I hate my breasts. They are saggy, large uneven areolas, and my nipples lay completely flat unless cold or stimulated (Photo)

Dear Ms. Moonovermypammy,
Thank you for your story, questions and photos.  
Nothing substitutes for a personal evaluation and a face to face discussion of your options.
Unfortunately without a examination and measurements  I can advise you in general terms, however I hope you will find them helpful.
Based solely on your photos you most likely will need a mastopexy (lift) and enhancement with a breast implant.
The look you want is based on a carefull understanding of your desires and customized surgical technique, selection of implant, placement and lift.
My response/recommendations:1) the reason your breast sags is that the "skin covering" is proportional larger than the breast tissue.
2) the majority of your breast tissue is below where the breast mound should anatomically be located.
3)if you refill the volume only(breast implant)... the nipple areolar complex (NAC) will tend to rotate over the top of the implant like a waterfall resulting in a full breast mound but unfortunately a downward rotation and location of the NAC.
4)the only method known to create a aesthestically acceptable breast will require trading incisions/scars on the breast for a pleasing contour and relocating the NAC.
5)depending on your desires (shape and size) the scar may vary from:A) just around the nipple (doughnut)B) to a added vertical incision (lollipop)C) to include a horizontal incsion in the breast crease (anchor).
6)while breast incisions/scars are required....there are ways to modulate/improve the appearance of the scarring process.
7) you could always start with a augmentation only and if you like the appearance= greatif you want a more sculpted breast with a higher NAC then you could undergo a lift (often just under local anesthesia).
8) select 3 nude model photos of breast you consider your goal breasts and bring with you to your consultation.
9) your areolar can be reduced to the size you desire.
10) nipple projection can be enhanced with fat injection Please make a appt. with several experienced Plastic Surgeons who are Certified by the American Board of Plastic Surgery and ideally a members  of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
My best wishes,
R. A. Hardesty, MD, FACSDiplomate and Certified by the Am. Bd. of Plastic Surgerywwwimagineplasticsurgery.com4646 Brockton AveRiverside, Ca 92506(951) 686-7600

Hello, Thank you for your question and posting your photos.
Based on your pictures, you need to have a breast lift and implants. There will be an incision around your areola, so the size of your areola can be reduced and they would look natural. It won't change the shape or size of your nipple though.
Kind regards,
Guray