I'm looking for recommendations for the best breast outcome. What should I do? (photos)

It appears that you will benefit from a lift and augmentation. In your case I would use textured silicone breast implants placed under the muscle. Please know that implant placement is vital in long term esthetic results. Do not allow anyone to place implants over the muscle as there are no structures to impede implants from making their way down your chest. The result will be low lying implants that will eventually stretch things further and making correction more complicated. Placement of implants completely under the muscle will help keep the implant in place. I would also recommend you choose the smallest implant possible to reduce long term complications associated with implants (chronic pain, displacement, contracture, etc).Hope this helps,Gary Horndeski M.D.

Happy New Year. Thanks for your question.Based on your pictures, I think you would most likely benefit from silicone moderate profile implants placed under the pectoralis muscles, combined with a vertical breast lift. Under the muscle implants would show less rippling, as would silicone implants. This is important for you because you are thin and have hollowing of the upper pole of your breast. Under the muscle implants will also give you a higher, more perky result than over the muscle implants.Based on your pictures, I think you definitely need a lift. Without this the breasts would appear to hang off of the implants and your areolae would not be addressed. (You noted that you want them smaller.) The exact implant size and specific type of lift you would require would be determined based on a thorough consultation and exam, although we have a general idea from your pictures and could get very close to making the specific determinations with a virtual consult. Most likely an implant in the high 300 to low 400 cc size-range would be appropriate.Good luck. You appear to be excellent candidate for these procedures. 

You would do well with a vertical augmentation mastopexy (lollipop lift). In my opinion, you have enough ptosis to warrant a mastopexy done with the augmentation otherwise you will be back for a staged mastopexy (not that there is anything wrong with that if you are absolutely opposed to mastopexy scars). Thanks for sharing.