Your implant has not deflated but has gone south along with your breast tissue, so you have sagging or ptosis of your implant and breast tissue. An internal lift can elevate the implant position but it will not lift your breast tissue unless your tissues are very thin. You appear to have quite a bit of breast tissue so you would need both an internal elevation of the implant along with an external lift of your sagging breast tissue.
A larger implant will only give you a larger, heavier, more pendulous breast. Implants do not lift your breast. Patients are understandably not excited about the additional scars associated with a breast lift, but that is the only way you can achieve a more lifted perkier breast with better cleavage.
Thank you for your question. At this point adding a bigger size implant will add more volume and provide some lift. However, the grade of ptosis you have might be better adressed with a breast lift. A breast lift will raise and reaffirm the breasts by removing excess skin and tightening the surrounding tissue to reshape and support the new breast contour. The key is working with an expert, board certified plastic surgeon to get the best plan for you.
Based on your photos, I believe simply adding a larger implant would just give you a bigger version of what you have now. Pregnancy can change the breasts dramatically, and it appears that you will need a lift (lollipop scar or anchor scar) to achieve higher, perkier, more youthful breasts with centered areolas. Sometimes it can be helpful to remove some of the heavier lower breast tissue to minimize the risk of re-drooping. I think your focus should be on shape over size. With the appropriate surgery, you should be able to have a breast shape that makes you happy. Make sure you see a surgeon with significant revision experience to ensure the highest chance of a successful surgery. Best of luck!
You could definitely go bigger. This would correct the boxy shape of the breast. However it will be a low pendulous albeit larger breast. Your other option it to undergo a lift keeping these same implants. The breasts will be higher on your chest wall and have a nicer shape. Best wishes, Dr. T.
It looks like you need a lift in the photos that you posted. Implants alone will not do the job. Best of luck.
Breast lift, some advices
thanks for the question. To perform the breast lift I recommend a Periareolar Round Block Breast Lift ("Benelli mastopexy"), which has an unnoticed scar around the areola, and if we see (in the surgery) that we can't obtain adecuate projection just with the Benelli Lift, we have to perform a "Lollipop breast lift".
Dr. Emmanuel Mallol Cotes.-
So your doctor in 2013 was likely incorrect in just doing a implant exchange, while I am guessing he had a conversation with you regarding a lift at that time, you were likely a borderline case at that time and sometimes surgeons will try to get away with doing just the augmentation without the lift. Regardless of what happened in the past, at this point you would benefit from a lift to reshape the breast and reposition the nipples into a higher/more natural position. The implants may need to changed out or it may be possible to keep them and tighten the capsule and/or add an internal mesh/sling to help with the superior breast fullness you likely desire. In addition to all of this some surgeon promote adding some fat grafting to the superior and medial aspects of the breast to assist with the cleavage area. Simply adding a bigger implant at this point might look ok immediately post-op, but once the implants settle will not look good and likely as worse than what you look like now.
Breasts saggy and deflated after implants then childbirth
As much as you probably want to avoid scars on the breasts, do not get bigger implants to avoid a lift. Even if they look good right after surgery, they will sag even lower within a few months. I encourage you to visit a board certified plastic surgeon (or a couple) to discuss what you want and see if your anatomy will allow for the look you hope to achieve.
Thank you for your question. From your pictures it appears that you have residual ptosis or sagging of the breasts which has led to a deflated appearance. A larger implant alone would likely make the problem worse. If you are satisfied with your volume I would recommend a breast lift or mastopexy. There are multiple techniques that can be used based off of your exam, tissue quality, etc. Seek consultation with board certified plastic surgeon to help you accomplish your aesthetic goals.
Do I need a lift or can I go with a bigger size implant?
I am sorry to hear about your concerns after breast surgery. Based on your photographs, it is clear that the one operation you will benefit from is breast lifting; the use of a larger breast implant alone will not help you in the long term. In my practice, I would offer you a breast lift operation first; breast lifting and capsulorraphy surgery will allow us to achieve a good foundation. A second stage breast re augmentation procedure will likely be necessary to achieve good cleavage and upper pole fullness if you so choose.
It will be important that you select your plastic surgeon carefully and communicate your goals carefully as well. Best wishes.