Thank you for sharing your photos! If you're sagging or asymmetrical, and are looking for perkiness, you'll need a lift--or, if you also want more volume, a lift and implants or a fat transfer. A mastopexy (breast lift) raises droopy breasts from one to several inches and excess skin is removed. To perk up a drooping breast, your surgeon will remove excess skin, reposition the nipple, and redrape and tighten the remaining skin to support the breast. It is possible to enlarge your breasts without implants using a technique called autologous fat transfer, and autologous simply means “your own”. Specially prepared fat taken from another part of the body, such as the stomach or hips, is placed under the breast tissue to provide increased breast size without the need for artificial implants. And who doesn't have a little fat to spare? The great thing about these techniques is that they can now be done with minimal scarring and performed as an outpatient procedure without the need for general anesthesia. I suggest making an appointment with a board-certified plastic surgeon to discuss your options in more detail!