Should I get my septum perforation fixed?

Not all septal perforations need fixing. In fact the majority are asymptomatic and they certainly don't need surgery. Then there's a significant number of perforations which can be managed medically. This requires perseverance and time but often results in such a reduced symptom load that surgery is no longer required. Finally the remaining symptomatic perforations are possible surgical candidates. However the larger the perforation, the less likely surgical success. So when all septal perforations are grouped together, only a small number need surgical fixing. 

This is complex surgery but can be very successful.  The surgeon must be prepared to stabilize the remaining septum to prevent future collapse.  This will frequently require cartilage grafts, either from the ear or rib.  Make sure you seek out an expert in this type of surgery.  It is beyond the scope of most rhinoplasty surgeons. 

Large septal perforation repairs are very difficult both technically and to achieve complete closure. The safest and most expedient fix is a septal button. Reconstruction will likely require cartilage grafts and septal flaps with allogeneic dermis. Rhinoplasty can be performed 'over' a septal perforation with emphasis on structural support/maintenance.