Hello and thank you for your questions and concerns. It is very common for women to want breast lifting when they get a breast augmentation. Reading your message, I know that is not the answer you were hoping to hear, but without the lift the sagging will remain. At the end of the day, an implant just pushes out what you naturally already have there. I tell all my patients that there's a 100% chance of asymmetry after any breast surgery with or without a lift. Of course, the goal is to try to make you as equal as possible, but everyone has asymmetries of the ribs, the muscles etc. It's very important to understand this as you, like all women, have some breast asymmetry that would be pointed out on examination and before any surgery. When women have excess breast skin, an implant can take up some of this excess skin. So, depending what implant size you're interested in being, there's a good chance that in your case a breast augmentation will have good results without any additional breast lift scarring. As a final thought, if you pick the infraareolar scar as your choice for breast implants, usually we can do a mini breast lift at the same time and I usually don't charge people for this. Of course, a full areolar breast lift or short scar breast lift is different and does involve more scars and more costs. Aging and even pregnancy is definitely hard on the breast areas and this is a comment complaint among women visiting my office. For some women that aren't quite sure, it is okay to do just the breast implant and if they desire more lifting afterwards, you can usually do that in the office as a separate procedure under local anesthesia and leave the implant alone and just remove some of the excess breast skin. I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of breast implants. Good luck with your future surgery! I hope this helps answer your question. If it does, please take a moment to up vote this answer on the “respond” button on the top right.