Follow-up to previous question: What's the difference between tuberous breasts and regular, saggy breasts? (Photos)

Thank you for
continuing to reach out for information and for posting photos. As others have
noted, "tuberous" refers to a specific diagnosis of a deformity,
rather than breasts that are sagging. It is difficult to say with any certainty
whether you have tuberous breasts or not, but it does appear clear that a
breast lift with areolae reduction could reshape your breasts in a way you
would like. If you are happy with the size of your breasts, there is no need to
get breast implants or fat grafting. As for your concerns about scarring from a
breast lift, it is my experience that patients who are disappointed with the
appearance of their breasts are much happier after having mastopexy even though
it involves incisions. The improved shape is simply worth the tradeoff. And
there are excellent treatments available these days to minimize the appearance
of scars. Good luck with your decision.

Patient concerns regarding the appearance of their breasts can typically be divided in two pools: volume, ptosis (droop). The procedures to address these issues are as different as the issues themselves. However, these concerns are not mutually exclusive. Many patients, whether they are aware or not, will benefit from both.
There are two factors which can help to answer the question of which surgery will deliver the most satisfying result: mastopexy, augmentation or both. Patients must first consider the position of the NAC (nipple areolar complex i.e. the pigmented portion of the breast) as it relates to the inframammary crease. If the nipples are at or below the level of the crease the patient may benefit from a lift or mastopexy. The breast lift is designed to elevate sagging breasts to a more youthful position. It also helps to reshape and tighten the skin of the breasts. This is typically accomplished via a periareolar (around the nipple) incision with or without a vertical incision.
Mastopexy is an effective way to address sagging breast, however, the changes which accompany weight loss or pregnancy can also decrease volume of the breasts. When a woman wants the volume restored, or increased, a breast augmentation will also be needed in conjunction with mastopexy. Augmentation can help restore the volume loss which is well known to women following children. There are a number of options available to women considering augmentation ranging from size and implant type to access incision.
A breast augmentation alone may also be appropriate if ptosis is mild. If the patient is comfortable with the natural appearance of the breasts but desires them to be larger, a breast augmentation alone is the right procedure. Augmenting significantly ptotic or sagging breasts tends to magnify the problem. In these cases, a mastopexy performed in conjunction with an augmentation is preferred.

Based upon the submitted photos, it is difficult to say with certainty whether there is a tuberous component. Regardless, you would likely benefit from a lift +/- an augmentation (for greater upper pole fill. Your scarring concerns are legitimate but ultimately you are trading an improved profile for the scar. Patients have to decide if the benefits outweigh the cost.

There is a procedure for every problem. To determine which technique is right for you, consult with a board certified plastic surgeon. Patients should discuss their concerns with their physicians in order to make an educated decision.

Far more important than the technique is the skill and experience of your plastic surgeon. Choose your surgeon rather than the technique and let them explain why one technique may be better than another.  See the below link on some suggestions on finding the most qualified Plastic Surgeon for a Breast Augmentation.  Always insist on a board certified plastic surgeon.

In my opinion a wise-pattern mastopexy with an implant for the size of the breast you want would be the best option.   (you speak of the breast you want but not illustration is given, I find the breast one woman wants is different for what another may want.)  First, a wise pattern lift is the only option that will increase the length of the shortened skin below the nipple region, typical of a tubular shaped breast.  (Remember that "tubular shaped breast" is a breast shape with multiple features, short distance from nipple to bra line, longer interval from clavicle to the nipple, enlarged and rounded nipple areolar complex that is usually disproportionately larger that the size of the breast.  No all feature need to be found one every single breast called a tubular shaped breast.)Scar will be necessary to decrease the size of the nipple areolar region and lengthen the distance between the nipple and the bra line.  A lift that only consisted of a areolar reduction will not give you the length needed and result in a smaller nipple areolar region that is close to your bra line.  I not sure of any value of fat grafting. Fat grafting only fill in areas of deficits.  You can't use fat grafting to successfully fill out the lower aspect of the breast and stretch the skin to the length you needs.  Just isn't going to happen.  Having  scar to get a better shaped breast is the only option.  

In my opinion, your breasts are ptotic but not tuberous.  I would recommend a breast lift with or without placement of an implant using an anchor scar pattern.  I believe this technique gives an aesthetically pleasing, reliable and long lasting result.  Good luck and be safe.John T. Nguyen, MD, FACS, FICSDouble Board Certified Plastic Surgeon