Hi Inventive245488, The single photo shows that you have some excess breast skin, and that your nipples sit at or below where the breast meets the chest wall (the relationship between the two is described by your surgeon as "ptosis"). Based on a limited evaluation, you are right on the cusp of needing a lift or not. I would suggest an evaluation by a qualified plastic surgeon, who can discuss the expected aesthetic (and nipple position) after breast augmentation. For some women with slightly low nipples, an anatomic/shaped implant can provide extra fullness in the lower pole, and prop up the nipple to potentially avoid a lift. Hope this helps. Best,Christopher Pannucci MDBoard Certified Plastic SurgeonPlastic Surgery NorthwestSpokane, Washington USA