Young Perky Breasts. How To Maintain Without Excising Skin? (photo)

There are several misconceptions here that plastic surgeons sometimes play into. 

Perkiness is an appearance term and not a physical condition. Excising skin doesn't increase perkiness nor do breast implants. They may give the illusion of increased perkiness but the skin and tissues don't change. 

Although I can't prove it, my experience is that wearing a bra or not wearing one has nothing to do with perkiness or sagging. Breasts respond to aging, gravity, and stresses such as pregnancy and weight changes by individual response. I also think this is true for properly sized and positioned breast implants. 

Currently there are no reliable methods or modalities to restore skin and connective tissue tone although there are numerous attempts and a lot of hype in this area. The problem with doing such things on breasts (including fat grafting) is that it's hard to prove that this has no effect on breast cancer. As we saw in the breast implant hysteria of the early '90's, it would be easy for someone to claim and potentially make money off the fear that some treatment in the past caused a woman's breast cancer or other disease. 

Due to the effects of gravity and aging, there is no way to maintain perky breasts forever.  Changes in your body shape (weight gain, pregnancy, breast feeding, and weight loss) will also affect the elasticity of your skin as well as your breast appearance.  There is no current technology to eliminate the effects of gravity or aging completely, but some women are more prone to changes in their breasts than others, which is why women have many differences in the appearance of their breasts as they age.  If you have been fortunate to have perky breasts thus far, enjoy it and know that you are the envy of many women around the world.  But enjoy it while it lasts because someday, unfortunately, things will change.

There is no reliable way to maintain a youthful appearance of the breasts despite much research into the technologies that you mention.  Over time there is stretching of the breast skin and rupturing of the fibers in the breast that keep the breast elevated.  I am very skeptical of most of the new technology that is supposed to significantly tighten the skin.  I think your best hope of maintaining a youthful appearance is to wear a supportive bra and to avoid significant weight changes including pregnancy.