I typically do not recommend implants to be placed directly under the breast tissue unless a previously placed submuscular implant is causing problems (scar contracture, etc.). Their are surgeons who will place implants under the gland to compensate for dropping/ sagging tissue...I think this results in an elongated (rock-in-sock) appearance that I personally do not care for...But I have heard patients say, when you see 10 different plastic surgeons, you may get 10 different opinions on what needs to be done.
So, see as many surgeons (Board Certified Plastic Surgeons, www.plasticsurgery.org) as you feel comfortable with, review their results, above and below the muscle, and evaluate what results most exemplify your goals and go with that surgeon!
I hope this abbreviated response helps!
Dr. C



