DD - sagging and back pain - Considering a reduction, lift or augmentation. What should I do? (Photo)

Thanks for your question! You need a breast reduction/lift. If you simply put an implant in, your breasts will still be droopy but they will be even heavier. I actually think it would be counterintuitive. Find a breast surgeon that specializes in reduction and hopefully you will have beautiful breasts with imperceptible scars. Good luck!

The different options that you mentioned would yield different results. If your goal is to address things like neck pain, shoulder pain, headaches, and upper back pain, then reducing the overall weight of the breasts would be the way to go. That would most effectively be accomplished with a breast reduction. That would require scars that look like an anchor.
I would not recommend an augmentation alone. That would simply be adding more volume to the breast, which might make your back pain worse. From an aesthetic perspective, an augmentation alone would result in either a waterfall deformity or a very bottomed out appearance, depending on where the implants were placed.
A mastopexy (breast lift) would be appropriate to lift up the breast tissue, reposition the areolas, and reduce the volume modestly. This option wouldn't have as significant of an impact on the back pain, but would provide a lifted, natural-appearing result.
A reasonable option to maintain volume and reposition the native breast tissue would be to perform an Augmentation-Mastopexy (augmentation with a breast lift). That would preserve or increase the overall breast volume (so it wouldn’t necessarily address the back pain issue) and then lift the natural breast tissue so that the areola is in the proper position and the breast would have an aesthetic shape to them. Similar to a breast reduction, this would require scars that look like an anchor.

Based on your postal photo, you do have a large breast, descent or sack, and the only way that this can be corrected is by a reduction lift with a small implant. There will be the anchor looking scar, and if you feel you cannot accept the possibility of this scar then you should not do the surgery. Best of virtual consult with to get a better understanding. Expect fees to arrange from $10,000-$20,000.