Ellicott City Breast Implants doctors

I have to agree with Dr Hochstein on two counts.  
1) It doesn't appear to me that you have a tuberous breast.  You definitely have drooping and at most a very mild component of constriction if any at all. 
2) I never place implants on top of the muscle any more.  I haven't performed Sub Glandular Augmentation in about 10 years.  There are so many benefits to Sub Muscular that it's hard to justify doing subglandular implants at all.  Capsular contractures (tightening of the capsular tissue making the implants feel hard), cancer detection on mammograms, little to no chance of synmastia (implants too close together) and much less chance of bottoming out, etc..... are all better under the muscle!   So, even if there were a slightly better cosmetic outcome with the implants on top of the muscle, I would still recommend under the muscle for the long term outcome.

Breast augmentation may be performed under local anesthesia with IV sedation (Versed may be one of the medications used) but your surgery should only be performed in an accredited surgery center.  In addition, the anesthesiologist should be a board certified MD or a CRNA nurse anesthetist under the direction of a licensed MD.

This is an almost impossible question to answer without seeing your photograph or having been able to perform a physical examination.  The 50cc difference is not significant , but 500 cc on a 32inch chest is a healthy size implant.  It may be great, but it depends on a number of factors including your muscle tone, hip width, etc. So I can't give you a good anwser.  In general I error on the smaller side as I feel aesthetically the breasts look more natural, but you need to have a lenthy discussion with your surgeon so the surgeon knows what you want. I often have my patients bring in a bathing suit or bra to show me how they want to look in this article of clothing.