If a woman were to get a breast lift because of sag, but with no implants, do they count as fake breasts?

No: A breast lift is not the same as breast implants. "fake" is a term you never have to use, regardless of which choice you make. You have choices, including doing both a lift and implants. Take a friend with you to your plastic surgery consult, ask to see photographs of each option. Take time to contemplate which option will be best for you before committing. Okay to go for two opinions. Be well.

Need a little help: I would not consider these as "fake" . It is of course natural for breasts to lose volume and support especially after weights gain/loss, pregnancy or with aging. A lift may help to restore a more youthful positioning of the breast on the chest wall. This will involve scars and may cause others to question you, so be prepared.

No: Breast lifting involves changing the position of the breasts ( and nipple/areola complexes) on a woman's chest wall; this operation does not involve placement of a breast implant. therefore, there is nothing “fake” that can be associated with breast lift surgery. Best wishes.