2 years post Mommy Makeover - Why do I have saggy breasts and deformed appearance when lying flat and bending over?

I would have to question if you have saline implants as one breast look distinctly different from the other. Saline implants can have slow leaks. If you have silicone, I'm not sure I even have a good guess as to why they are so different. A physical exam can help figure out some of this stuff.

Your one breast is moving more to the outside of your chest when you lay down. If you want, the pocket can be tightened to minimize this movement. Some lateral movement is normal when you lay down.

Thank you for your question regarding what to do with your breast after a mommy makeover. Thank you also for your pictures and for describing the situation. Since you are two years out from your surgery, I think the breast will not change much more. Therefore, if you want your brast corrected, I would suggest surgical intervention. You mentioned two specific things: one, that when you lay down, the skin and the fat moves. That means you need a mastopexy or a breast lift. Considering the amount of excess skin and fat, this may require an incision around the areola or down the front of the breast like a lollipop, or a full-ancor incision around the areola, down the front of the breast, and under. This is called a full anchor or an inverted T mastopexy. The second thing you mentioned is that you have firmness around the implants and the implants don't necessarily move when you lay down. This means that you probably have capsule contracture around the implant. This would require either a partial or total capsulectomy or a capsulotomy. That means either part of all of the capsule will be removed or an incision will be made in the capsule. Your plastic surgeon should discuss all of this with you. The capsulectomy or the breast lift will be performed at the same time. The procedure takes approximately 3-4 hours to complete and is performed on an outpatient basis. If you were ever considering changing the size of the breast implant, now is the perfect opportunity. You could go bigger, smaller, or stay the same size if you wish. Thank you for your question and good luck.
Sincerely, Dr. Katzen. (“Verified” Plastic Surgeon, President of the American Society of Bariatric Plastic Surgeons, certified by the American Board of Plastic Surgery, Fellow of the International Society of Aesthetic Plastic Surgery, American College of Surgery, and International College of Surgery and member of the American Society of Plastic Surgery, American Academy of Cosmetic Surgery and RealSelf Hall of Fame.)