You are right, you have tuberous breasts of high grade of deformity, being your concerns more than justified; I am treating tuberous breasts and using my own proprietary technique more than 15 years ago, and many many patients come to me with the same question: may I be fixed without implants?The answer is: theoretically yes, in practical terms not. I'll develope.You wish smaller areolas; ok, this is accomplished by areola reduction, not a big deal and no need for implants for such goal.You need a rounded breast mound, no conical shape, no tubular breast anymore; ok, also feasible with one (mine or others) of the techniques allowing the transformation from tubuloconical to round; implants neither required about this.But you also need, seek and would not be ever happy without it, you also dream of having these tuberous breast deformities corrected:-fullness of upper pole: typically empty in every and each tuberous breast due to the constriction righ which restrains the breast growth to such limited base-lowering of the inframammary crease: the constriction ring of tuberous breasts do set the submammary fold at a way higher than normal level thus leading to emptiness of brassieres, bikinis and a weird mammary shape-connected with the previous item you massively lack breast mass or volume, in crescent or banana shape, below your current submammary crease the anatomically canonical location of the new and required surgically-built inframammary creaseThese 3 previous deformities can be corrected ONLY using breast implants, highly recommendably anatomical shaped ones, and if possible polyurethane coated to prevent their typical cephalic migration in tuberous breasts. Other options as synthetic fillers, fat transfers, etc are dangerous, disappointing or deforming.Hence you have 2 options:-without implants: you'd get a small tiny ball of breast beneath the smaller areola, but no upper pole fulness, no reconstruction of the lower pole, no descent of the inframammary crease, it is a parcial correction and always a frustrating insufficient improvement, guarantee you'll seek surgery again to receive the implants-with implants: to receive both, glanduloplasty, areola treatment and reshaping plus full reconstruction of the tuberous deformity and complete repair; a really rewarding procedureOnce said, it is clear no one of my patients ever chose a partial correction, however I receive revisional cases of frustrated patients done elsewhere who seek the implants.I strongly recommend you seek the services of a surgeon highly experienced in tuberous breast deformity treatment, masters anatomical implants and if possible he has experience in polyurethane coated prostheses.See the link below to find many cases of my own practice very similar to yours which I had the opportunity to operate successfully on, sharing a lot of common features with the technical problem you have posted. If you wish better grounded opinion well lit, focused and standard images have to be assessed: frontal, both lateral and both oblique views, also underneath the nostrils. Feel free to request any additional information from me.