In general, when breasts are still this low and lax so early after a breast lift procedure, it means to me that either the lift was not performed aggressively enough, or the wrong technique for lifting was selected. Some techniques are more "powerful" lifts in that they allow for more tightening and more reliable lifting of the nipple and breast tissue. It appears as though you had a vertical, or "lollipop" lift, and this technique is a great technique, but if there is enough looseness of the breast tissue, it may not be enough to get the breasts where we would like. While these types of decisions are best made in a personal consultation, and I typically don't like being a "Monday morning quarterback" and second guessing my colleagues, in this case, I believe based upon your one week images, that the technique either was not applied aggressively enough, in other words, not enough was removed to sufficiently tighten the breasts, or it was not the best technique to use, and another type of lift should have been used. This isn't really "bottoming out" as that refers more to implants that have migrated too low on the torso and now rest below the fold under the breasts; this is really residual, or persistent, ptosis, or sagging of the breasts. There is always some recurrent loosening of the breast tissue following any lift, and we need to take this into consideration when planning these operations, however, even that isn't totally responsible for your current appearance as even at one week you were still too low and loose, not to mention the asymmetry that either is left over from before surgery or is a new finding and the result of the surgery itself. As for selecting the size of implants, all I can say is that these operations are always a balance between removal of some breast tissue, addition of more stable volume in the way of an implant, and tailoring of the loose breast tissue and skin to fit the breast mound. I usually like to go by photos of desired breast shape and proportion and then use sizers in the operating room to find the best size of implant to most closely produce the desired outcome. It is very hard for me to accurately pinpoint what size of implant will do that before the surgery, thus I like to have the latitude to select from a number of different sizes. Your result is not "horrible," in that you have healed, and you have natural looking breasts overall, but it is less than ideal in my opinion.
