Avoiding Vertical Breast Lift Scar?

Hello and thank you for posting. Avoiding the vertical scar is not a real option in your case. Not if you want to have the best results possible. Not even if you want to have mediocre results actually. Unless doctors tell you want you want to here instead of what you need, all surgeons will basically say you need a vertical scar lift for optimal results. 
Your breasts are asymmetrical, they are sagging and sit low on your chest wall.... plus most of your breast tissue is bellow your breast folds with a very low areola position. This is called Breast Ptosis and you are at, Grade 3 Ptosis. This means that implants alone will not lift them. You are actually a great candidate for a breast lift with implants with an Anchor type scar. 
Please understand that a smaller scar translates into less of a lift while larger scars equals more lift. This is why I think an anchor lift is necessary if you want the most perky results possible.
So the real questions you should be asking yourself are the following...
1. Are you ready for scars? Because if the answer is no, your simply are not ready for a lift.
2. Will you be happy with larger breasts that are still be saggy? With nipples that still look down and still sit on the bottom half of your breasts? (Probable results from a Breast Augmentation, regardless of a Donut Lift, to try and fill out excess or loose skin) Or... 
3. Will you be happy with very large breasts that are completely filled with very large implants that might weigh down your breasts and might make them sag or fall, faster then they should? And with nipples that still look down and still sit on the bottom half of your breasts ? (Probable results from a Breast Augmentation, regardless of a Donut Lift, with very large implants to fill out all the excess or loose skin) Or...
4. Will you be happy with bigger breasts that do not weigh too much, that are firmer, perky and more symmetrical but, with a larger scar that should fade with time? (Probable results from a Breast lift with Implants with Vertical or Anchor Scar technique with the correct sized implants plus skin and tissue excision for lift and symmetry.)
I feel that the questions most patients should answer yes to are questions number 1 and 4. If you want the best results and the longest lasting results, a breast lift with implants with the vertical scar is your best option. If your are ok with "soso" results then a breast augmentation alone is ok for you. But Most patients that try to avoid these scars, normally end up getting a revision as soon as possible. 
Best of luck!!
Dr. Miguel Mota

Thank you for your question. Unfortunately, there aren't any scarless breast lifts. You need to understand that there will always be a trade off - you will have scars but you will have the breast shape you desire. You cannot get one without the other. Anchor scars tend to be more unsightly, but may yield the best results for some patients. Other patients may get great results with a vertical lift, leaving a thin vertical scar that tends to heal very well.However, there are great scar treatment options out there! Using Embrace silicone strips or Biocorneum to treat your scars will reduce their appearance and aid in healing. 

In my opinion- none. Based on the your photo- the best way to achieve perkier breasts- and move your measurement to 23 or so cm-- you would need the anchor type lift.