Is the best way to fix my bad breast reduction a breast fat transfer or implants? (photos)

Obviously, an in person exam would give the greatest amount of information.That being said, based on the photographs you sent, it appears that the vertical incision from your nipple to your inframammary fold is too long.  If a higher horizontal incision of normal length, was done it would correct the apparent bottoming out, give fullness to the upper quadrant of your breast, and possibly obviate the necessity for fat grafting and/or the placement of a breast implant.Your nipples turning outward and upward, I believe, are a function of the elongated vertical incision, and if this was shortened, your nipples would point in a more desirable position, both vertically and horizontally.I believe your plastic surgeon did a good job as far as he or she went, and this type of problem is experienced by all plastic surgeons who do lift/reductions at one time or another.  If I were you, I would go back and speak with your personal plastic surgeon.  

Thank you for your question and for your photos. An in person examination with a board certified surgeon would be best to discuss various treatment options and what results to expect. I feel that for now a breast revision surgery would be best to remove the inferior skin.

First of all, it seems that your “short scar” appears quite
long, thus the “bottoming out” look. To correct the deformity, the mastopexy
needs to be redone with shortening of the vertical scar to about 4-5 cm from
the bottom of the areola to the inframammary crease . . . and extend the
horizontal scar as necessary.  This will
give you the ideal shape and contour.
            Secondly, if
you want to be that full C cup, a submuscular prosthesis can be placed at the
same time . . . or “stage it” and do the “augmentation” at a second stage
months later. Also, it may need support with AlloDerm (human) or Strattice
(pigskin) to act like a sling for the prosthesis.
            The end
result should be a full C cup (size) and a well-contoured (shape) breast. Fat
transfer is not the “preferred” option at this point. Do the
augmentation/mastopexy first . . . and then do autologous fat transfer
to “fine tune” the result months later – if it is even necessary.  
Good luck!
 

Hello and thank you for your question and sharing your photos. I believe you benefit from a revision surgery, to remove some of the redundant inferior pole skin at the fold in a horizontal fashion. Fat grafting and implants are both reasonable options. You should discuss the pros and cons of each with your plastic surgeon. Best,

You need a formal evaluation by a licensed plastic surgeon and expert in breast revisions to determine what is best for you and your goals.
Corrective breast surgery encompasses the correction of an array of problems that can occur after breast augmentation or other aesthetic breast surgeries. It is considered the most challenging aesthetic surgery of the breast and requires a range of techniques, including the use of acellular dermal matrices, fat grafting, internal pocket adjustments, and external skin tightening maneuvers. Although highly complex, I find this surgery fascinating as it puts to use all of my skills to solve unique issues. Some patients may be traumatized by their previous experiences, so strong communication skills are vital to understand a patient’s goals and to help them understand the kind of improvements we can achieve.
This type of surgery is extremely important for the patients suffering from deformities, and my experience with these complicated cases also helps me provide excellent results and minimize complications with more routine breast augmentations and mastopexies.
I suggest consulting with a board-certified plastic surgeon and expert in Breast Revisions. - Dr. Cohen

From your photos it appears that you would benefit from skin excision to help with the shape.  If you are wanting more volume an implant will provide upper pole fullness to the breasts.  Fat transfer will give you more volume, but the overall look may be different than an implant.  I encourage you to meet with a board certified plastic surgeon near you to discuss your concerns and goals for surgery.