"In the past 4 years I have had 2 children & breastfed both for the first year causing the need to revise. I was a 32 B prior to my first augmentation 8 yrs ago; now a deflated VS D. I have Mentor silicone implants 375 & 425. I’m hoping to increase my size to a full DD; maybe 550cc? The PS said it depends on what my tissue can support. He intends on doing lateral capsullorhaphy & an UHP implant. Will this improve cleavage, sagging or would you also recommend inferior “tacking”, a lift?"
I think you will benefit from 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 and laterally. Associated issues with positioning of nipple/areola complexes should improve with this operation.
Generally speaking, the use of acellular dermal matrix or bio synthetic mesh for patients in your situation may be helpful occasionally. This material may be helpful as a supportive matrix and help with the breast implant displacement/malposition you are experiencing. I usually recommend their use depending on the patient’s anatomy (for example quality/elasticity of the involved skin) and past surgical history.