Hello and thank you for sharing your question on RealSelf.com.Your concerns are not that uncommon with women who want to be lifted and have a large breast size. This may be one of the most frustrating problems for both patients and their plastic surgeons.The main issue is that all sagging breasts have thin skin with loss of elasticity. That is why they tend to sag as one ages or after pregnancy and breast feeding. There are several ways to lift a sagging breast. There is no good way to give a woman at the same time skin that is more elastic and youthful. At the same time, an implant does give upper fullness but will also in some women pull the breast down from its weight. The bigger the implant, the heavier it is and more chance to pull the breast down.Sometimes, a second lift is needed to get the results you want. That may necessitate a smaller implant as well but not always. In your case, it does seem that they are sagging again. Very frustrating, indeed. Best bet is to allow your breasts and scars to fully heal and then discuss your concerns with your surgeon. I hope this explanation helps you understand why this problem does at times occur.
Thank you for your photos and question. At this point, it is unlikely your result is going to significantly change. Although I do not have any preoperative photos, you look to overall have a good result given your overall frame and breast size. A breast lift will elevate your nipple position however your breasts will always settle somewhat as you heal. I do not think further lifting will provide more superior fullness. Similarly, your breasts are essentially touching in the mid line, so I am unsure as to how much more cleavage you were expecting. Certainly, discuss your concerns with your surgeon. He or she is the best person to give you advice regarding your results. Best regards.