There are several factors that help determine the need for a breast lift at the time of augmentation. These include the location of the nipple relative to the fold beneath the breast, the location of the breast gland relative to the fold, and the relationship of the existing skin/soft tissue envelope and the planned size and shape of the implant. Many times it is obvious to the patient and the evaluating surgeon that a lift is necessary to get a good result, eg if the nipple-areola complex is pointing straight down, or if the majority of the breast gland is sitting well below the fold of the breast. The descent of the gland is referred to as "glandular ptosis", the N-A descent is sometimes called "nipple ptosis". The position of the gland itself, as well as the relative position of the N-A complex are both important. For example if you are standing in front of a mirror, and the nipples are pointing straight down and most of the breast itself is below the line that your underwire makes---you would benefit from some type of lift.
Its really important to have great communication with your surgeon in the case of mild ptosis. There may be decisions to make that involve certain"trade-offs". For example it may be that adding a lift, which may involve additional visible scarring, improves the shape and quality of the result. You and your surgeon will discuss whether the anticipated improvement is enough to justify doing the lift.
In some cases placing the implant alone will help improve the appearance of a mildly ptotic breast without adding a lift. The spectrum of "lifts" starts with a limited incision, leaving a scar around the areola, next could be the circular scar with a vertical component(sometimes called a lollipop or tennis racket shape), and a traditional "full lift" with the inverted "T" scar. A consultation with an experienced plastic surgeon will help sort out all the options.
