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

If you're desiring just an augmentation, it can certainly be done but you will not have 'perky' results.  You will need a lift for that.  But if you simply want larger with a 'natural droop' an augmentation alone will do that for you.  As for approaches, the armpit approach is associated with the greatest risk for contractures so never my first choice.  Nipple incisions heal great and under the breast incisions are never really seen by anyone and over time, do become very difficult to see.

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.

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.

The issue is the position of your nipples relative to your inframamary crease.The photos are not adequate and do not illustrate the position of the nipple relative to the crease.If your nipples are below the crease you will need a lift.