Do I need a lift? Or is a larger sub glandular implant the best choice for me?

I don't think you would need a lift with the right implant. It doesn't have to be too large either, it has to be the right dimension though. Sometimes a periareolar lift gives better nipple position and a wider implant might look better with a lift, but it should not be necessary depending on the implant. It would be easier to know however from a full exam. The placement could be subglandular but I prefer to use a dual plane or partial submuscular position especially in patients with thinner skin and a relative loss of upper breast volume. This however can be decided at a consultation. If you felt more comfortable with one of the board certified plastic surgeons you met, I would go and ask about their plan in more detail and if you are comfortable with that go with that plan and don't worry about the other recommendations. Remember a lift can be done later if needed, even years later.

Hello and thank you for your question and sharing your photos. Based on these photos, you should be able to avoid a formal breast lift, using a 'dual-plane' technique. In this technique, implant is placed under the muscle, with the top half covered by the muscle and the bottom half directly underlying the breast tissue, which allows for better expansion of the lower pole and better rotation/mobilization of the nipple-areola complexes upward. Best,
Pejman Aflaki, M.D.                                            

Johns Hopkins-trained double board-certified plastic surgeon