Will simultaneous breast lift & fat transfer to breast result in suboptimal breast lift results? (Photo)

This is a great question. Starting with A cup before your initial implantation surgery will mean that after your explantation of your breast implants, your breasts will lose volume and drop a little more. In order to lift the breast, you will need to have a breast lift (mastopexy) to bring the nipple position higher. To add volume, fat can be transferred to the breast, however only a modest improvement in size and projection will be achieved in one stage. More volume can be added is subsequent stages with more fat, but may not achieve the perkiest breasts like you desire.
Therefore, in order to get the best shape, volume, projection and perkiness, replacing the implants with a lift will offer the perkiest results. If you want to have the implants out without replacement, then a lift with fat grafting in one stage is feasible, knowing that you may need multiple fat grafting sessions to get the volume and perkiness you want. The amount of fat available that can liposuctioned can be a limiting factor for some patients. It is also important to know that a lift with multiple fat grafting sessions will not give as good results as if you decided to have implants with a lift.
Fat grafting will not lead to widening of the scar or contribute to sagging of the skin. The sagging will happen over time regardless of fat grafting. Undergoing the breast lift with fat grafting in one stage is possible and safe, but in all likelihood you will need multiple rounds of fat grafting to get you to your goals.

It is difficult to determine the amount of breast tissue you have left without a physical examination. However, adding fat grafting during your breast lift surgery may help to improve the fullness and perkiness of your breasts. The amount of fat that is retained after fat grafting can vary, but a skilled plastic surgeon can achieve good results by properly harvesting and injecting the fat.

Combining the breast lift with fat grafting in one surgery is a common approach and can be safe and effective. There is no evidence to suggest that combining the procedures would result in suboptimal lift results or cause later sagging. However, it is important to discuss your concerns with your surgeon and determine the best approach for you based on your individual circumstances and goals.

Regarding the vertical scar, this will depend on the extent of your breast lift and the technique used by your surgeon. The vertical scar is often necessary to achieve a more significant lift, but your surgeon can discuss the location and length of the incisions with you before the procedure to help minimize scarring.

In terms of doing two separate procedures, it is possible to do the breast lift first and wait several months before considering fat grafting. However, combining the procedures can be more convenient and cost-effective. It is important to weigh the pros and cons of each option and discuss them with your surgeon to make an informed decision.

I hope this helps,
best of luck !