You can only know for certain at the time of the consultation. But as a general rule of thumb, if your nipple (the projecting part, not just the colored area) sags to the level of your under wire area or below then you probably have to have a lift for the best appearance. Breast implants whether saline or silicone gel are designed to act more like putting a new "base" underneath an existing "cone" or "pyramid". If your cones (breasts) are slanted then the slant needs correcting to get the best result. Although your breast will be larger, if the slant is not corrected, the final appearance will look like your breast tissue is sliding off the top of your implants.