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Considering a breast revision - will I need a lift or can I achieve a perky look with silicone implants alone? (photos)

40girl
I am 41, I had a lift with saline implants in 2016. By the pictures, I’m wondering what the majority of doctors would say I need another lift or if implants of silicone would give me the perky more cleavage closer together appearance? My current scars don’t bother me but my nipples are so much bigger now and stretched out since the first surgery. Is it possible that if my implants weren’t as big my nipples would go back to a smaller size?

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