I'm 5"8, weigh 128 and a 36A, are 475-500cc silicone implants under the muscle to big?

Without your pictures it is hard to determine.  You need to schedule a consult with a board-certified plastic surgeon for an examination.  

Your criteria alone are not enough to answer the question definitively; however , saline has the highest complication rate, larger implants have more problem than small, gel is softer, ruptures less, and is more stable over time if you use textured under the muscle. Finally, see your surgeon and consider going smaller such as 400cc or 425 round base gel for instance from Sientra.

Thanks for your question. It's difficult to assess without the benefit of your pictures. IMHO 475cc-500cc may be too large for your current size. I don't know if you've had kids breast fed etc. All of which would help in determining how much skin laxity and soft tissue coverage is available.I would definitely use silicone gels placed behind the muscle. If you use saline, the chances of rippling or wrinkling go up exponentially as you increase in volume. The other question you need to ask yourself is what look do you desire. Fake or natural? Concentrate more on the look than the actual eventual cup size. Always remember that the eventual cup size following a breast augmentation is always the sum of the existing breast tissue volume plus the added implant volume. The same size implant in you may be a totally different cup size down the road than your friend.I have been in practice and performing breast augmentations for the past 29 years in the land of breast implants, Miami, Florida. I feel that many of the augmentations that I see have been overdone and look fake and vulgar. I prefer a natural look to an enhanced breast. The best compliment a patient of mine could be paid is: " I would have never guessed you had breast implants". Women have very creative ways of showing off their new breasts. However, what is appropriate for a social function or club is not appropriate for work.Think about it. When and if you decide to have your surgery please seek out a surgeon certified by the American Board of Plastic Surgery with years of experience in breast augmentations.How about the center, clinic or facility? Are they accredited by a national organization or do they just have State approval. Understand that at the current time, there are three nationally recognized organizations responsible for the highest levels of patient safety, AAAASF, AAACH and JCHO. You owe it to yourself to position yourself for the best possible results but under the most stringent safety regulations, If you have kids, even more so.How about anesthesia? Will you have a medical doctor certified by the American Board of Anesthesiology or a certified nurse anesthetist (CRNA)? Understand that there is no substitute for research. Cosmetic surgeries, no matter how simple they may be to the patients, are invasive procedures and as such carry certain risks and complications.I wish you the best on your journey. Good luck

With your statements concerning volume and filler so all over the place. Best to return for a more intense examination. Or seek additional IN PERSON examinations to clear all this up for you.. 

In my opinion implant selection should be a careful and logical process involving both patient and surgeon.  The patient should be able to articulate her aessthetic goalsl  bust fullness, figure balance and breast shape, and afer listeng to and examing the patient, the surgeon should be able to make sound recommendations as to how best achieve the goals of the patient.  So no one can give you a definitive answer on line.  I do think that 500cc implants are large implants and generally when patients choose such they have to make sure they are understanding the potential long term risks associated with their choice.

The best cosmetic result in any
particular breast augmentation patient depends on a variety of factors,
including: your individual anatomy, desired outcome, realistic expectations, a
thorough discussion with the plastic surgeon about the options, and an
understanding of the pros and cons of any particular implant choice. Proper
sizing is not just about the number of cc’s. The thickness of your tissue,
breast dimensions which include the width, height, and projection, as well as
chest wall width all need to be considered when choosing an implant. Trying on
implant “sizers” of various shapes and volumes while wearing a tight t-shirt,
bra, or bathing sit at a preoperative visit will help you and your surgeon choose
the optimal implant.

Keep in mind that following the
advice from a surgeon on this or any other website who proposes to tell you
what to do based on limited 2 dimensional photos without examining you,
physically feeling the tissue, assessing your desired outcome, taking a full
medical history, and discussing the pros and cons of each operative procedure
would not be in your best interest. I would suggest that your plastic surgeon be certified by the American Board of Plastic Surgery
and ideally a member of the American Society for Aesthetic Plastic Surgery
(ASAPS) that you trust and are comfortable with. You should discuss your
concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

Too determine the best result from a breast augmentation there is no substitute for examining you in person. Key points are the amount of soft tissue you have at the top of your breast, if very little then under the muscle is best to produce a natural take off of the breast. How wide your breast is and the amount of skin laxity all determine how big an implant you can have without looking unnatural. You should take the advice of a reputable board certified surgeon. Best wishes

Thank you for the question and pictures.  Despite good intentions, online consultants will not be able to provide you with  meaningful specific advice.  Ultimately, in person consultation with well experienced board-certified plastic surgeons will be necessary. Careful measurements, dimensional planning, and careful communication will be key.
Generally speaking, the best online advice I can give to ladies who are considering  breast augmentation surgery ( regarding breast implant size/profile selection) is:
 
1. Concentrate on choosing your plastic surgeon carefully.  Concentrate on appropriate training, certification, and the ability of the plastic surgeon to achieve the results you're looking for. Ask to see lots of examples of his/her work.
2. Have a full discussion and communication regarding your   desired goals  with your plastic surgeon. This communication will be critical in determining which operation and/or breast implant size/type/profile will most likely help achieve your goals.
In my practice, the use of photographs of “goal” pictures (and breasts that are too big or too small) is very helpful. I have found that the use of words such as “natural” or "C or D cup" or "busty look" or "silly" etc means different things to different people and therefore prove unhelpful.
 Also, as you know, cup size varies depending on who makes the bra; therefore, discussing desired cup  size may also be inaccurate.  The use of computer imaging may be very helpful during this communication phase.
3.  Once you feel you have communicated your goals clearly,  allow your plastic surgeon to use his/her years of experience/judgment to choose the breast implant size/profile that will best meet your goals.  Again, in my practice, this decision is usually made during surgery.
I hope this, and the attached link, helps.

If you are an A cup, pushing the envelope for a 500 cc implant is too large.  Consider other consultations before scheduling surgery.  Try on sizers in your surgeon's office as you discuss a realistic size for your body.

Thank you for your question.  500 cc breast implants are quite large.  I would be very concerned if a plastic surgeon is pushing youto choose a larger breast implant.  That sounds as though the plastic surgeon is concerned about following the surgeons needs and opinions rather than your needs and opinions.Patients you do not want the best the look and want a natural breast augmentation beneath the chest muscle typically choose breast implants in the 300 cc to 400 cc range.For more information on how to choose breast implant size in cc please read the following link: