Do I need a lift? Want a very conservative augmentation to restore upper pole fullness.

Good afternoon!I think a donut mastopexy with implants will look awesome! Under the muscle silicone is the way to go!

It is difficult to determine this by only looking at a frontal view of the photograph.  There is however some ptosis (sagging of the breasts). It would highly benefit you to go consult with a Board Certified Plastic Surgeon in person to get the best results possible. 

Hard to tell from photos without an exam, but really depends on what type of result you are looking for.  Patients who are potential candidates for a lift and undergo augmentation alone appear much lower on the chest wall. This works well for some patients.  IN general the larger the implant, the better this works. For those looking for a more elevated appearance with upper pole fullness, a mastopexy is then usually required.  In-person encounters can tell us more specifics like skin redundancy, soft tissue quality, and exactly what someone is looking for.  Experiencing a consultation with a board certified plastic surgeon will provide you with all of these.