Should I go with 625cc textured gel implants under or 800cc silicone over the muscle? (photo)

From your before photograph, it is obvious that you need a
lift. Large implants will not achieve
the look you desire, your nipples will be pointing downward and you will be
dissatisfied. I recommend a new
technique called Breast Augmentation with Mini Ultimate Breast LiftTM. Using only a circumareola incision it is
possible to reshape your breast tissue creating upper pole fullness, elevate
them higher on the chest wall and more medial to increase your cleavage. Through the same incision, implants can be
placed. Aligning the areola, breast
tissue and implant over the bony prominence of the chest wall maximizes
anterior projection with a minimal size implant. Small round textured silicone gel implants
placed retro-pectoral look and feel more natural, are more stable, less likely
to ripple or have complications needing revision. Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it. The best way to achieve the “porn star” like
projection is by alignment, not excessive large implants that will displace. Best Wishes,Gary Horndeski, M.D. 

Thank you for your photos.  I understand that you desire a certain look but you will have serious issues in the future with 800 cc implants.  You BC PS is given advice that will protect you long term.  Dr. ES

The size of the implants are based on a combination of a patient's goals and objectives and her anatomy. In order to provide a natural looking augmentation, the surgeon needs to evaluate many factors including soft tissue coverage, skin laxity, chest wall width, breast imprint width, the shape of the breasts and relative level of constriction to ensure that the breast implants are appropriate for your body. Consult in person with 3 experienced and expert board certified plastic surgeons to understand your options.

Be careful going too big. What looks good today may cause real problems in 5-10 years. Large implants will stretch and thin out your tissues and you may be looking at very expensive surgery in the future to correct the problems. Having said aid that, implants under the muscle will be supported better. Look for a surgeon who has a Vectra 3D camera. This device can take a 3D image of your breasts and simulate what any implant size and profile would look like on your frame.

Hi rainstormrrThank you for the question. I hear many women with small breasts want to go very large. I also hear women with heavy hanging breasts want to go very small. "it's always greener on the other side of the fence". However, i would caution you to think carefully about your decision. 1. the after pic you show does not indicate the woman's height or frame. 2. she is wearing a very tight shirt which pushes up her breasts, making them look larger and higher. 3. Over the muscle implants will look very projecting and forward but has some downsides: There is more rippling, and more likelihood of firm capsular contracture. Further, without the muscle insertions into the breast bone, this size will create tight cleavage, but make it more risky to develop a symmastia ( a symmastia is a very difficult complication to correct when the breasts connect in the middle and form one wide breast) Either size will be very large for you and I think, although it may not satisfy your dream size, the smaller is the better option in the long run. Neither will prevent the need for a breast lift in the future. Did you try on sizers in the doctor's office? You mention that you saw two different docs; a cosmetic surgeon and a BC  plastic surgeon. Would you be comfortable having someone operate on you who wasn't a board certified plastic surgeon? anyone can claim they are a "cosmetic" surgeon and not have to got through the long training and certification process of becoming a board certified plastic surgeon. You can also consider an extra high profile silicone implant in the 600-650 cc size range. It will give you the added projection you want and not risk the problems of an over the muscle implant. Best to you in your decision. 

For the type of look you are after, you are correct that 625cc will not create that much volume. If you are choosing silicone implants the largest available is 800cc. Whether it is over or under the muscle is not as important as choosing the volume of the implants.

Only IN PERSON evaluation allows us to determine the size for you! But I lean toward the boarded surgeon's advise... 

I think that these two sets of implants are quite large and may not be appropriate for you. It is best to be seen in person for a proper evaluation.

I would recommend you consider having your breast augmentation performed by only a qualified surgeon. There is no question that this would only be a Doctor certified by the  American Board of Plastic Surgery. No other doctor has the credentials, training, and experience to perform this procedure with the expertise you deserve. I don't have enough information on your individual anatomy, height , size etc to give advice on implant sizing issues. I however would recommend  the large implants you desire be placed in the dual plane sub-muscular pocket if you care how your breasts look now as well as in the future. Very large implants placed over the muscle create problems in a very short period of time which are costly and challenging to surgically to correct.

Dear kilee628,Breast augmentation requires careful preoperative analysis and planning. Unfortunately, this is not possible through an online forum.Choosing very large breast implants puts you at a much higher risk of long term complications including tissue thinning, stretching, rippling, and bottoming out.Please see an experienced, Board Certified Plastic Surgeon for a detailed evaluation and discussion.Warmest wishes,Larry Fan, MD