You will need anchor breast lift and breast implants. You do not have tuberous breasts. However you have marked sagging and lack of breast tissue. Thus you need breast lift as well as breast implants.
An areola reduction alone would not do any lifting. Neither would breast implants. For the pictures you posted, it looks like you have moderately to severely droopy breasts and that an anchor lift could be appropriate. You should also know that your surgical results can change in the future with pregnancies and significant weight change. If you decide to follow through with surgery, ask your surgeon if he/she use the IDEAL breast lift approach with the anchor lift. For more information on this and similar topics, I recommend a plastic surgery Q&A book like "The Scoop On Breasts: A Plastic Surgeon Busts the Myths."
If you are looking for more perky rejuvenated breasts then yes you will need a lift. The type of lift depends on the surgeon. All the options you talk about require additional incisions on the breast. So a lift would likely be an anchor lift. You have laxity of the skin and larger areolas. To address all of those I would likely also recommend and anchor lift and implants.
You do appear to have a fair amount of skin that would be best treated with the anchor lift. A vertical lift might work, but you would still have the possibility of the lower scar. Just doing the areolar lift would not deal with all your excess skin.
An anchor shaped lift is certainly one alternative, but there are others they can be done within incision around the areola and a vertical incision (lollipop incision). I find that more patients are comfortable with that incision so I really use the anchor shaped breast lift anymore
Yes, you will need an anchor lift to remove the excess skin and reposition your breasts and areolae. You may also want to have breast implants placed at the same time. Unfortunately, an areolar lift alone will not be adequate.
Hello and thanks for your photosWhile it's difficult to make a definite recommendation without examining you in person, I think that in general someone with a breast shape like yours would do best with a lift plus implants. The implants would expand the width of your breasts and make them appear rounder. The lift can be done many ways, depending on surgeon experience and preference, but I prefer a vertical (lollipop) type lift in this type of breast shape. I don't think that an "areolar reduction" alone is going to be effective in your case.
From your photos, I do not think just an areolar reduction alone will give you the results that you want. Just moving the areola slighter higher and giving it a smaller circumference will not give the breast a better shape.
Thank you for your question. Based on your photos, it does appear that optimal contouring would require some horizontal component of the incision along the breast crease; this can be a full anchor or a more limited variety. Be sure to consult with an experienced board certified plastic surgeon. Good luck!
Thank you for your question and photos. From what I can see on your picture, you would do best with a formal, full breast lift. This is primarily due to the low location of your nipples and the significant overhang of tissue below your breast crease. You have some elements of a tuberous breast, mainly the constricted, high breast crease and narrow breast. An areolar lift/reduction alone is unlikely to deliver a result with which you would be happy. You would likely do very well with a breast implant combined with a formal lift. Good luck.