As a general statement, there are three main variables that determine breast augmentation outcomes. The first is the patient’s candidacy for the procedure in the first place. The second is implant selection in regards to shape size and type and the third is the surgeons ability to put the implant in the correct anatomic location. Patient candidacy is important. Patient candidacy includes variables like breast shape, breast position on the chest wall, breast divergence, and the degree of breast droopiness. For example, in your case you have significant breast divergence, which is more on the right then on the left. Your left breast sits slightly higher on the chest wall in your preoperative pictures, which is true for most people. The position of the breast on the chest wall is determined by the position of the IMF (infra mammary fold) The IMF is higher on the left side in your before picture. We can’t see the IMF on the left side in the after pictures. It’s possible your provider opened the IMF in order to make room for an implant that’s wider than your natural breast diameter.In regards to implant selection, each plastic surgeon will have their own way of guiding patients through the implant selection process. Regardless of what implant type or shape is used anytime excessively large implants are used the chance of undesirable side effects, complications and then need for revision surgery will go up. in many ways, the issues your having are related to implant size. Implant size and potentially the positioning of the implant are probably the biggest issues excluding the breast divergence, which was directly related to your candidacy. It’s important for us to understand if the implant was placed above or below the pectoralis muscle. The surgical placement of the implant has a big part in what the results look like and the especially the potential for the results to change over time. When placing an implant behind the pectoralis muscle are usually try to keep pectoralis muscle intact, and attached to the chest wall to allow the muscle to support the weight of the implant against gravity. When the muscle is transected the contraction of the pectoralis muscle and gravitational forces can push the implant down. If the implant is placed above the pectoralis muscle, then the implant cannot be held in place by the muscle itself. Both above the muscle and below the muscle are appropriate approaches, though most plastic surgeons, myself included, seem to prefer putting the implant below the pectoralis muscle because of the several major advantages. It doesn’t look like you’re implants are bottoming out and that’s a good thing. To make a quality assessment regarding the outcome of any plastic surgery procedure we need quality before and after pictures. If you don’t have those then ask your surgeon to forward them for you. Try to keep your arms down by your side when taking pictures. Take pictures from about 6-8 feet away. Use the timer on your camera or have someone else take the pictures for you. Overall, I think the result looks pretty good. I don’t see any strong indication for you needing any revision surgery. I think using smaller implants would have made things a little easier and potentially giving you a little more natural outcome. Implant envy is a real thing and lots of women like big implants. Big implants cause a lot of problems. Best, Mats Hagstrom MD