Can I still achieve desirable results without the mastopexy?

Dear Glamour0208,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift. To be sure a consultation with a board-certified plastic surgeon will help determine what the patient actually needs.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Your nipples are above your breast fold so you do not need a lift. A breast augmentation should give you a great result. I would put the implants under the muscle for multiple reasons, but especially since you want a natural slope to your upper breast. Personally I would advise you to leave your slightly larger aerola alone since I think the scar will be worse and more noticeable than your mild asymmetry. Good luck.