Complex breast revision after 3 surgeries, Nuss repair, tight submuscular pocket/capsule—what are my best options? (Photos)

I’m a 30-year-old trans woman, 5'11", seeking advice about a complex breast revision after three prior augmentations and a history of Nuss repair. I currently have 415 cc moderate-profile implants placed under the muscle. My inframammary folds were lowered modestly, and I previously had areola reduction, but the circumareolar/donut lift I requested was not performed. My main concerns are persistent firmness/tightness, limited implant movement, poor lower-pole expansion, a compressed/high appearance, wide medial separation, and nipples/areolae that sit lower on the breast mound than I would like. My surgeon has felt that the capsule and pectoral muscle are not stretching adequately. I am trying to achieve a rounder, more projected breast with fuller lower poles, better medial fullness/cleavage, and more centered nipples. For a fourth surgery, would you consider capsulectomy/capsulotomy with pocket reconstruction, additional IMF lowering, or conversion from submuscular to subfascial/prepectoral placement? Would a higher-profile implant be more appropriate than simply increasing volume in the same pocket? How would you approach nipple/areola repositioning after prior areolar surgery, and does my Nuss/chest-wall anatomy change the safest strategy? I’d especially appreciate advice on what type of revision surgeon/expertise I should seek.