From your photos this looks like grade 3 (advanced) ptosis, where the nipple sits at the lowest point of the breast and points downward. At this grade a formal lift is needed to reposition the nipple and tighten the skin, using either a vertical "lollipop" scar or an inverted-T (anchor) scar depending on how much loose skin there is. Whether you also need an implant comes down to the look you want: if you would like a fuller, rounder, more pronounced upper cleavage (decollete), an implant placed at the same time achieves that. But if you are happy with a natural shape and do not mind the upper pole being softer and not perfectly round, the lift on its own is enough. One reassuring point is that the scars are exactly the same whether or not an implant is used, so adding volume does not add to your scarring. A quick in-person measurement of your nipple position and skin would confirm the precise technique.