36DDD saggy breast solutions. Would it be reasonable to hope for close to the same cup size but round and high?

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another. See the below link on some suggestions on finding the most qualified Plastic Surgeon for a  Breast Augmentation

Hi morejmb; As the others here have said, you can either consider doing a breast lift with or without breast implants. You can do both together in one procedure or do the breast lift first. Regardless, the long term results depends on the strength and quality of your breast tissue and skin; the worse the collagen and elastic quality of the tissue, the higher the risk of an additional procedure to either fix a loose breast pocket or further lift and correct the loose breast tissue. As plastic surgeons, we cant change the canvasses that our patients bring to the table. Based on our experience and surgical abilities, each of us has our reasons for doing a single stage breast lift combined with implants or break them up into two procedures. In my practice, when the patient may not need implants and has large breasts or has very small breasts to their body size, I will do the lift first in most cases. In those patients that desire upper breast fullness and have deflated breasts, I will combine the procedures with good results. Without the benefit of photos, there is not any way to advise you. A full consultation and exam is the best way to advise anyway. We have a Vectra 3D imaging system that can simulate the results from these procedures and enable more thoughtful discussion during your consultation. Best. 

Thank you for your question, You do not need implants! All you need is a breast lift that will use your own tissue to fill the top of your breasts. The Bellesoma Method was not only designed to achieve upper pole fullness without implants, but it has also eliminated the dreaded vertical scar component. Breasts are beautifully reshaped and elevated with minimum scarring. Long term results are this technique's hallmark. An internal support is fashioned using a woman's own tissue to keep the newly shaped breast high for years to come. Nipple sensitivity along with the ability to breast feed is also preserved. Remember, implants are not stable devices and as such require maintenance in the form of costly revisions. I hope this helps. Best wishes and kind regards, Dr. Gary Horndeski

Thank you for your question and goals. The indications for an augmentation-mastopexy (breast lift with an implant) is usually because you have volume deficiency and/or asymmetry of your breasts with accompanied ptosis (which is the sagging of the breast). From your description "same cup size but round and high", I think you would be a good candidate for this procedure because you want extra fullness up top. With a breast lift alone, you would have a better nipple and breast position but not the extra "round and high." I think you should see a plastic surgeon who can give more detailed information after she examines you and can answer all your concerns and make a plan with you to achieve your goals together. Good luck!

Best wishes, 
Dr. Suzette Miranda 

Hello,
Although it may sound like opposites, this surgery reduces excess and ptotic breast tissue and skin, and replaces it with sub-pectoral implants.  Reducing natural breast tissue and adding back large implants changes the balance of your tissue to implant ratio, making your breasts more idealized (read fake looking), a quality that women with sagging breasts frequently desire.  Like augmentation mastopexy, this is a difficult surgery and has a high complication and revision rate in the hands of surgeons that don't perform this surgery on a regular basis. Go visit a few ABPS certified/ASAPS member surgeons that specialize in complex breast surgery.