32DDD lift and implant or lift and reduction? (photos)

Hello and thank you for your question.  The
best advice you can receive is from an in-person consultation.  With that
being said, based on your photographs, the best shape and contour could be
achieved with an implant and a vertical or wise pattern breast lift.    A vertical or wise pattern lift with an
implant can result in a very nice shape if good technique is
used.    The size of the implant is based on your desired
breast size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.   Make sure you
specifically look at before and after pictures of real patients who have
had this surgery performed by your surgeon and evaluate their
results.   The most important aspect is to find a surgeon you are
comfortable with. I recommend that you seek consultation with a qualified
board-certified plastic surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Dear ravenvictoria,based on your photo, it does look like you will need a breast lift with either anchor or lollipop incision. If you want to get perkier breasts then a breast reduction might be an option. If there is enough breast tissue then you won't need implants. I would suggest you to consult a board-certified plastic surgeon.Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 

Member, Am. Society of Plastic Surgery