Favor higher profile implants to minimize rippling
5) Favor silicone implants for a more natural feeling/appearing breast in a thin skinned and samll breasted individual
6) Consider (not currently popular) textured implants to make them "stick" and prevent gravitational descent. However, they have other disadvantages and while they are popular in Europe, they are not commonly used in the USA.
7) Once augmented, wear a supportive bra at all times 365 days a year 24x7 (even at night) to support the breast and minimize the effects of gravity on your skin.
I hope this helps.
Breast augmentation supports lax skin
In our practice the average patient is over thirty and has one to two children when seeking breast augmentation. The deflated breast skin from pregnancy with stretch marks is pretty typical and enhanced volume and shape with smoothing of the stretch marks is what motivates many. Augmentation today isn't just about those who are underdeveloped.
The issue to consider first is the position of the nipple in relation to the fold under the breast. If the nipple is at the fold, or above, augmentation should work without a breast lift.
The next issue is how full an implant to fill out the skin envelope well. You may not wish to return to a D cup, however the implant should be large enough to fill out the skin well and fit the breast like a hand and glove. We recommend placing the implant under the muscle in most to get the best shape and reduce the capsule rate.
Concerning stretch marks we find that the implant smooths them out and though they are not gone they are less visible.
Explore the web for augmentation examples. I'll bet you will see many just like yourself who have done well with augmentation after pregnancy.
Best of luck,
The size of your breasts now, your chest dimensions,the desired size you would like after an augmentation, AND the amount of excess skin will help you and your surgeon determine what procedure(s) might be suited for you. To counter the effects of the excess skin, a large device may be need to get it to redrape and the nipple reposition in the right location. If this implant is too large for you, a lift may be needed with the appropriate size device. devices that are too large stretch the skin, make it thinner and increase the potential for rippling.