Should I get a breast lift or is an areola reduction enough? (photos)

You will not get an adequate result with areola reduction alone.  The nipple would still point downward and the degree of gather that would be required to get the large circle to close around the small new areola would leave a pretty significant and gathered scar with a tendency to spread and widen.  You would do much better with a formal mastopexy.  The size of the areola may make this a somewhat complicated procedure, depending on the amount of unpigmented skin you have beneath the areola.  The margin between a great and poor result in cases such as this is slim.  I would recommend you see an expert in the field.  Certainly a board certified plastic surgeon but beyond that, one that does a lot of breast lift surgeries with excellent outcomes.  Best of luck.  

The majority of my patients who have nipples at the lowest point on their breasts wish to have a full breast lift rather than just a reduction in areola size.  A plastic surgeon could describe the different types of breast lifts in detail and their expected outcomes.

To downsize your areolas, you will need
a full mastopexy. Not only will it downsize your areolas to a nice, crisp round
shape, but also your breasts will be nicely reshaped and lifted. The
satisfaction rate is very high with these procedures and I would not hesitate
to recommend it to you. Know that the procedure can affect your ability to
breast feed, so you want to hold off if this is important to you. Thanks for
sharing.