As a 10 year survivor, it is safe to say the breast cancer is behind you. However, to get good looking reconstructed breasts you must carefully navigate the limitations dictated by your mastectomies and remaining tissue characteristics.
The reason why the vast majority of implants in Breast Augmentation are placed UNDER the muscle is because all implants ripple and their shells are palpable. To get an attractive result, implants MUST be covered with as much tissue buffer as possible. Good results with breast implants placed under the breast gland / over the muscle can only be achieved in women who already have enough tissue to allow this coverage.
In Breast reconstruction, the breast gland and underlying muscle cover (the fascia) are removed with a varying amount of the breast skin. The left over breast skin is often thinner than normal breast skin. Any implant placed under these breast skin flaps over the muscle will be visible and palpable because BY DEFINITION these "breasts" had to have their soft tissue inner fill removed thereby denying implants the cover they need.
In Breast Reconstruction, placing the implants under the muscle is routine for the above reasons and you may choose to have silicone filled implants which are lighter, feel more natural and ripple less than the saline filled implants.
Dr. P. Aldea