Do I need a breast lift or can I just get a fat transfer? (Photo)

First off, congrats on your weight loss. I tell my patients it's nature's cruel consolation prize that for your good efforts and weight loss success you receive breast deflation in many cases. But to answer your question, you need a breast lift. This may not be what you were hoping to hear, but it is based on what is called the Regnault classification of breast ptosis, or sag. The classification system essentially says that if the nipples are almost at the level of the under-breast fold, or inframammary fold, then you may achieve an aesthetically favorable result with augmentation alone, but if they are below being just under this fold then a lift of some sort is usually required. The third stage is when the nipple-areola complex is at the lowest point on the breast mound, and this virtually always requires a lift for optimal breast rejuvenation. Also, an additional element that may not excite you...if you receive a lift procedure that creates tissue flaps, then fat grafting at the same time is not advised, because it can cause trauma to those flaps and impair healing. So some things to think about and talk with your surgeon about before surgery, which should always be designed tailored to you and your goals. Good luck on your continued journey.

Fat grafting will improve the volume and shape of your breasts provided that you have sufficient fat to graft .In your case a mini mastopexy may be necessary.

Your nipples appear to be located below your breast fold, therefore a lift would be recommended. Fat transfer would most likely be insufficient. The lift can also improve asymmetry.