Thinking about a breast reduction, now 36D. What are my options? Is it worth it? (Photo)

Though you're not a typical breast reduction patient, it doesn't mean that you wouldn't benefit from the surgery and some of the happiest patients are those who had a relatively small reduction.  Based on your photos, I would use recommend a vertical (lollipop) breast reduction.  Though you would have to accept scars to achieve your goal size, the scars around the areola and extending vertically on the breast will frequently heal very inconspicuously.  Given the relatively small amount of reduction anticipated for breasts of your size, it is doubtful that your insurance would cover the procedure, so you should plan on the procedure being self-pay.

Your
breasts lie quite low, lateral and may be the cause of your symptoms.  The technique I recommend is The Bellesoma
Method.  This technique will reshape your
breast tissue creating upper pole fullness without implants, elevate them
higher on the chest wall and more medial to increase your cleavage.  The weight of the breast is transferred to
the underlying pectoralis major muscle resulting in pain relief and long term
stability.  Vertical scars are avoided,
nipple sensation and the ability to breast feed are maintained.  The breasts can be reduced slightly at the
same time if desired.  At size 36, each
200 grams removal corresponds to 1 cup size change.  To achieve a 36 B, you would require 400 gram
removal, which may be excessive.Best Wishes,Gary Horndeski, M.D. 

Hi and thanks for your questions. After reviewing your photos and description, it seems that that you would be a good candidate to have a breast reduction and lift using the Bellesoma technique.   
Bellesoma is a new breast reduction and lift technique that seems like it would be a great fit for you.  This procedure utilizes 3-D volumetric scanning and a multi-point measuring system to design a precise surgical blueprint exactly tailored to your body and the reduced breast size that you desire. The Bellesoma procedure reduces the sagging and weight of your breast, lifts your breast and reduces areola diameter, preserves the nipple sensation, and looks as full and perky as if an implant had been placed without using any implant, so no need to compromise.  One of the huge positives of this technique is that there is no vertical incision traveling down the front of your breasts.
Some of the differences between Bellesoma and the traditional breast reduction/lift techniques:
-Bellesoma creates upper pole fullness that traditionally needed an implant to achieve.
-There is NO vertical scar, only well-hidden scars in the fold under the breast, and around the areola.
-The breast is dynamically supported by attaching it to the muscle, so there is no recurrence of sagging which are expected with traditional lifts or reductions.
-The entire central portion of the breast is undisturbed, so nipple sensation remains intact and is very unlikely to be compromised.
-For absolute best results, patients should have a stable weight and have a BMI under 30.
The procedure is accomplished by using the skin of the lower pole of the breast (the part below the nipple that sits in the bra cup) to shape the whole breast into a perky dome, then straps are made of the extra skin, anchoring it to the underlying chest muscle so that there is virtually no chance of repeat sagging.  The skin that above your nipple and below your collar bone is utilized to cover the perky, lifted dome that has been created and then a new (usually smaller) circular opening for the areola is placed at the high point of the cone, creating your new lifted, full and shapely breast.
From your description, you seem to be a very good candidate for this new technique and should really get the look that you are desiring without implants or unnecessary visible scars. I would recommend that you search for an ABPS board certified plastic surgeon who is also a member of the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgeons in your area or an area that you would like to travel to on holiday who offers the Bellesoma technique to discuss your breast reduction and possible results.
Best wishes!
Daniel Brown, MD, FACS Diplomate, American Board of Plastic Surgeons MemberAmerican Society of Aesthetic Plastic Surgeons MemberAmerican Society of Plastic Surgeons Real Self Top 500