I had surgery (silicon implants) in the early '90s. They were under the skin and on top of the muscle. The doctor was not a certfied plastic surgen but was recommended by another doctor. I went from barely an A to a D so there was a lot of stretching involved and that part was the most painful. I knew it would hurt but hey, it is surgery so it is to be expected.
After about 2 years, one side started to harden (encapsulate) and after 3 years, the same doctor “re-did” that side but had to use a saline implant. It was ok but did not feel as real.
The doctor died shortly after the second surgery and I did not go to another doctor for many years. Both sides became pretty hard but I really didn’t want to have surgery again. However, during a mammagram, they found that the encapsalation in one breast had opened and the implant was “squeezing” out the opening. It was headed toward my arm pit. Great, a breast under my arm.
I consulted with a highly recommended certified plastic surgeon (this time) about fixing the problem. He recommended saline implants placed under the muscle. Since I knew how different the “feel” was, I decided on silicone but I did have them placed under the muscle. With the skin already stretched, the pain was not nearly so bad. The only pain was from the muscle stretching and that was not so bad. (By the way, pain killers make me very sick so I had to stick to an OTC pain killer.)
It has been 3+ years since that surgery and I am still very pleased. Since I am one of those prone to it, I expect one or both will encapsalate eventually. I had the 2nd surgery when I was 62 and I am now 66. I probably won’t care by then.
If you decide to do this, make sure you have a good doctor (certified) and don’t expect the impossible. There will be some pain. You just have to decide it is worth it to you.
Note: The cost is an estimate of the second surgery.