Would I benefit from breast lift or breast fat transfer?

The short answer is both!  A breast lift will make your breasts look smaller, but will make them perkier.  A fat transfer will increase the volume and even out the asymmetry, but will not make them perkier, so ideally you should have the combination!  Good luck!

You need a formal evaluation by a licensed plastic surgeon and expert in breast augmentations to determine what is best for you and your goals.Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient. Every woman who comes to my practice has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure. For those women who prefer a "Natural Breast Augmentation" without implants, fat grafting is a safe, natural, and minimally invasive approach that offers low-maintenance, long-term improvement in size and contour. After harvesting the fat from your body, we purify and enrich the fat before injecting it in the desired areas to improve volume and shape.
My experience performing thousands of aesthetic breast surgeries in a wide anatomical range of patients enables me to achieve consistently beautiful and natural results that are customized to each patient’s body type and goals. These results are the product of extensive communication, meticulous planning, and skillfully executed surgery.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Augmentation surgeries. - Dr. Cohen

Yes, I can see that you have a small amount of ptosis to your breast and a breast lift specially a periaereolar mastopexy can suffice for you. Along with that, you can easily go for a breast fat transfer at the same stage to give you a great result. 

The answer to your question depends mostly on the shape and size you are looking for.  Breast fat transfer, like insertion of a breast implant, will increase the breast size and thereby fill out your breast skin and lift the breast a little.  So if all you want is larger breasts with a slight lift, then the fat transfer might be enough.  However, my perspective is that to get the most attractive shape, you would need a breast lift to remove extra, stretched out skin and especially raise the nipples higher and into a more central position on the breasts.  On the other hand, if you don't mind the very low breast position, then you can avoid the lift.

Dear D2018M,My preferred lift is a lollipop lift when a periareolar won't do (ie greater than 2cm lift required). The lollipop technique was created by a Canadian plastic surgeon named Elizabeth Hall-Findley and treats the breast as a three dimensional structure instead of two dimensions (anchor - lift). Most importantly it does not require the horizontal component scars that the anchor-lift requires and breasts appear much more natural, lifted, and less boxy. Lastly, the lift lasts longer because the lollipop doesn't rely on the skin to hold the breast up, its actually breast tissue thats being brought together to support the breast and hence improves longevity. If you are considering a surgery, I would suggest you to consult a board-certified plastic surgeon. Only after a thorough examination you will get more information and recommendations.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Breast lift rather than breast fat transfer.  Lollipop lift is a relatively easy technique and requires less time to perform and works well in the right patients.   A vertical lift has the potential to help you a great deal without the complete anchor incision.The full breast lift allows for the surgeon to create a much tighter result with nicer shape and greater longevity.  There are so many subtleties here that you are best to look at results of plastic surgeons.  The round, perky, high, tight breasts with superior pole fullness are achieved by few.  Another key is longevity based upon the relative laxity of the skin.  Find the plastic surgeon with ELITE credentials (ABPS board certified, experience, education, training) who performs hundreds of breast lifts each year with the type of results you are seeking.  Kenneth Hughes, MD, ABPS Board Certified Plastic SurgeonLos Angeles, CA

Fat
transfer would be unsuccessful.  You
would benefit from a breast lift and the technique I recommend is The Bellesoma
Method.  This 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.  Vertical scars are avoided, nipple sensation
and the ability to breast feed are maintained. 
The lollipop lift would be ineffective since your breasts are too ptotic
and creates ugly vertical scars, nipple numbness and the inability to breast
feed.  Best Wishes,Gary Horndeski, M.D.

The most important step for improving your breast shape would be a breast lift.You could potentially add implants or fat grafting for more fullness, once the skin envelope and nipple position has been corrected with the lift.But skipping the lift and just doing fat grafting or implants alone is unlikely to give you a pleasing, "perky" shape.

Hi and thanks for the photos.  A lift with a small implant for shaping purposes will give you a nice, more rounded shape up top yet not add to much weight.  The nipple would also be raised and your breast fold shortened.Its a good operation if you do not mind the tradeoff for the scars. 

D2018M.  It appears from your photographs that a breast lift is by far your best option. You will not achieve much lift with fat transfer alone. Mastopexy will give you perky, more shapely breasts. However, be certain to consult with a board-certified plastic surgeon in your area. Good luck.