Are my breasts tubular or just small?

Your breast have minimal herniation of nipple but no evidence of tubular breasts. You will benefit from breast augmentation with silicone implants though fat transfer is an option. Implant will give better projection and satisfactory results. Fat transfer will involve multiple procedures and unlikely to give desired projection. 

Hello and thank you for the question and sharing your photos. You don't have tuberous breast deformity. I believe you are an excellent candidate for breast augmentation. Topics to discuss with your surgeon are type of implant (gel vs. saline, smooth vs.textured), location of incision (peri-areolar, inframammary crease, arm-pit) and location of the implant (above or under the muscle). There are advantages and disadvantages to each technique. 
In term of implant type, saline or gel implants, each have their own advantages and disadvantages. Gel implants have a more natural feel and tend to have less rippling (implant visibility) compared with saline implants. Patients with gel implants are recommended to have periodic surveillance MRIs (every 3 years) to check for rupture/leak. Having said all that, both gel and saline implants can give nice natural results. Ask your surgeon to discuss these options with you. 

As far as texturing and shape are concerned, textured implants have been linked with a rare form of local lymphoma (also known as ALCL). Shaped implants can rotate in the pocket and cause  problems. I would only use smooth round implants, which give very nice and natural results. 

In terms of the incision, inframammary incision is a common approach that gives great access for creation of a natural pocket, heals very well and can be hidden under bikini. Periareolar approach can be utilized in patients with medium to large areola diameter. Trans-axillary approach is more challenging and associated with higher incidence of implant malposition, particularly in inexperienced hands. Additionally, if a revision is required, additional inframammary incision will likely need to be made to access the implant pocket.

Placing the implant under the muscle is associated with a smoother and more natural upper pole slope., and less risk of capsular contracture. Placing the implant above the muscle, in particular in thin-skin individuals can have the downside of visible rippling.

Regarding the implant size, many factors including patient's desired breast size, skin envelope (both quality and quantity) and breast width diameter among others are important in selecting the implant size. Choosing the right implant should be a shared decision between you and your plastic surgeon. In a typical consultation, you try a variety of in-bra sizers and in combination with several other measurements that your surgeon will do, the final implant volume is selected. Best,

Pejman Aflaki, M.D.

Johns Hopkins-trained double board-certified plastic surgeon