The breasts are droopy making the case candidate to a breast lift, likely a Lejour's principle lollipop breast lift mastopexy with only vertical scar, should the surgeon have experience in it.
The upper pole is empty and the cleavage too so that to fill these areas up the use of breast implants is required, regardless the patient might want to keep similar breast size or larger.
In such crossroad situations the patient has to receive accurate, realistic and trustworthy information from the surgeon, the surgeon should be technically versatile and able to execute any reasonable and indicated patient's request and, needless to say, carry ahead an excellent informing task so that the decision making process is unbiased to the patient.
In this depicted case the patient expressed her reluctance to accept scars and her acceptance to the evident breast droopiness, actually the fact the breasts were low was not a concern for her and neither the reason for seeking surgery.
The patient requested to fill up the breasts with minimal scarring plus achieving a plenty cleavage and a moderate grade of enlargement of breast size; such goal was technically feasible with reasonable safety, not harmful for patient's health and anatomically and psychologically proportionate and justified.
The former was accomplished with modern anatomical shaped implants filled with cohesive gel, which is the golden standard nowadays, placed in the minimally invasive and non aggressive safe subfascial pocket, the technique of choice to prevent complications and bad results. This is feasible even with large implants like in this case in which the patient sought an extra large size for her new boobs.
Breast droopiness, as can be seen in the images, remains the same, no worse no better, just like patient wanted; should she change her mind in the future a breast lift mastopexy would be a feasible option at any suitable moment.
The quite lateral location of the breast mounds made impossible and unwise a more medial and cleavage oriented placement of the breast implants; there is a golden rule in breast augmentation regarding the location of the nipple areola complex, since it rules as the center of the breast mound and also is the landmark ruling the location of the breast implants, being the surgeon bound to achieve the maximum centricity possible of the maximum projection point or peak of the prosthesis right beneath the nipples, so that major deformities and unsightly results are prevented.