Why are my breasts so low & sagging? (Photo)

Thank you for the question and photos. It is difficult to comment on these,since all the photos are post op and you do not provide any pre op photos. You have breast asymmetry with some scarring issues. Your right breast has glandular ptosis (sagging) which was not addressed adequately during your surgery. The fact that your surgeon insisted on one size implant only, would've been the time to walk away and seek a second opinion. Now it is harder to walk away, work with your surgeon on a possible revision in 5-6 months. Good luck.

You will want to discuss this with your surgeon.  Part of the issue is that the larger the implant that is used in someone with a droopy breasts, the less skin that can be removed to lift the breast.  It is kind of like a see-saw in that you have shape on one end of the spectrum and size on the other.  A happy medium is a compromise of the two unless you opt for a two stage procedure.  Your surgeon may have been concerned with removing too much skin and resulting in an exposure of the implant if your vertical incision did not help.  Acellular dermis or a mesh sling is helpful in these situations but more costly.

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.