Should I get breast lift with implant or just a breast implant?

Hello and thank you for your question and sharing your photos. I believe you will need a lift. Implant alone will not be sufficient in your case given the degree of ptosis. 
Best
wishes and good luck,
Pejman
Aflaki, M.D.

Thank you for the question and good quality photographs.   Based on your photographs, I think that you will do well with breast lifting plus/minus augmentation surgery.  You will do well with breast augmentation surgery performed alone. 
  Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars and/or implant exposure.
 
 My best advice: seek consultation with a few board-certified plastic surgeons who can demonstrate significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully as well.   Best to use visual aids such as goal photographs, not a discussion of cup sizes, during the communication process.  
Working together you will come up with the best plan to  achieve an outcome that you will be pleased with.  Best wishes.