Are my only options a lift with implants or implants over the muscle? (Photo)

Hi from Istanbul, thanks for your question. For this type of sagging, I usually recommend placing the implants over the muscle, as placing them under the muscle would definitely lead to a waterfall deformity. Adding a slight lift can help you achieve the breast appearance you're dreaming of. Hope this helps!

Because your nipples appear to be located below your breast fold, a lift would be recommended. The implants can then be placed above or below your muscle (whatever is recommended by your surgeon). A lift and augmentation would most likely give you the more obviously augmented look.

Thank you for your question and photos. Your pictures show loss of upper pole volume, and very mild ptosis. Both nipple/areolar complexes are at the level of your inframammary crease and point directly forward. I pre-pectoral or submuscular implant can be placed. This will give you a more youthful appearance, and improved shape and projection. In my opinion, a lift is not required.

From the submitted photos it is possible for you to consider implants under the muscle. The question is the lift. It does appear you have nipple asymmetry which would only be corrected with a lift. I encourage you to visit with a few board certified plastic surgeons in your area to listen to varying opinions based on your desired surgical outcome.

Your nipples are a bit low but not so low that you require a lift. You have more deflation than true sagging. If you have a properly done dual plane augmentation, I think you will have a very nice result without the scar or cost of a lift. You also have the advantage of a more natural look and lower complication rate by having most of your implant covered by muscle. You do have mild asymmetry with your left breast [or right if photo in mirror] has a slightly lower nipple and slightly higher breast fold. Neither of these will stop you from having a very nice result. Good luck.