Thank you for your question! It is normal for the breast to lose its firmness and perkiness over time, which is accentuated with age, pregnancy/breast feeding, weight gain/loss, and gravity. This ultimately results in ptosis, or sagging, of the breast with a “deflated” appearance. Women often seek the mastopexy, or breast lift, procedure to regain the previous youthful appearance of her breasts and desire that uplifted and perky appearance of her breasts. Women report increased confidence, self-esteem, and femininity once she achieves this desired shape and fullness. Breast lifts may or may not be performed with implants – the implant would add increased size but also greater fullness in the upper pole of the breasts which creates more cleavage. It is also common for the areola to enlarge and stretch during these changes. The lift will also serve to raise the nipple areolar complex to its appropriate position above the breast crease and at the most projecting portion. In addition the areola size will be decreased, which is often desired by the woman. A circumareolar, a lollipop incision, or a full inverted 'T'/anchor incision may be needed to give optimal shape. I wouldn't compromise shape and overall result to minimize scarring. Given your photo, a lollipop/circumvertical lift will likely give you the best result with the degree of ptosis that you have. The implant would give increase upper pole fullness. The decision for a breast lift will be up to you...depending on how much you are bothered about the shape as well as your concerns. Consult with a board certified plastic surgeon well-versed in breast surgery and s/he will assist you in deciding if a mastopexy will be the right decision for you. Thank you for your question! Hope that this helps. Best wishes for a wonderful result!