Your photos show some breast asymmetry with mild to moderate looseness and the nipple/areola sitting relatively low on the breast mound. A breast augmentation can improve volume and upper-pole fullness, but it does not truly lift the nipple or tighten loose skin. Whether you need a lift depends on the nipple position in relation to the breast fold, how much loose skin is present, and how much size increase you want. If the nipples are at or below the fold, or if you want a perkier shape rather than simply more volume, a lift is usually needed for the most predictable result. If the sagging is mild and your main goal is more fullness, augmentation alone may be possible, sometimes with different implant sizes or pocket adjustments to improve asymmetry, but it may leave the breast sitting low on the implant. Breastfeeding-related changes can also make asymmetry more noticeable, so an in-person exam and measurements are important before deciding between augmentation alone, lift alone, or lift with implants.