I'm 5'7, 140lbs with 550cc HP silicone overs. Will downsizing/going under the muscle make them perkier? (Photos)

Actually, downsizing will have the opposite effect.   I recommend an in-office examination as well as a detailed discussion with a surgeon who you are comfortable with.   Finally, make sure your surgeon is a Double-Board Certified Plastic Surgeon certified by the American Board of Plastic Surgery (ABPS), a member of the American Society of Plastic Surgery (ASPS), a member of the American Society of Aesthetic Plastic Surgery (ASAPS), and a fellow of the American College of Surgeons (FACS).Best,Dr. DesaiBeverly Hills Institute for Aesthetic Plastic SurgeryHarvard Educated, Beverly Hills & Miami Beach TrainedDouble Board-Certified, Double Fellowship-Trained Beverly Hills Plastic Surgeon

I know you want answers to the questions you posted but your situation is a bit complicated and not one that can be reliably commented on via online photos only. It is imperative you seek out consultations with a few board-certified plastic surgeons with a lot of experience in breast implant revision surgery. Good luck!Thomas Taylor, MD, FACS

Hello,Although you provide a photo of yourself and your goal, it is impossible to be specific about how to achieve your goal without a physical examination. However, I would recommend changing position of smaller implants to a dual plane, subpectoral position. In most instances, this also means a breast lift would be indicated. Go visit a few ABPS certified/ASAPS member surgeons who specialize in revision breast surgery. Best of luck!

Your 550 cc implants
weight over 1 lb each.  450 cc implants weigh
1 lb each.  The weight of these implants exceeds
the ability of your skin envelope to hold them. 
As a result, your breasts have descended.  In order to create the desired effect, you
will need a new force to reverse descent. 
The technique I recommend is Explant with The Bellesoma Method.  This technique will reshape your breast
tissue creating upper pole fullness without implants, elevate them higher on
the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation
and the ability to breast feed are maintained. 
At the same time or later, fat transfer can be performed if more volume
is desired.         Best Wishes,Gary Horndeski, M.D.

Dear Stacy111111,I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. 

When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.
Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.
Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.
You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Thanks for the question and photos. Looks like you have some descent of the implants and your native breast tissue, with some asymmetry of the position. This likely requires some breast lifting to be done if you want to try to achieve something closer to your goal photo. Downsizing would likely also necessitate the lift in order to match the skin envelope to the pocket size and shape of a smaller implant. Repositioning into the dual plane (muscle over the top portion of the implant) is usually advised in order to lower the risk of capsular contracture (at least according to our best data today). You would need exam in the office in order to assess you properly and make recommendations.

Downsizing can be helpful to decrease the weight of the implant on your tissue. Your pocket can then be tightened as well. With smaller implants, hopefully you will have less sagging in the future.

No, downsizing and/or converting to the sub Musser pocket will not lead to a  "procure" outcome.  It is likely that significant adjustment of the surrounding breast implant capsules will be necessary to improve your outcome.If I were seeing you in consultation I would ask that you communicate your goals with the help of goal photographs (as you have done here) and computer imaging.  Terms such as "perkier" or "C or D cup" are subjective and may mean different things to different people.  
My best advice: seek consultation with a few board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with.  Again, communicate your goals carefully as well.  Working together you will come up with the best plan to  achieve an outcome that you will be pleased with.  Best wishes.  

The amount of skin on your breasts is significantly more than the skin on the breasts of the photo you included. Downsizing the implants will result in your having more excess skin. The only way to tighten the skin is to have a lift where skin is removed. This will mean scars on your breast. I suggest seeing a board certified plastic surgeon with experience in doing these procedures.

The skin can stretch over time especially over the muscle .  I find going under the muscle can really help keep the implant in position and prevent encapsulation .   Downsizing your size and changing pocket position you may need skin removed which means a lift which would put a scar on your breasts .   Best to seek out a board certified plastic surgeon who can show you lots of pics as being seen in person is best .   Good luck !