Thank you for your pictures and questions. This is the age-old question. Here is the honest answer.....you are going to get a much better result with doing a lift at the same time. That being said, if you want to avoid the lift and are ok with accepting some things as "less than perfect" to avoid the lift, it is possible. First, you are going to need to choose a larger implant size to completely fill out the skin envelope. You can discuss with your plastic surgeon what that would be, but you need to understand that will a larger implant, your final result is going to be a much larger cup size and if you do not want to end up that large, then this is a bad choice. Next, you are going to have to accept that no implant, no matter how large, truly "lifts" the nipple. What it can do is that by expanding the skin outward, more of the skin below the nipple gets exposed or shown, the more center the nipple appears on the breast mound, thus giving the appearance of nipple elevation. And lastly, you are going to have to accept that a larger implant in an already stretched out skin envelope is going to result in additional stretching of the skin over time and you are going to be prone to earlier revision surgery to maintain results. In other words, you may avoid the lift temporarily, but over time it will catch up with you. Hope this helps! Dallas Buchanan, MD VIVIFY plastic surgery Tampa, FL