I suppose the first thing to note is that you are a young lady with essentially "normal" breasts from the standpoint function. As many others have said, "normal" breasts come in all sizes and shapes, and the one that really needs to be happy with your breasts is you. Thus, I would never want you to feel as though you HAVE to EVER have anything done to your breasts. On the other hand, if there are specific things that you would like to have changed about the appearance or tone ("feel") of the breasts, that may require some surgery. This is why it is very important to be sure that you are truly not satisfied with the way your breasts look or feel, and then it is important to specifically analyze and identify what it is about them that you don't like so that an appropriate plan can be formulated to meet your aesthetic goals. It will be impossible to tell you precisely what can or should be done to address your breasts without a personal consultation and exam, but based upon your description of things and your images that you have posted, I can give you a few preliminary thoughts. It doesn't appear that you have true tuberous breast deformity, rather it's more like the lower tissues of the breast - between the nipple and the fold beneath the breast - are tighter, or more constricted, than the upper tissues. This creates a sort of shortening of the lower dimension and an increased length of the upper part allowing the nipple to sort of "fold over" the front of the breast. If this is coupled with a looseness, or lack of tone in the breast tissues themselves, it may make them look and feel "floppy" or "saggy." This type of thing is most likely genetically mediated and something that runs in your family or your specific genes. When breasts develop, it is a complex interaction between the enlarging breast glands which are responding to hormone signals at puberty and the supportive tissues in the surrounding fat and skin into which the enlarging breast gland expands. If the lower tissues are tighter and create some constriction, the upper tissues may be the "path of least resistance" and the breast preferentially expands that way, giving breasts that look like yours. This is not "abnormal," it's just one way that breasts can turn out. And if this is not the way you want your breasts to look, then we would have to do something to change that. Usually in cases like this we might perform a mild nipple positioning procedure, or a lift, with or without an implant, depending upon your specific needs and goals. In the end, this is usually an issue of "trade-offs," that is, what is more important? Is it the shape and position of breasts and nipples or having scars? If it turns out that having the scars required to create the other aspects of the breasts you want is worse than what you have, then surgery probably isn't for you. This is why it is so important to really decide what you want and then consult with an experienced plastic surgeon who can guide you in the right course of action based upon what you want and what your body and tissues will need to accomplish that. In addition to being certified by the American Board of Plastic Surgery, your surgeon should also voluntarily participate in the Maintenance of Certification program administered by that board. This is the best way to know that your surgeon not only has the best training and experience for the procedure, but that he or she has maintained currency in the certification requirements as opposed to practicing on a "lifetime" certificate which has only been reviewed once at the beginning of his or her career. For more information on this you can visit ABplsurg.org or ABMS.org. Good luck.
