Will implants alone achieve my desired rounder and fuller 32d breasts with centered nipples, or is a lift needed? (Photo)

If you are getting breast augmentation with breast implants, the implant will be placed behind the chest muscle in most cases. There are a few exceptions where the breast implant is placed over the chest muscle due to the activity level you may enjoy.
At NorCal Plastic Surgery, we use gummy bear implants, which are smooth, round implants that will enhance the appearance of your natural breast, safely. They are among the safest and most commonly used implants for breast augmentation.
There are also a few options for placement of the incision, such as under the armpit, along the border of the areola, and under the breast. During your initial consultation, we will determine implant placement and incision type.
Breast augmentation can also be achieved with breast fat grafting, which uses liposuction to collect the fat and then small cannulae to graft the fat into the breasts. Many women also combine breast augmentation with a breast lift, which can help improve breast sagging.

You have a very mild tuberous breast--in my practice, I usually treat these with a breast augmentation (dual plane or subfascial, with a few other steps to help round out the breast), and avoiding a lift unless necessary. The nipples often become less puffy as a result of breast augmentation alone, but after the augmentation if you still would like less puffy nipples, I typically do the donut/Benelli lift in a second stage. Combining the augmentation and lift I typically reserve for more pronounced tuberous breasts.

Based on the photos and description of your goals you will have the best result from implants and some degree of a lift. The areola size can be addressed with the lift. You also have some asymmetry that would be improved. See a board certified plastic surgeon near you for a consultation to learn more.