I have very saggy breasts & am currently a 34DD. Which type of breast lift would best suit my case? (Photo)

You have beautiful breasts already. Why do you wish to alter them? Yes they are somewhat saggy but they look beautiful and the sogginess makes them look ore natural.However if you seek a long term solution what you need is a formal mastopexy or breast lift. You will have at least a periareolar and a vertical scar. In someone like you I would try to avoid giving you an inframammary fold scar.You do not need implants because you already have plenty of volume. What you need is for that volume to be rotated up and give you great projection and perkyness.Getting an implant in addition would give you more volume but in the future you will have to replace the implants. In addition implants stretch the breast tissue and over time that creates extra saggyness.As you see there are many parameters here to simply be explained over internet consults.

In a consultation, we would clearly define what your cosmetic goals are - I see some differences in size/shape between your breasts - this issue could be addressed with a breast lift using a vertical technique. Your case is somewhat similar to the photo set I've linked below.

Hello Mpassion. Thanks for your post and photos. Without examining you, I cannot conclusively give you a recommendation for a particular breast lift. However, I would lean more towards an anchor pattern breast lift versus a lollipop. Best, Dr. ALDO.

Dear MpassionBased on your pictures, your breasts can be reshaped and your nipple-areola-complex can be repositioned with a vertical breast lift. This lift will often have a "lollipop scar"  but will give you the most projected breast shape. You can improve your breast symmetry at this point. I often recommend reducing the larger breast to the size of the smaller breast. If you also want overall larger breasts, then they can be both be augmented with implants at the same time. In my experience, this will often lead to the most symmetric outcome.  Take your time and see more than one plastic surgeon in consultation so you can make a well informed decision.

From your photographs, it seems that you would be best served by a lollipop or anchor pattern breast lift. You would probably get the best shape and longevity of results from either of these.

You might want to research results of breast lifts that give auto augmentation. This procedure also known as the Graf mastopexy is designed to suspend the drooping breast tissue to the muscle  to ensure upper pole fullness without resorting to an implant.  As you prefer the larger breast I would probably recommend autologous fat grafting on the smaller side and again avoid an implant

Thank you for your question.  The single most useful question I have found to ask people in your situation is: "In a bra, are you happy with the size of your breasts?".  Depending on your answer, that will help us decide what the best procedure is for you to undergo.  If you say that you're happy with your size in a bra then that leads me to talk more about a mastopexy or "breast lift" with you.  It may be the sagging of the breasts and the position of the nipples that really bothers you.  If you tell me that you would like to be larger than you currently are even in a bra then a lift and a small implant may be reasonable.  On the other hand, occasionally people even say that they wouldn't mind being smaller than their current size but would just like their nipples in a higher location.  This is someone who could benefit from a reduction.  Either way, in order to provide you with the best long term results, I think that using a short scar "lollipop incision" technique using the glandular breast tissue for support as opposed to relying on the skin for strength would both decrease the overall scar burden and provide excellent long lasting results.  I hope this helps.  Sincerely,Kyle Belek

Given your asymmetry, ptosis and particularly your desire for a long lasting result, I would recommend a vertical mastopexy.Although it is impossible to assess your breast firmness and skin laxity without actually examining you, the fact that you have stretch marks and feel your skin is loose means that some type of vertical lift at the time of your augmentation will likely be needed.An implant can be placed at the same time and should not increase recovery time beyond the time required to recover after just a lift (typically s few weeks).

Thank you for the question and pictures. As you stated, your pictures demonstrate asymmetric breast ptosis. You will benefit from breast augmentation/lifting surgery. Some variety of vertical mastopexy and/or full mastopexy surgery will likely be necessary. In my practice, I use a “tailored tacking” technique to assess what size/profile breast implant can be SAFELY utilized while performing the breast lifting procedure.  Generally speaking, breast augmentation/lifting surgery is more complicated than either one of the procedures done separately. On the one hand, the breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
Generally speaking, it is difficult to achieve the “perfect” result with breast augmentation/lifting surgery, despite best efforts. Patients should be aware of the complexity of this combination procedure, achieve REALISTIC EXPECTATIONS prior to proceeding, and understand that additional surgery ( along with the additional recovery time, stress, expenses etc) may be necessary in the short or long-term. Patients should understand that the results of the procedure will not necessarily match aesthetically the results of patients who have undergone breast augmentation surgery only.
For example, some patients who wish to maintain long-term superior pole volume/"roundness" may find that this result is not achieved after the initial breast augmentation/lifting operation. An additional operation, possibly involving capsulorrhaphy, may be necessary to achieve the patient's longer-term goals ( with superior pole volume/roundness). It is helpful if patients understand that this breast implant capsule used to provide the support for the breast implant is not present during the initial breast augmentation/lifting operation. The capsule (layer of scar tissue) forms around the breast implant and may be a good source of supportive tissue during revisionary breast surgery, Including correction of breast implant displacement/malposition problems ( such as bottoming out, symmastia, lateral displacement etc).
Potential risks associated with breast augmentation/lifting surgery include infection, bleeding, incision line healing problems, loss/change of nipple/areola complex sensation, and blood flow related issues to causing skin or tissue necrosis. Poor scarring, pigment changes, areola/nipple asymmetry etc. are also potential problems. Again, patients may experience implant related problems such as encapsulation, leakage, displacement problems ( too high, bottoming out, lateral displacement, asymmetric positioning etc.), rippling/palpability of breast implants etc. Patients may also be dissatisfied with breast size, shape, and/or how the breast implants and overlying breast tissues “interface” with one another. Occasionally, a breast implant may even have to be removed and the patient will generally be “implant free” for several months at least. Obviously, this situation can be quite physically, emotionally, and psychosocially stressful to the patient involved.
Given the complexity of the combination breast augmentation/lifting operation and the greater risk of revisionary breast surgery needed, there are good plastic surgeons who will insist on doing the procedures separately.
For me, if I see a patient who needs a great degree of lifting, who has lost a lot of skin elasticity, or whose goal is a very large augmentation then I think it is best to do the procedures in 2 stages (in order to avoid serious complications). However, doing the procedure in one stage does increase the risks of complications in general and the potential need for further surgery. This increased risk must be weighed against the practical benefits of a single stage procedure (which most patients would prefer).

Conversely, if I see a patient who requires minimal to moderate lifting along with a small to moderate size augmentation (and has good skin quality), then doing the procedure one stage is much safer. Nevertheless, the potential risks are greater with a 1 stage procedure and the patient does have a higher likelihood of needing revisionary surgery.
Having discussed some of the downsides and potential risks/complications associated with breast augmentation/lifting surgery, most patients (If properly selected and who are doing the operations at the right time of their lives psychosocially) accept the scars associated with breast augmentation/breast lifting surgery as long as they are happy with the improvement in contour, size, and symmetry.
I hope that this summary of SOME of the issues surrounding breast augmentation/lifting surgery is helpful to you and other women considering this procedure in the future. Also, given her young age, I would suggest that you TIME the procedures carefully in relation to your life circumstances ( such as relationships, pregnancies…).
Obviously, much to consider… The attached link may also be helpful.
Best wishes.