Your condition is often referred to as pseudo ptosis. True breast ptosis describes the relationship of the nipple position in relationship to the inframammary fold. Based on your pictures, your nipples are still above your inframammary fold which gives technically equals grade 0 ptosis. Pseudo ptosis is the term for lack of volume in the upper half of the breast, when the nipple position is still not below the inframammary fold, In addition, your breast diameter is slightly smaller, bordering on very slight tubular breasts. Both tubular breast, deformity and pseudo ptosis is best treated with implant augmentation. That transfer is good at increasing overall breast size by 1/2 cup, but does little to change the shape of the breast, and in the end your condition is more an issue of shape rather than of actual size. Such a transfer is not particularly good at restoring volume in the upper half of the breast. Grafted fat survives based on where the patient has the most abundant supply of host tissue, which in your case is the lower half of the breast. There may be good reasons to not want to have implant augmentation but in regards to pure aesthetic outcomes implants are without question your best option. I suggest having multiple in person, consultations with local board-certified plastic surgeons in your area. Ask each provider to open up their portfolio and show you their entire collection of before, and after pictures of the previous patient who had breasts similar to your own. An experienced plastic surgeon should have no difficulty showing you the before and after pictures of at least 50 previous patients. It may be challenging to find that many cases of patients who have the same breast shape, but a sufficiently talented and experience provider should be able to have examples of previous patients, who look very similar to what you do. That is the best way to get a clear understanding of what a single procedure can, and cannot accomplish, and good likelihood of what your results will look like. As a general rule of thumb patients, do not schedule enough consultations, and should be more selective when choosing providers. Best, Mats Hagstrom, MD