Over the muscle or under for 700cc breast implants? (Photo)

Thank you for your question. Its difficult to comment without an examination. First ensure  your surgeon is a specialist plastic surgeon and consider two opinions as using very large implants to fill out a stretched breast envelope is not always the best option and a smaller implant in combination with a lift/skin tightening procedure is safer and will be a much better option in the long term.700 cc implant is a very large implant. Visit the Australian society of plastic surgeons website to ensure your surgeon is a plastic surgeon. 

You are far better to go under the muscle in my opinion. You will have a much more natural appearance even going to such a large size of implant and that appearance will last far longer than if you go over the muscle.Be sure you talk to your surgeon about the width of the implant and what your skin and soft tissue will accommodate.Good LuckDr. JA. Dean Jabs M.D., Ph.D.Board Certified Plastic SurgeonBethesda MD/McLean VA

Under the muscle will give you a better result.Not sure about 700cc.If you have stretch marks, your skin and soft tissues will find it hard to support 700cc over time.All the best

Thank you for the question and picture.
In general, I think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning  also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position. The main downside with sub muscular breast augmentation is the potential for animation or flexion deformity; patients will note movement of their breast implants when they flex/utilize their pectoralis major muscles.
I hope this, and the attached link, helps.

If you have lost a great deal of volume, then generally speaking below the muscle is the way to go.My only concern is a 700cc implant?That is very large.I suspect your surgeon has chosen this implant to avoid the lift, but over time especially because you have stretch marks this will lead to suboptimal results with worsening of the stretch marks.I hope this helps and good luck.

It's very difficult for us to give you the best advice without seeing and examining you.  I am a uncertain however about the recommendations you have received so far. Make sure you are seeing a qualified plastic surgeon.How did you come to the recommendation of 700cc? That is a very large implant. I'm not sure how tall you are or your weight, but be very sure about the size before proceeding. Even if you choose under the muscle, most of the implant will not be with such a large implant. Have another chat with your surgeon. All the best.

The quality of the skin, the elasticity, and the  position of the nipples are best looked at in person. Online consultants cannot feel or examine your breasts, so in-person consultations like you have done are best.  Picking a size for you based on a thumbnail photograph  would not be a good idea. So if you still have questions, go back again, or seek another opinion. 

I think one of the most important aspects of the breast augmentation process is implant size selection.  There are a variety of ways to arrive at this decision but some logical and verified process must be used.  I would definitely make sure you know how big your breast size will be after receiving 700 cc implants as well as know how they will feel and weigh.  Perhaps having 700 cc silicone sizers in a sports bra would help in providing this information to you.  In terms of under or over the muscle, most of the implant will not be under the muscle even if its placed "under the muscle".  You will likely have to choose a HP or extra HP implant to make sure the width or the implant does not surpass the width of your breast.  Finally, you may want to discuss the use of an internal bra support such as ADM or Allergan's silk mesh as a way to increase the longevity of your breast shape.All the best,Dr. Remus Repta

You are asking for an analysis of a very complex situation here, and one that really can't be answered in its entirety on this forum.  This is because one of the most important pieces of information necessary to provide the best recommendations to you is absent here - that is a good examination of your breasts.  Your surgeon has to take not only detailed measurements, more than just notch to nipple, but he or she will also need to get a good idea of the actual tone and dynamics of your breast tissues.  This can only be achieved at exam.  I can offer a couple of general points here that may be helpful, though.  First, while it is tempting, and perhaps even sound rationale in some cases, to put in very large implants as a way to avoid doing a lift.  You must bear in mind that the larger the implants, the greater the resultant stress on the tissues long term.  If you are already starting with stretched, lax tissues, this may be made worse.  Furthermore, you have to be certain that you want implants that large and the volume, dimensions, and proportions that come with them.  If you do, that's fine; just know what's in store for you realistically.  A second consideration here is placement with respect to the muscle.  Again, it can be a sound plan to use a subglandular (over muscle) placement to your advantage in this setting, because that will many times "take up more of the slack" in the loose breast tissues and maybe avoid the need for a lift, but in reality only in those cases that are borderline anyhow.  Again, this comes at some expense too, because the subglandular placement will also put more stress on your tissues, it separates some of the natural supporting structures of the upper breast from the muscle, and it is known to have higher rates of capsule contracture than submuscular or dual plane placement.  In addition, the implants may be more visible, giving you a more obviously implanted appearance with possible visible or palpable rippling or folding of the implants.  These are just some general considerations for you; there are many other things to consider too, such as textured versus smooth implants, round versus shaped implants, and which manufacturer's gel or implant type may be best suited for your tissues.  All implants, while very close, are not created equal, and some have distinct advantages in some situations over others.  This is why it is very important for you to not minimize these issues and to consult with an experienced board certified plastic surgeon who has access to all types of implants available and understands the subtle differences between them and can give you a realistic expectation of your results.  Good luck.