What can be done to help me achieve a more perky appearance after two failed breast augmentations and a capsulectomy? (photos)

For achieving a tighter and improved breast appearance after explant surgery, fat grafting can be an excellent option. Here’s how it might help:
Fat Grafting Benefits: Fat grafting can help restore volume and improve contour in areas that appear flat or wrinkled after explant. It’s particularly useful for enhancing the overall shape and providing a more natural look.
Combining Techniques: Consider combining fat grafting with a breast lift. A lift can address sagging and reshape the breasts, while fat grafting can add volume and improve the texture of the skin, reducing the "shriveled raisin" appearance.
Smaller Areolas: If you’re interested in reducing the size of your areolas, this can be addressed during the breast lift procedure. Your surgeon can discuss the best approach to achieve your desired look.
Avoiding Donut Lift: If you prefer not to use the donut lift technique, other lift options include the vertical lift or a more traditional anchor lift, which might better suit your needs.
Consultation and Planning: A thorough consultation with a plastic surgeon experienced in fat grafting and breast lifts will help you develop a personalized plan. They can assess your specific situation and recommend the best combination of procedures to achieve your goals.
Understanding these options and discussing them with your surgeon will help you find the best path to achieve your desired breast appearance.

It’s unfortunate you’ve had such a negative experience. A lift and areola reduction may help you achieve a less “shrivelled”, proportionately contoured appearance. No implants are needed.