Pseudoptosis options? (Photo)

Thank you for your question. My inclination as a first step would be a breast augmentation alone. This may give you the 'lift' you need without the scars of an actual breast lift. This approach does not burn any bridges or prohibit a mastopexy in the near or distant future. Good luck and I do recommend you see board certified plastic surgeon.

You would need an in-person exam with a board-certified plastic surgeon to get the best options for you.
Your nipple position is fine, so it does not appear any elevation is needed. Your skin envelope is stretched out, mainly on the bottom, as you were an "h" during breast feeding. A 600 cc implant in a stretched skin envelope will continue to stretch and would even if you had some skin removed in the lower pole. It looks like any vertical excess is below the nipple, and removing that if desired usually is best done with an inframammary incision. Your surgeon would like to know your nipple to fold distance. A donut lift could take a small amount of vertical excess below the nipple, and then determining the size that you would like be the next step. Be advised that a donut lift, tends to stretch out the areola, particularly with a large implant.
Since you are on the small size, being a 32, a 600 cc implant, would seem inadvisable due to stretch problems down the line.

The technique I recommend is a lift using The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers can be performed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.