How do I know if I need GalaFlex (internal bra) or not? Maybe my doctor just lowered my crease and I'm not bottomed out (Photo)

I would recommend downsizing to a smaller implant and placing Galaflex to support the pocket tightening that should be performed. It appears that you have a long nipple to fold distance. This may require an "inferior mastopexy". I would recommend seeing a very well trained plastic surgeon in aesthetic breast surgery; one that is also comfortable using Galaflex.

Your implants appear large and your photos show a double bubble, which means they have dropped below the fold. IMO you are at risk for recurrent bottoming out without the addition of support, which a capsulorrhaphy alone does not provide in the way that a Galafex internal bra does.

As you have a visible double-bubble (crease of your old inframammary fold) showing on the left, they absolutely lowered your fold to accommodate a larger implant. I'm not a fan of that maneuver except in some severe congenital deformity cases as they can settle MUCH lower then intended as here. Sometimes that's inevitable btw if you have stretchier tissue and wasn't a technical error during the procedure. That probably will require mesh (Galaflex or Durasorb) to hold the position you're demonstrating unless your capsule tissue is very substantial which I would be skeptical given how much its already relaxed.