I Am a Size 44g or 44h Depending on the Bra but I Am Sagging with No Real Info on How to Repair Them. HELP? (photo)

Looking at your pictures I think if you do anything other than a reduction you will be unhappy.  There are 2 key elements to a beautiful breast....Shape and then Size.  If you do an augmentation you only make you breast larger and make the shape worse.  The sagging of your nipples will get worse and the implants will push your chest out.  Bad Idea. 

If you do a lift, you will have all the scars that you want to avoid without the benefits of improved shape because you have too much breast tissue to give you a round and attractive shape.

Therefore your best option is a reduction.  The incisions will fade over time and many times in African Americans the scars are very limited.  You will get a lift by virtue of removing the breast tissue that is weighing your breast down and finally you will have a round, full and perky breast.  The final size will be up to and your doctor.   

Just make sure you find a doctor that has lots of experience with reductions as well as with African American Skin types.   Make sure he is a board certified plastic surgeon.  Hope that helps.  Good luck

Since your breasts are sagging and also very large, I think your best option is a breast reduction (which also lifts at the same time). This does involve the full "anchor" type of scar, but in turn provides you with a much improved shape. The photographs are taken from an odd angle, but it looks as if your nipples are at or below your elbows, and really they should be about half way between your shoulders to your elbows. I would not recommend adding breast implants. Since you are starting with a G or H cup breast, even with a reduction you could be a D or DD without implants. I prefer doing a supero-medial pedicle reduction, which tends to have better cleavage and less drooping over time, compared to some other types of reductions. I recommend seeing a board certified plastic surgeon for this type of procedure. Please see the link below for examples of before and after photos.