Based on your photos, I think you could get a nice result from an implant alone without additional scars. Typically, a Perry area incision is created, and the natural breast fold is released. This allows the implant to sit lower and stretch out the skin under the nipple. Unfortunately, it is fairly common to end up with a double bubble. This is where you can see the bottom of the breast implant, and you can also see the natural breast crease slightly above it. Most of the time, releasing the breast fold minimizes the appearance of a doible bubble. A lift minimizes it further, but if you want to avoid the scars, I think you can still get a nice look. Some patients like using an anatomic (or “tear drop”) shaped implant since this pushes out the bottom part of the breast more than the top, which can help stretch the skin. However, there is a risk the implant could turn and not maintain the right breast shape. Finally, some surgeons will incorporate fat transfer into certain areas of the breast to add more tissue coverage over the implant where the breast tissue is naturally thinner. I have had success with this as well. Best wishes!