The mastopexy scar is the number one tradeoff to consider. After all, we have a goal to create a pert well shaped breast which is pleasing bare, or in the nude. The bra is the great equalizer though you may not always want the full cover of one, and the scar may make you feel uncomfortable without.
Breast augmentation will provide the volume that you need and as I have indicated in my other responses about lift or mastopexy, augmentation may lift the nipple a degree if the nipple, the center of it, is at or above the fold under the breast. The implant may otherwise tend to produce a downward tilt to the nipple, a more "mature" look, but this may suit you and your life style just fine. If the scar will make you feel self conscience or unattractive by all means don't do it. Even if all surgeons say you will look "better" with the lift, stick to what is right for you. A lift can always be done at a later date if you wish.
With your loose skin, breast augmentation requires special care reguarding implant selection, placement, and size. The implant needs to be placed with consideration as to the tissue cover, and be of a size adequate to take up the loose skin. The pocket should create a soft smooth augmentation with a good marriage between breast and implant to that they feel as one. Take time to choose an experienced surgeon who has your interests at heart.
Best of luck,
peterejohnsonmd
