Once the breast is large, the skin stretches under the weight of the large breasts. After weight loss, unfortunately, skin elasticity does not improve. Adding a large implant to the equation will make the lift less durable. Large breasts and the maintenance of perkiness do not coexist. I find that a high profile gel fill implant can do a nice job of filling in the missing upper portion of the breast along with a lift with an inverted “T” scar. The more skin removed, the more long lasting the lift. If you are filling the space with a large implant, it makes taking out of the extra skin more difficult as some of the skin has to stretch to accommodate the implant volume. My best advice would be to find a board certified plastic surgeon who has experience with bariatric cases especially in breast.