Implants over the muscle in thin frame with slightly saggy but deflated breasts?

Unfortunately you cant have it all, in someone with very little soft tissue I typically use round smooth implants under the muscle

I think you can get great results with either a smooth round implant or a textured shaped implant.  There are pros and cons to each.  See a BC PS in your area.  I do not recommend going to the DR for surgery.

Since you have saggy deflated breasts, you need
a simultaneous lift. 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. The worst possible choice would be to place
the implants in front of the muscle in drooping breasts. This cuts all supporting ligaments, adds
weight without mechanical support and your breasts will droop even more.Best Wishes,Gary Horndeski, M.D.

In Canada we've had shaped breast implants for a while and while there was a lot of hype about them when they initially came out, now fewer and fewer surgeon use them for cosmetic reasons. Why? Because when compared side by side more women like the round implants. For example we had a patient come in for a consultation today asking specifically for the gummy bear shaped teardrop implants. So I had her try a shaped implant on one side and a round implant on the other side. Her reaction was predictable. She liked the way the round implant looked better. Happens every time I have patients try a shaped and a round implant side by side.As to the deflated breasts being filled better when placed over the muscle, that may be true but impossible to comment on without examining you in person. That being said, it is possible to fill in your loose breast skin with a sub muscular implant as well. Going under the muscle will give you a tear-drop like shape while using a round shaped breast implant and at the same time the rounded shape gives you more upper pole fullness which is what 99% of women prefer

I don't like to put implants over the muscle for anyone really, but certainly not in patients that have thin and deflated breast skin envelopes. I believe that you would have a much better chance of getting a natural and long lasting result using a silicone gel implant in a subpectoral or dual plane position. I prefer smooth implants, but the newer textured implants are also quite good. A round implant properly placed in a dual plane position looks just as natural as a shaped implant and probably is more of the look that you are really wanting.

The nipple position does appear to be above the breast fold which is good. You do not appear to need a lift. Implant alone would be fine. For you it would seem a round device or a shaped device would work depending on what your goals are. If your skin and tissue are thin I feel it it better to go partially below the muscle to gain some coverage over the device. Pocket choice has its pros and cons and is very surgeon-specific. I usually go above the muscle only in body builders or women who are very active in the gym with pectorals work. Otherwise I have found a partial below the muscle pocket to give the best results. I am sure there are many who put them all above the muscle. In my hands I get the best results with a partial sub muscular pocket.

Round moderate profile implants,in the dual plane is the best option is my opinion.subglandular implants in your case has more disadvantages.

While some patients are good candidates for a sub glandular implant, you are thin with little breast tissue or fat and I think you would be a good candidate for under the muscle implants. I would also be concerned about rippling or wrinkling with textured implants over the muscle. Please understand this is not a substitute for a consultation with a board certified plastic surgeon, but I would consider using a shaped silicone implant like the Sientra or allergen 410. I find these also tend to give additional lift to the breast without the round appearance that many thin patients end up with to get adequate fullness and projection. Good luck with your decision., Dr. Schuster in Boca Raton.

There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”. I will try to outline some of the differences here; you may find the attached link helpful as well.I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position. This includes athletic patients.The submuscular 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 breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.On the other hand, sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants seen with flexion of the pectoralis major muscle) that can be seen with breast implants placed in the sub muscular position. Overall, after considering pros/cons carefully, I find that there are many advantages to placement of breast implants in the sub muscular ( dual plane) position.Generally speaking, the type of implant used may determine the final outcome for some patients, especially if the patient does not have significant covering breast or adipose tissue. For example, most surgeons feel that silicone implants have a more natural look and feel than saline implants because silicone gel has a texture that is similar to breast tissue.Each patient differs in the amount of breast tissue that they have. If a patient has enough breast tissue to cover the implant, the final result will be similar when comparing saline implants versus silicone gel implants. If a patient has very low body fat and/or very little breast tissue, the silicone gel implants may provide a more "natural" result. My best general advice for patients seeking to undergo breast augmentation surgery 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're looking for. Ask to see lots of examples of his/her work.2. 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 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.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.I hope this, and the attached link, helps.

I think that with thin tissues it is probably best to place the implants under the muscle. Best to be seen in person.