5'8, 128lbs, 40yr old transwoman, HRT 2 yrs, trying to make sense of options! What can I do to pick the right dr? (photo)

Thanks for submitting your photos. Based on the photos I think that you will benefit from an inframammary fold incision with high anatomical implants. For your expectations the best available size would be 350-375 cc. The implants should be located subfascial as it will give a better natural look . Please consult with a board certified plastic surgeon.

Hello dear, thanks for your question and provided information as well..

The breasts may lose their elasticity and firmness which can be caused by different factors such as pregnancy, massive weight loss, lactation and aging. To reaffirm the breasts and restore the natural look your surgeon can perform a mastopexy or breast lift. A breast lift restores a firmer, perkier, and more aesthetically pleasing shape to sagging breasts. This not only can improve a patient’s appearance by restoring her youthful, feminine proportions, but  also help bras and swimsuits fit more comfortably and attractively. By removing excess, stretched out skin, reshaping the breast tissue, and raising the nipple & areola into a more forward position, a cosmetic surgeon can create a more youthful breast contour. Stretched, large areolae can also be reduced during breast lift surgery, creating an overall better proportioned, natural looking breast, Actually the perkiness on a person or another, depends on patients skin and breast tissue… Breast augmentation surgery increases or restores breast size using silicone gel implants, saline implants or in some cases, fat transfer. One of the most popular and frequently performed aesthetic surgery procedures, breast augmentation has a long and successful track record in satisfying women who wish to enhance, regain or restore balance to their figures.

Thank you for the question and pictures. Based on your photographs, I think that you are starting at a good place and should have a very nice outcome with breast augmentation surgery. Ultimately careful selection of plastic surgeon, careful communication of your goals (in my practice I prefer the use of goal pictures, direct examination/communication in front of a full-length mirror, in bra sizers, and computer imaging), careful measurements (dimensional planning), and skillful execution of the procedure will be critical.I would suggest starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well experienced board-certified plastic surgeons.
Then, I would suggest you visit a few surgeons whose practices concentrate on aesthetic surgery. 
***Ask to see lots of examples of their work and preferably speak/see patients who have had similar procedures done.I hope this (and the attached link and video, dedicated to transgender patient breast augmentation) helps.