Pros and cons of under vs over the muscle?

Hello and thank you for your question. Judging from your photographs alone, the short answer is for a natural look and C cup goal, I think you would most benefit from an implant closer to 300cc (than 500cc as you mentioned), UNDER the muscle.
From a general standpoint, your question
does bring up the overall process of ideal breast implant selection which
can be quite involved, as breast augmentation involves a number of different
issues.  The first step would be to clearly define your desired
breast outcome goals – this would include the size you would like to achieve,
and your ideal breast shape.  I would then select the best breast implant
for you based on:


(1)   Volume of the implant –
actual implant sizers that you try on during your consultation can help with
this.  I commonly used the Mentor volume sizing
system for this purpose.


(2)   Contents of the implant –
saline vs silicone, saline tends to be a little stiffer, rounder and can cause
rippling of the skin


(3)   Shape of the implant –
round or anatomic;  I would show you how both round and anatomic can
provide a natural shape


(4)   Position of the implant –
if it is over or under the pectoralis muscle; each location would provide a
different shape and projection.  The
advantage of going “under the muscle” is that it provides a lower risk of capsular
contracture, lower risk of skin rippling, and better visualization on future
mammograms.  Also, many patients describe
the appearance as more natural, and describe the feel as more consistent with
that natural breast.


(5)   Skin stretch of your breast
– younger patients tend to have more taught skin with more… SHOW MORE
resilience, and respond well to an implant; compared to an older breast with
more stretch marks, which would typically requiring a larger volume to fill the
breast


(6)   Degree of breast ptosis
(sagging) – a significant sag would benefit from a breast lift


(7)   Breast diameter and overall
chest circumference


(8)   Native breast tissue volume
– the amount and distribution of the natural breast tissue.


(9)   Any history of prior
surgery or trauma to the breast


The next step for
you is to seek out a board certified plastic surgeon who specializes in
aesthetic plastic surgery.  In your consultation, be sure
your surgeon addresses all your concerns and discusses the surgery details
including the position and size of the incision used (with actual photographs),
the type of breast implants available, the risks and benefits of the procedure,
recovery time, and post-operative course.  Also, be sure to see plenty of
before-and-after pictures in women who have a similar breast appearance to
yours, and preferably at different time frames (3 weeks out, 3 months out, etc)
to more accurately predict your own surgical outcome.


And lastly, I think the most important
component of the consultation is to establish a good connection with your
plastic surgeon.  It’s the connection that allows you to clearly define
your desired breast outcome goals, the first step of this whole process. If you
don’t feel you have a good connection with your plastic surgeon after your
consultation, he/she may not be the best surgeon for you.
For more information on breast augmentation, please refer to the link below.


Good luck.


Mark K Markarian, MD, MSPH


Harvard-trained Board
Certified Aesthetic Plastic Surgeon

Thank you for your question. An in person examination is very important in order to give you a valuable opinion. If this is not possible any doctor would like to see some of your photos in order to have an idea of the conditions of your breast. The laxity of your breast is very important in order to decide all the parameters needed to give you a nice shape. If you have slightly ptotic breast, probably the Dual Plane technique would be the appropriate. Please attach some photos in order to help us.