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A proper breast lift (mastopexy) will not only improve significantly the sagging of the breast, but also improve the apparent "gap" when the nipples are elevated. Fat can be added to improve upper pole fullness, but may not be necessary. I would consider adding fat later if needed (delaying grafting will also facilitate healing of the lift). please see attached web reference. Good luck.
Fat grafting can provide more fullness to the breast, however, you may still benefit from having a breast lift at the same time. I would also say that fat grafting is a reasonable alternative to breast implants if you have a to add a moderate degree of volume to the breast. If you want add a lot of fullness, then you may want to consider either more than one round of fat grafting, or breast implants. I would visit with a board certified plastic surgeon to discuss your options in more detail.
You may be a good candidate for a dermal suspension, parenchymal reshaping mastopexy that uses your own breast tissue to lift and fill the breasts. It may not make them look closer...you may need a push up bra to narrow the gap between. If you like your look when you lift your breasts straight up, then you may just need a lift using your own tissue and avoiding an implant. Make sure you see a Board Certified Plastic Surgeon and member of the American Society of Plastic Surgeons. Good luck!