Capsulorrhaphy & implant exchange (Photo)

Thank you for your question.  There is no question that you are bottoming out, otherwise known as inferior malposition of implants.  You definitely would benefit from an inferior and lateral capsulorrhaphy-suturing the pocket and mirror image capsulotomy-cutting the pocket.  A large proportion of my practice is dedicated to revisionary breast surgery, and I wrote the original paper on how to perform capsulorrhaphy. You should be able to have the result that you're looking for.  Best wishes to you.

I strongly recommend you choose the following:1. Anatomical shaped implants with ultracohesive 5G gel: being so skinny the round implants will look like 2 coconuts once they are settled beneath the nipples, and they do not fill the upper pole, about this the anatomical shaped implants are unique; additionally being so transparent your skin you are prone to ripple and be it visible, so the 5G ultracohesive gel is highly recommended to prevent such side efect.2. Capsulorrhaphy is, indeed, the one and only treatment for cases like yours, it is a very very difficult technique and you have to check the proficiency and skill of the surgeon carrying it ahead; if you wish additional fixation to prevent recurrence of the bottoming out dislocation then I'd tell you the top in the market about adhesion and fixation is the biovelcro of the polyurethace coated implants.See the link below to find few cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted.
If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also from underneath.
Feel free to request any additional information from me.

There
is no significant difference between 485 cc and 500 cc implants and your
breasts will bottom out again.  I
recommend explantation using The Bellesoma Method.  This will reshape your breast tissue creating
upper pole fullness without implants, elevate them higher on the chest wall and
more medial to increase your cleavage. 
Vertical scars are avoided, nipple sensation and the ability to breast
feed are maintained, if not injured during your previous surgery.  At the same time or later, fat transfers can
be performed if additional volume is desired.Best Wishes,Gary Horndeski, M.D.

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. 

Thanks for your question.  I agree that exchanging your current implants for a slight smaller volume, in combination with tightening of the capsule would be the best course of action.  I would also recommend using a mesh such as Galaflex, to serve an an internal bra for support.  Best of luck!

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. 

Based on your photos i would fix the pockets with a capsulorraphy, place Galaflex mesh to support the repair and use smooth silicone implants - whatver size you wanted. I am not a fan of textured implants due to ALCL concerns.