I have Mentor, smooth round, high profile, saline, 330cc, 400cc final fill, under muscle. I want larger but not a lift. (Photos)

Hi sologirl123,

Determining whether you need simply a breast implant versus a breast lift or both can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position.

Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just breast augmentation depending on the size of the implant the patient wants. I often use an implant when I perform a breast lift because it provides more upper breast fullness after the lift.

These two surgeries can be done at the same time and this may be optimal as the risks can be minimized. 
My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift).

Most importantly, it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, it is actually breast tissue that is being brought together to support the breast and hence improves longevity.

In addition, upper pole fullness is achieved with appropriate implant selection but more importantly, submuscular placement, and precise pocket dissection. The submuscular placement allows the muscle to cover the top part of the implant which allows the upper pole to appear fuller. Keeping away from the lateral chest during pocket dissection allows the implant to remain higher and prevents it from falling off to the side.

You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.

Daniel Barrett, MD, MHA, MS

Certified, American Board of Plastic Surgery

Member, American Society of Plastic Surgery

Member, American Society of Aesthetic Plastic Surgery

Larger
implants will not solve your problem. 
You definitely need a lift and I recommend The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness, elevate them higher on the chest wall and more medial to
increase your cleavage.  Vertical scars
are avoided, nipple sensation and the ability to breast feed are maintained, if
not injured during your previous surgery. Best Wishes,Gary Horndeski, M.D.

 Although nothing will replace in-person evaluation when it comes to providing you with precise advice,  based on your photographs, I would be concerned that the use of larger breasts implants (without undergoing breast lifting also) will leave you with an aesthetic outcome that you will not be pleased with. Best wishes.