You mostly need a breast lift if your nipples are pointing downwards. But to be sure, you need an in-person consultation so that your plastic surgeon can determine if you require a breast lift. Not all of the patient need or benefit from a breast lift. This is a good question to ask as most women mistakenly assume breast implants alone can create a more lifted look or change the placement of their breast to a higher position.
However, the truth is implants only add volume. Consult with your plastic surgeon to see how to achieve the look you hope for whether breast implants alone or with a breast lift to get your desired look.
Hope this helps to clarify!