Hello and thank you for your question. From the picture you have provided, you have some striae (stretchmarks) throughout the upper breast pole and some associated flatness there as well. From just this view, I cannot tell if there is any ptosis (drooping/sagging) present, or if you just have a deflated upper pole. The "donut lift" you are referring to addresses a different issue than the dual plane technique for breast augmentation. Regarding the "donut" incision sometimes used for mastopexy (breast lift)- this incision is only used when there is minimal excess skin and the nipple areolar complex (NAC) needs to be slightly repositioned or lifted a max of 1-2 cm. It results in changed to the breast shape- breasts tend to be flatter after this technique. Also the most common complication after the procedure is NAC widening. The vertical (or "lollipop") incision allows for removal of more skin than the other technique, would allow you to lift the NAC higher than 2 cm, and would not result in flattening of the breast shape. Also it would be better to help control the symmetry achieved with the surgery. Regarding the vertical scar, if you adhere to proper scar care and sun avoidance after surgery, it should eventually heal to be minimally noticeable. If you are happy with the size of your breasts in a bra, and their size is pretty close (hard to tell here), then the volume is not the issue, so breast augmentation would not help you achieve your goals. If you desire more volume, that's when breast augmentation (implants) can help. Generally, any technique for breast augmentation can provide a very minimal amount of lift to the breast, so if you are on the border of even needing a breast lift but you also desire improved volume, breast augmentation alone might be sufficient to achieve your goals. The difference between subglandular (above the muscle), submuscular (below), or dual plane technique concerns the plane in which the breast implant is placed, not the amount of lift achieved. The main benefit of dual plane placement, is it can provide a little more upper pole fullness by partially releasing the pectoralis muscle. With all that said, it is always difficult to provide tentative surgical recommendations, as there is only so much information to be gained from any photos and descriptions provided. I recommend for you to come see me or another plastic surgeon for a formal consultation to thoroughly discuss your surgical goals, undergo a formal examination, evaluate all your options (surgical and nonsurgical), and decide on the best procedure(s) for your specific case. I hope this helps! Best wishes, Dr. Donald Groves Plastic Surgeon