Do I need breast implants or a breast lift or both? Do I have mild sagging breast? or serve? (Photo)

Thank you for your question.  I agree that you need a consultation with a board certified plastic surgeon to correctly answer your questions.  That said from your photographs I believe you will need a breast lift in addition to breast augmentation.  Implants in your case cannot be placed through the arm pit as this could push your nipple further down and create a snoopy deformity.

With all you requirements I would NOT venture to give you any over the internet advise or recommendations. I believe you are best served by ONLY IN PERSON consultations to address each and every one of these issues. My guess is you need lifting with implant and NO the axillary approach WILL NOT apply. Goos Luck.. 

It's hard to tell if you need a lift from your photos, but you are certainly borderline. Droop, and thus the need for a lift, is based on the position of your nipple in relation to the crease below your breast. This is best answered for you after you visit a board certified plastic surgeon. If you only need an implant they can be placed via the arm pit. As for scarring, while as plastic surgeons we do have methods to help minimize your scar, ultimately your body will scar the way your genes allow.