Capsulorrhaphy & implant exchange (Photo)

Hello neighbor:The most important aspect of the surgery would involve modifying the pocket from inside. Some call it capsulorrhaphy. Others simply refer to it a internal pocket modification. As far as the implants go, you can either go up (modestly), go down, or stay the same. I would strongly recommend silicone because you are thin and would have a higher likelihood of seeing and feeling ripples if you were to choose saline implants. It should be beautiful. 

Thank you for the question and pictures. Based on your photographs and description of goals,  I think that you will do very well with a well planned/executed revisionary breast operation.  In my hands, this would likely involve capsulorraphy (adjustment of the breast implant capsule, maintaining better position of the breast implants below the nipple/areola complex).  In my practicI use a 2  layered permanent suture technique to close off the space inferiorly and laterally (towards the axilla). The use of acellular dermal matrix is an option ( although not usually necessary)  especially if significant implant rippling/palpability is present.
 The “internal bra” refers to a procedure where the breast implant capsule is utilized ( the procedure is called a capsulorraphy) to prevent the breast implants from moving too far downward or to the sides. Sometimes, the use of additional material such as acellular dermal matrix or biosynthetic mesh, may be helpful for additional support. In my opinion, careful attention to postoperative activity restrictions is one of the keys to success. In my practice, I asked patients to keep their elbows by their sides for the first two weeks after the procedure is performed. Longer-term activity is also restricted in an effort to avoid  the potential for implant malposition recurrence.
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well.   I find that the use of goal photographs and computer imaging are very helpful during this communication phase. Working together you will come up with a good plan to achieve your goals.  Best wishes.