I'm scheduled to get 600cc implants, but I'm not a candidate for submuscular. Any advice or knowledge on this? (Photo)

Your breasts are too low on the chest wall.  600 cc implants weigh over 1 lb each and simply adding large implants will result in large low breasts.  The technique I recommend is The Bellesoma Method.  This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage.  Vertical scars are avoided, nipple sensation and the ability to breast feed are maintained.  At the same time or later, fat transfers can be performed if additional volume is desired.  Implants are not lifetime devices and half are removed by 9.5 years.  Fat transfers are permanent and incorporated into the body.Best Wishes,Gary Horndeski, M.D.

To accurately answer your question would require an examination. However, your breasts are some what ptotic, or droopy, and may require a lift at some point. Often , large implants are used to avoid performing a lift, however the breasts may feel very heavy and pendulous afterward. Most of those patients will end up requiring a lift at a later date, and many will want smaller implants. I would not recommend subglandular implants, because this disrupts much of the blood supply to the breast tissue, significantly increasing the risks of complications as well as compromising the results if a lift is performed at a later date. I would recommend consultation with several experienced surgeons to discuss your options.

Dear Considerate4189,
determining whether you need simply a breast augmentation versus a breast lift can be somewhat complicated. It depends on a number of factors including skin laxity and current nipple position. Generally speaking, if the nipples are lower than the inframammary line the patient will most likely need a breast lift. If the nipples are at or above the inframammary line we can generally get by with just a breast augmentation depending on the size of the implant the patient wants. I often still using implant when I perform a breast lift because it provides more upper breast fullness after the lift.
Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

I would have a hard time recommending any size implant in your breast without a lift.  Your breast fold is pretty long, although your nipple position is just a bit low.  If doing an implant only is the only route you would take, then a dual plane III technique would really be needed to perhaps get some kind of lift.Maybe time to get another opinion ?

There is no question in my mind.  You need a lift or your breasts will never be right.  You should get a lollipop type lift with smaller implants under the muscle.  They heal great and will give you a better shape with minimal scarring.  Be advised however that not all surgeons know how to perform that operation so you may need to get a few opinions.

Dear Considerate4189, The plan you listed is a potential option but I think you are going to be disappointed with the breast on the right side of your photograph.  It appears to be drooping below the level of your breasts fold, at a minimum you should discuss with your surgeon whether a left crescent lift would be warranted.  Best of luck to you.
Robert D. Wilcox, M.D.

Your question indicates that you are not sure if you are making the right decision. Your breast tissue laxity ,nipple position in relation to the infra mammary fold and asymmetry all are indications for the lift. The decision to place large implant in already sagging breast will cause more sagging, thinning out and more asymmetry few months after surgery. I would suggest to see your surgeon again and ask to see long term results of patients with similar breast shape and size.

I would be concerned about your decision-making;  based on your photographs demonstrating some (asymmetric) breast ptosis, I wonder whether you will do well without breast lifting surgery?    Make sure you carefully cnosider the pros/cons associated with sub muscular versus sub glandular breast augmentation as well as the pros/cons associated with breast lifting surgery, as you make your decisions.   Make sure the decisions you make have a high likelihood of ending up with a result that will "hold up nicely for the next decade".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 are looking for. Ask to see lots of examples of his/her the morning yes thank you work.
2. Have a full discussion and communication regarding your desired goals with your plastic surgeon. This communication will be critical in determining 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. For example, I have found that the use of words such as “natural” or "C or D cup" or "too big" etc means different things to different people and therefore prove unhelpful.
Also, as you know, cup size varies depending on him who makes the bra; therefore, discussing desired cup size may also be inaccurate. Again, the use of computer imaging has been very helpful during the communication process, in our practice.
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, after the use of temporary intraoperative sizers.
I hope this helps. Best wishes for an outcome that you will be very pleased with.

Dear Considerate,
Hello and thank you for your excellent question. Breast implant sizing is a combination of current versus desired breast size, chest wall and breast measurements, and skin and subcutaneous tissue quality. Based on your photos, I do not think that you need a subglandular (instead of submuscular) implant. Second, I think that you could get an excellent result without a lift, but cannot commit to this without an in-person evaluation. It is best to answer your question during a face-to-face evaluation, when you can discuss your goals and expectations for the procedure, and you can have a physical examination to evaluate for that procedure. Preoperative visualization with Crisalix can simulate what your body will look like after surgery and can help you make your decision. I recommend that you find a board-certified, or board-eligible plastic surgeon with whom you are comfortable. Be sure to have all of your questions answered during a face-to-face meeting with your surgeon, and review before and after pictures of similar patients whom have had this procedure. Good luck!

Best,

Jon Ver Halen, MD FACS

Harvard educated plastic surgeon

Double Board Certified Plastic Surgeon