Choosing your surgeon based on the operation you think you want is a mistake...
Please understand I only say this to prevent you from experiencing headaches down the road...
The best way to go about this is to choose a surgeon based on his/her education, training, experience, reputation, personality, outcomes, and patient satisfaction.
Once you've chosen a surgeon based on those things, follow the recommendation they give you after you've communicated your goals. A good surgeon will know what works well in their hands to achieve the goals you describe.
Some of the worst outcomes I've seen have occurred when an otherwise good surgeon was talked into trying something outside of their normal routine by a patient who had made up her mind that she wanted a certain operation.
Furthermore, with all due respect to my colleagues, I don't think I would be doing you (or the surgeon you eventually choose) any favors by complicating your decisions with my opinion- especially without meeting you and performing a careful examination.
The one who has to cook the meal should be allowed to be the one who helps you decide what's on the menu, right?
Choose a good surgeon and let them do what they do best.
Breast lift with implants: lollipops and donuts.
You are describing too difrerent looks. Ones is a perky and full breast with the lollipop and smaller implant whereas the latter will achieve a buxom full breast with possibly enlarged nipples. Discuss your expected look with your surgeon. IF you truly desire a DD, it sounds as if you can accomplish your result with a periareolar lfit.
Periareolar breast lift works well with breast implants.
Periareolar breast lift will work well. Here's how to pick breast implants:
Answer by George J. Beraka, MD
Manhattan Plastic Surgeon
1) This is the most common type of question on RealSelf.
2) It is the surgeon's job to pick the right breast implants, not the patient's. Implant selection is really pretty technical.
3) Make sure your surgeon REALLY understands the look you want. Mentioning a cup size is not enough. Show your surgeon pictures of breasts you like.
4) Then your surgeon has to tell you if your chosen look is realistic for your anatomy. The most common mistake is to go too big.
5) I recommend that the surgeon NOT make a final implant choice in advance, because this is just an educated guess.
6) The surgeon should have a large inventory of different size and shape implants available in the operating room.
7) Then the surgeon can put sterile disposable implant SIZERS in your breasts during surgery, to see what a particular implant really looks like inside you. This is how to make the best choice. A sizer costs only $45, and takes all the guess work out.
8) Finally, the sizer is discarded, and the correct breast implants (based on what you want and on your anatomy) are opened from the operating roon inventory, and put in your breasts to complete the operation.
Web reference: http://www.drberaka.com/proc_performed/breast_aug_surgery.html
Donut versus vertical mastopexy
In my practice I have found over the years that the "donut Mastopexy" is of limited use at best, It tends to distort and flatten the normal cone shape of the breast, while taking out a "dart" which is what you essentially do with a vertical mastopexy, mainatins the natural shape better and gives a nicer result. Insist on seeing lots of before and after photos before making up your mind. Good Luck!
Hope you like sweets because the lollipop may be the answer
Based on the information given I have the following thoughts.
1. In augmentation-mastopexy a modest size implant is usually warranted to reduce the chance of loss of the nipple/areolar complex from pressure of a very large implant (500cc) in combination with incisions around the complex.
2. Your natural base widths do not match the base widths of modest size implants 275-325cc.). In order to match those widths then a vertical component to the lift would be necessary to remove a small amount of breast tissue to narrow the base width.
Based on those factors will most likely need what the first surgeon is recommending: Lollipop lift and 280-320 cc implants.
Breast lift and choice of implant size depends on the look and size you want.
It is great that you included so much information in your posting. Breast augmentation can help breasts look perkier, but does not reposition a low nipple unless a really large implant is used.. A breast lift moves the nipple up to a higher position. A combination of both procedures can be carefully done, when the patient wants both a perkier and a larger breast. If you currently wear a 38D bra, any implant will increase your size to higher than a D, and a 500 cc implant will make you quite busty. I think the first question you should be clear about is whether or not you want to larger than a 38D. If so, then some form of lift/augmentation is appropriate. What surgical approach or incision your surgeon recommends really depends on what he or she has the most experience with. In my practice, I get very good, long lasting results using a periareolar incision and a lift that moves the breast tissue to a higher postion on the chest wall, doing more than just tightening the skin.
Breast augmentation may require a "lift" for a good result
Hello - It appears as though you may need the lollipop incisions for your lift and augmentation. Typically, during the operation I'll place the implants first and then lift the nipple-areola over the implant into a good position. If I can do the lift with just an incision around the areola then I'll leave it at that. Otherwise, I'll make a small vertical incision below the areola if required to make the breast aesthetically pleasing.
Periareolar lift abandoned in my practice
I have totally abandoned the periareolar lift because 9/10 the pts. areola's stretch 1 year later. This has never occurred with the lollipop lift. The additional scar is worth avoiding the unsightly large areola.
Breast lift with augmentation
As you have witnessed, there are many ways to achieve a goal.
I find you in the gray zone where I would recommend an augmentation alone, allow you to heal and ensure the implants stay in the desired position, then decide later if you still desire the lift as you may be pleasantly surprised with the result and no longe desire one. Your areolas will be stretched out more and subsequently larger if a lift is not done and you will have to be accepting of this and less than perfect results.
If you are dead set on doing both procedures at the same time, I would favor a lollipop technique because I believe the periareolar technique has a tendency to flatten the projection of the nipple and the scars are more likely to stretch out over time. The vertical component of your scar will not be very long.
Breast lift and augmentation
With the heavy size of your breasts the lollipop lift is the preferred option. Also, going with a smaller implant is more beneficial to prevent more rapid sagging due to the weight of the implant itself. Breast lift options all revolve around the amount of scarring involved vs. the shape and longevity of the results obtained. The less scarring will give you less of a long lasting result - specially with larger breast size to begin with.
The lift surgeries with more scarring will give you a longer lasting result with more control over the shape of the breasts. I would side with your first "favorite" surgeon as you will have a better and longer lasting result with his recommendation. Scar vs. Shape is the battle when considering breast lift surgery. Also, remember don't add a heavy implant to an already heavy breast. Good luck.