Bellesoma breast reduction/lift or auto augmentation? (Photo)

I’ve historically been on the bustier side, but with ongoing weight fluctuations I’ve developed noticeable sagging and a loss of upper pole fullness. At this point, I’m considering surgery both for physical relief, since I deal with chronic back and shoulder pain, and for aesthetic reasons. My goal is to reduce some weight while achieving a lifted shape with better fullness at the top, but without feeling overly heavy. I’ve been researching a Bellesoma breast reduction with lift versus a reduction that incorporates auto-augmentation through internal tissue rearrangement. From what I understand, both approaches aim to improve upper pole fullness without implants, which is important to me, but I’m trying to better understand how they compare in terms of long-term results, especially with weight fluctuations. I’m also curious how surgeons view these techniques when the procedure is being pursued for documented physical symptoms, since I would ideally like to go through insurance for the reduction component if possible. I’m trying to find the best balance between functional relief, aesthetic outcome, and longevity, and would really appreciate insight from surgeons or patients who have experience with either approach.