Mastopexy (breast lift) and augmentation can frequently be performed simultaneously, but in some patients with larger breasts it is best to perform the mastopexy first and then several months later perform the augmentation.  Reduction and augmentation, as odd as it may sound, are sometimes performed simultaneously as well.  It sounds counterintuitive, but what is being accomplished (ideally, if the appropriate surgical technique is used) is removal of excess lower pole and lateral breast tissue, and simultaneous augmentation of the upper / medial aspect of the breast by means of implant placement.  It is critical in these surgeries to be very conservative with the size of the implant, as too large an implant will quickly stretch out the lower poles and produce a 'bottomed out' appearance.  Which generally results in another trip to the operating room to tighten the lower poles, usually by the removal of additional lower pole skin.

So the most important consideration in planning the surgical rejuvenation of your breasts is determining: (1) whether or not you will have upper pole breast fullness (above the nipple/areola complex, especially the upper cleavage area) with a lift or reduction alone, and (2) whether or not you are willing to consider the placement of modest-sized breast implants for the purpose of creating upper pole fullness if it is determined that there is not enough natural breast tissue to create an ideal, youthful shape without implants.  This assessment can be reliably made by a board-certified plastic surgeon who has plenty of experience with cosmetic breast surgery.  As your doctor examines you he or she will take a number of measurements, simulate a breast lift or reduction, and assess whether or not you need an implant to provide you with lasting upper pole breast fullness.