I was advised with 300cc silicone rounds high profile over the muscle with no lift. Opinion?

The aesthetic appearance from a lift would likely be superior to implants alone above the muscle. The complicating factor is your plan to have additional children. Many variables come into play and the decision would be heavily influenced by your goals and what you would accept aesthetically. Spend the time to thorough educate yourself regarding options and the potential outcomes.

dear patient: thanks for your question and photos.  I think you should do other consultations with Board Certified Plastic Surgeons.  If you get a hp300cc over the muscle it will not give you the desired result of upper pole fullness alone with a periareolar lift.  Furthermore, if you are considering having more children, your chances of ending with significan more sagginess and stretchmarks is even higher.  Wait until you are have all your kids and then you can have a Full Breast Lift with Silicone gel implants under the muscle.  Hope this helps!Dr Ron Soltero FACSMember ASAPSMember ASPS

hello thank you for your question and provided information as well..based on your photos, I see that you are a good candidate for a breast lift with implant silicone, in your case ideally you are evaluated by a certified plastic surgeon in person to determine the technique and amount of cc you need to achieve the result you want.

Dear Mamasita2204,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

Thank you for your question.  I believe that doing just a breast augmentation will actually worsen your excess skin and make your breasts sag more and your upper pole will not get the fullness that you want.I think (by looking at your pics) that you would benefit from an augmentation (submuscular) and a lift.  This way your excess skin will be removed and your breasts will sit where they should on your breasts and not sag.  You will also have increased upper pole fullness.

Thank you for your question.  A significant portion of my practice is dedicated to revisionary breast surgery.  I completely agree with the opinions expressed below.  After reviewing her pictures, any surgeon that would recommend placing implants on top of the muscle and performing a doughnut-type lift is probably not a board certified plastic surgeon, and I would cross him/her off your list.  There are not many things in my world that are as clear is daylight, but that surgical plan would result in a disaster.  Please review the category of "chronic changes associated with implants placed on top of the muscle" under revisionary breast surgery on my gallery.  also, reviewed and a tentorial I published titled "poor practice". On the other hand, I believe he would have an excellent result with breast augmentation under the muscle and a full mastopexy (lift).  In most cases, you should be able to breast feed after having breast augmentation and a lift procedure. Best wishes to you.

Putting 300 cc HP implants in your breasts is not a good idea without a breast lift.  If you still plan on future pregnancies, and want to ensure your ability to nurse those babies, do not have breast surgery now.  Wait until you are done having children.  You will need a breast lift and breast implants.  This can be done in two stages or as a single operation (with a higher revision rate and risk of complications).  Always seek a surgeon certified by the American Board of Plastic Surgery with experience in breast surgery.

Thank you for your photo. Due to the position of your nipples and breast tissue, you would require a lift. If you do implants alone above the muscle, you may feel they look acceptable in the short term but you will be going right back to the surgeon's office soon enough as your skin and tissues will continue to stretch and sag. This will give you a "rock-in-a-sock" look. A breast lift will reposition your nipple and your breast tissue higher onto your chest. You should expect at a minimum a vertical incision down the front of the breast below the nipple. The incision just around the nipple will flatten your breast shape into an unnatural form and will not give you the amount of lift needed. Adding that extra vertical incision will help maintain a nice conical and aesthetically pleasing breast shape. Implants can also be placed at the same time or at a separate surgery if you would specifically like more fullness or roundness on the top of your breast and a larger size. A breast lift alone will make your breasts slightly smaller since some skin and tissue will be removed to tighten the envelope and lift your breasts. Again if you are unsure, you can always have implants placed at a later time which will also allow you to make some adjustments to your breasts. Doing the procedures separately decreases your risk of needing additional touch up surgeries.  Hope this helps!!
Johnson C. Lee, MD
Board-Certified Plastic Surgeon
IG: @drjohnsonlee

Your photos suggest a need for a more proper, formal breast lift if you are to get a result that 1. Looks good2. Satisfies your stated goals.Placing subglandular implants into your saggy pocket will allow the implants to drop into the skin envelope, which is your surgeon's way of getting around having your implants look high and your breasts look low, but over time, the weight of the implants will stretch this further and you will need a formal lift at some point. A perilift is really limited to bringing the nipple up about 1.5-2cm, and when applied to try to lift more than that can result in widened areolas and scars.

Thank you for the question and photographs.   Based on your photographs, I think that you will do well with breast augmentation/lifting surgery. I do not think that you will do well with breast augmentation surgery performed alone. I also think that you are wise in achieving your long-term stable weight prior to proceeding with elective breast surgery. Best also to undergo the procedure after completion of pregnancies, if you plan on being pregnant in the near future. Some general thoughts may be helpful to you:
  Generally speaking, patients undergoing the breast augmentation/lifting combination operation should understand that it is significantly more complex than breast augmentation surgery only and that it is associated with a significantly higher risk of complications and need for additional surgery. 
Also, patients undergoing the combination breast augmentation/lifting surgery should understand that there are limits as to how large of an outcome can be achieved, given that breast lifting surgery does involve breast skin removal. On the one hand, breast augmentation surgery is expanding the breast skin “envelope” while breast lifting is (by definition) tightening up the breast skin envelope. These 2 forces are counteracting each other. 
Therefore, it becomes important to remove the appropriate amount of breast skin and to use the appropriate size/profile of breast implants to balance these 2 forces appropriately and to allow for achievement of the patient's goals while minimizing risks of complications. 
In my practice, "tailor tacking" is an important part of the mastopexy and mastopexy/augmentation procedure. It involves TEMPORARY  closure of the skin (for example with temporary skin staples)  to double check the amount of skin that is to be excised during the procedure. This maneuver is done to ensure that enough skin, but not too much, is removed. On the one hand, it is important that enough skin be removed to achieve the aesthetic breast lifting results the patient is looking for; on the other hand, is important not to move too much skin creating tension upon closure and potential wide scars and/or implant exposure.  Make sure you learn about the pros/cons associated with sub muscular versus sub glandular augmentation; you will find a lot of information in this regard on this website.
 
Also, generally speaking, the best online advice I can give to ladies who are considering breast augmentation/lifting 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 work. 
2. Again, 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" 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. The use of the tailor tacking technique and the use of temporary intraoperative sizers with the patient in the upright position makes selection of the best breast implant size/profile relatively easy.
Best wishes.