If you don't like how your breasts hang
you will need a revision. From your photos, your lower poles are much too long, resulting in a concave upper pole and nipples that point upwards. If you like this look, then nothing needs to be done. But if you desire a fuller upper pole and nipples that point more forward, your lower pole needs to be shortened and the method of doing this will depend on where your fold is and what risks and complications you are willing to accept. If you already have an anchor scar, it could be used very easily to shorten the lower pole at least temporarily... and this can be done in the office under local to keep costs low.
Concerns after breast augmentation/lifting surgery…
I am sorry to hear about/see the problems you are having after breast augmentation/lifting surgery. I think your concerns are appropriate; your breast implants do seem to sit quite low on your chest wall, consistent with asymmetric breast implant displacement ("bottoming out”).
It is possible that you are feeling the implants significantly along the lower poles of the breasts. Also, consistent with the breast implant positioning problem, the nipple areola complexes seem to be sitting relatively high, because the breast implants have settled too low.
I think you will benefit from additional revisionary breast surgery which will likely involve capsulorraphy ( internal suture repair). This procedure serves to reconstruct the lower poles of the breasts and prevent migration of the breast implants too far inferiorly. Associated issues with positioning of nipple/areola complexes should improve with this operation. In my practice, this type of repair involves a two layer, permanent suture repair (reconstructing the inframammary fold areas). Sometimes, depending on the clinical situation and history, the use of additional support materials such as acellular dermal matrix or biosynthetic mesh is also helpful.
The good news: with a well executed procedure and careful attention to postoperative activity restrictions, significant improvement can be achieved.
Make sure that the plastic surgeon who does this procedure for you can demonstrate significant experience with this type of revisionary breast surgery. Again, key will be: your surgeon's experience level, careful execution of the procedure, careful attention to postoperative care/activity restrictions.
I hope this, and the attached link (dedicated to corrective surgery for bottoming out concerns), helps. You will find a separate page, on the same website, dedicated to revision surgery concerns in general.
I had a revision in my left breast and it is still much larger/lower than the right, does it need a second revision?
It is very difficult to give you good advice based on a single photograph so I would suggest that you meet with another board-certified plastic surgeon to get a second opinion in a face-to-face setting. Your photo suggests to me however that you may have only had a vertical mastopexy and if so or even if you have had a full mastopexy I think the full anchor pattern mastopexy needs to be repeated on both sides with placement of similar or smaller sized implants in a higher position. This may also include a capsulorrhaphy.
Your best advice again is from a face-to-face consultation. Get a second opinion which I think you will find helpful.
Jon A Perlman M.D., FACS
Diplomate, American Board of Plastic Surgery
Member, American Society for Aesthetic Plastic Surgery (ASAPS)
Beverly Hills, California
You have significant asymmetry and probably need something done for improvement. Without knowing the details of the first surgery and the revision, that's all we can say at this point.