An in person consultation is required to make this important decision - but based on your photos, I think you have enough sagging breast tissue to justify a breast lift (with a small reduction) in combination with a reasonably sized implant.
Yes. It would be possible for you to get the fullness that you are looking for with a straight augmentation alone. At your consultation, your plastic surgeon will measure you. This will assist him or her in assisting you in determining the right size implant for you. To see breast augmentation before and after pictures of women similar to you, refer to the link below.
Here's how to understand the choices since it doesn't look like you need or would benefit from a lift.
A proper breast lift repositions the nipple-areola to a higher level, repositions the breast gland higher on the chest, and tucks the lower pole skin. It does not fill out the breast, fill in the upper pole, or give what most people consider "perkiness".
Breast implants are only pillow volume and do not actually lift the breast but fill it out which gives the illusion of a lift and perkiness by thrusting the nipple-areola forward, filling out the lower pole, and filling in the upper pole.
If the nipple is too low relative to the inframammary crease behind it, then an implant cannot be positioned properly behind the base of the breast, but your nipple position looks high enough to not need or benefit from a lift. A properly sized and positioned implant could make you look about 1-2 cup sizes larger and better filled out depending on the choice of the forward volume (profile) of the implant. The width of the implant should match the internal base width of your breast upright and with arms down.
While it is difficult to be certain without seeing you, your photos suggest that you would be suitable for an augmentation without needing a breast lift. The size of implant is your choice but around a 400 cc mark is likely to give you a good result. While a combination of Breast uplift and augmentation is quite safe in the hands of a fully accredited Plastic surgeon, you dont need this combination. Good luck
Without an in person exam, it is really impossible to say but based on just your photos, you can probably get away with just an implant. I would advise you to schedule a consultation with a board certified plastic surgeon in your area (link below) to discuss your options. Best, Dr. Nazarian
and the jury as spoken and its unanimous. If someone tries to talk you into a lift as being essential, get a second opinion. Your photos do not show a need for a lift but if you have a particular look you desire, its always possible a lift may be needed for that. If you're just desiring fuller and larger breasts, you do not need a lift by your photos. As for implants, always best to use external sizers to help you visualize what you will be. Despite what some surgeons may tell you, my patients all feel the sizers have very accurately predicted their outcome. And I do add 10% to the volume of the sizer to achieve the look of the sizer in your unlined brassiere.
I think that you could definitely have a breast augmentation without a lift provided that you are otherwise healthy. I think the key is for your surgeon to show you pictures of women with and without lifts who are built similarly to you so that you can make an informed decision. The attached video will provide more information on this decision.
Nipple is above the fold. You have breast deflation. I would expect a nice result with a breast implant using the proper device. More information on breast implants are answered in the attached video. While 475 cc is a large implant, I think it may be an appropriate choice for you. Good luck!
Your photos show that your nipples are well above the level of your inframammary crease, and it would appear that you have some mild but not excessive overhang of your lower breast below the level of the crease. These two factors would determine whether you would need a breast lift, and it would appear that you would get a good result from augmentation alone without a lift. If nipples are too low, they may be down pointing after augmentation alone, and if the breast hangs too far over the crease, this tissue may hang loosely off the implant and not be properly filled out.
If on examination it appears that your breast is a little too overhanging, with a good high nipple position but a little too long a distance from nipple to crease, this can be treated by removing some skin at the crease where the inframammary incision is. This can treat mild cases of lower pole laxity by shortening the long distance from nipple to crease, resulting in a "lower pole lift" while keeping the scar hidden in the crease under the breast.
As long as you are willing to be larger I think filling and enhancing your contour with breast implants is all that you need. Your breasts are naturally low and a breast lift will not reposition them so the addition of the volume of the implant is all that I believe is necessary. Your natural shape and skin appear to be very favorable to what is likely to be a very good result that will better balance with the proportions of your body.
Discuss your goals carefully with an ABPS Bd Certified plastic surgeon in your area since nothing can substitute for a face-to-face consultation.