What you desire determines what you need

Think about what will make you happy as your final result. Together with an assessment of your normal anatomy, a plastic surgeon can determine what is required to achieve your result. In general, a breast lift or mastopexy by itself removes very little volume but can compress the remaining volume as it firms the consistency of the breast. THis will lead to a smaller volume and size. The shape of the breast will change  and different types of lifts can restore volume in the upper portion of the breast to varying degress. If you feel you require more fullness, then an  implant will be necessary. If the shape is less important and you just want the breast lifted, you may be happy without an implant.

In general, implants can be placed at the same time as a lift but it is dependent on the comfort of the surgeon, the technique of the lift, and the size and position of the implant.  Some surgeons do not feel comfortable doing a simultaneous augmentation-mastopexy because of a theoretical increase risk of complications. Address these issues openly and thoroughly with your surgeon.

Breast Lift (Mastopexy) involves tailoring the excess skin of the breast and re-packaging the existing breast tissue into a smaller skin envelope.  At the same time, the nipple is lifted higher on the mound of the breast, and the areola diameter is reduced.

It is inevitable that some small amount of breast volume will be lost during the process of reducing the skin envelope of the breast.  Whether this lost volume will be significant cannot often be determined in advance.

It is not generally necessary that Breast Augmentation should be done simultaneous with Breast Lift (Mastopexy-Augmentation).  Many women simply do not want breast implants, or don't think they need them.  Under this circumstance, it may be preferable to do the lift first, and live with the results for a few months or more.  If the breasts are ultimately smaller or less plump than desired, a delayed Breast Augmentation can be done to add volume and fullness to the breasts.  Arguably, it is somewhat safer to proceed in this two-staged approach, since there is no compromise between the Breast Lift (which tightens the breast envelope), and the Breast Augmentation (which stretches the envelope), and fewer potential wound healing problems.  The only down-side to the staged approach is that two surgeries are involved, rather than one.

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It is true that you will lose a small amount of breast tissue with the average breast lift, but only about a "shot glass size" amount. A breast lift mostly reduces skin, not the breast tissue. If you are happy with the size of your breasts when you have a bra on, then you should not get implants; just have a lift. If you think your breasts are too small, even in a bra, then you should consider adding implants.

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