In our office we help many patients with that same decision, along with several others. You are right to have questions.
First, I would suggest that you may lose very little of your current volume if you choose breast lift (mastopexy) alone. It should improve breast contour and projection. It may also enhance breast firmness. Patients frequently report they change bra size a little (up or down) because the reshaped breast fits in a bra differently.
Second, I suggest you make the decision about implants based on whether you are happy with your current size or want to be fuller. If you do, and the surgeon thinks it can be done safely, implants can be a good choice.
Patients do generally get a different shape when implants are added during mastopexy. Implants give more fullness to the upper pole of the breast than lift alone. They can also give more projection for some patients. If you want those effects, you may choose to add implants.
Combining mastopexy and implants can increase the chance of complications, depending on the patient and type of mastopexy procedure (there are several, tailored to your needs). For most patients, they can be done together safely.
However, planning a two-step method may be excellent: an initial mastopexy to give you the best lift, followed months later be an implant augmentation to your desired size. This allows you to decide about the size, and get the tightest lift.
