Should I get high profile 700 cc silicone implants over or under the muscle?

700 cc implants weigh
approximately 1 ½ lbs each, will be mechanically unstable and will
descend.  They will not be able to fit
under the muscle without tearing it or requiring extensive damage to the muscle
in placement.  That is why your physician
recommends over the muscle instead.  Best Wishes,Gary Horndeski, M.D.

hello thank you for your question and provided information as well..based on your question my recommendation that you be seen by a certified plastic surgeon who sees and evaluates your case. because it is difficult to evaluate you if the case does not have a photo.

Hello and thank you for your question.  700cc is a large implant.   There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.  This entire surgery can be performed with a
small incision technique.  Make sure you specifically look at before
and after pictures of real patients who have had this surgery performed by your
surgeon and evaluate their results.   The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Most patients undergoing a breast augmentation today go in the dual-plane/ subpectoral position.  This gives you muscle coverage over the top 3/4 of the implant while allowing it to be soft and act like a breast should.  Going on top of the muscle has a higher capsular contracture rate in all our studies, and you have a higher chance of seeing the edges of the implant in the upper pole over time.  I would discuss this with your board certified plastic surgeon and see what they have to say.  I hope this helps.

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.
 Subglandular Augmentation (“overs”): 
Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also fasterSubglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling when compared to subpectoral augmentation.Subglandular implants can also create the illusion of improved cleavage by preferential over-dissection of the central/medial pocket allowing the implants to be forced more to the midline. There is no limiting muscle as there is in a submuscular augmentation. 
Subpectoral Augmentation/Sub-muscular (“unders”): 
Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.Subpectoral implants have a lower rate of capsular contracture.Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.In my practice, the vast majority of patients will have the implants placed submuscular for all the reasons listed above. I would caution such dramatic volume as the complication rate is much higher with oversized implants (especially when considering subglandular placement). It is important to understand...greater volume = greater weight = greater stress on supporting tissues = decreased longevity of result.
As always, discuss your concerns with a board certified plastic surgeon (ABPS).

Thank you for sharing your excellent question.  Although most implants are placed beneath the chest muscles in order to achieve a more natural look and feel, as well as to lower the risk of complications, ultimately the decision on placement is based on your physical exam and goal result you are after.  I would advocate speaking to your surgeon at greater length as to why he is recommending placement over the muscle.  Hope this helps.

Dear biotegirl,I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Hello biotegirl, 
It’s a pleasure to answer your questions! One of the most important decisions prior to a breast augmentation procedure with implants is the selection of the breast implant pocket. In this respect, I favor Dual-Plane over both Partial Submuscular (under the muscle) and Subglandular (above the pectoralis muscle of the chest) breast augmentation, because Dual-Plane placement allows for a more natural appearance while keeping the benefits of having the muscle cover the implant. There’s also a reduced tendency for the breast implant to ride high, as well as a reduced tendency for the implant to lateralize. Larger implants may be able to be placed with over the muscle (subglandularly) implants placement. However,   among the disadvantages of placing the implant over the muscle are the following: 1) implant palpability may occur when the patient’s breast soft tissues are very thin; thus, it is vital that the plastic surgeon assess the soft tissue of the breast before deciding to place the implant subglandularly, and 2) there’s a higher risk of seeing ripples (especially with saline breast implants) and capsular contracture (almost 1 in 4 women). On the other hand, under the muscle implant placement is typically more painful, have a significant risk of double-bubble or snoopy deformity of the breast, and it’s associated with a longer period of recovery, and more post-operative discomfort. With regards to size, the maximum implant size would depend on the base diameter of your breasts which will be measured by your plastic surgeon. Going beyond the recommended size based on your breast parameters is associated with higher risk of complications,including poor scarring, bleeding, breast sagginess, implant mal position, thinning of the overlying breast tissue, rippling, palpability, and implant exposure and extrusion. Good luck and may God bless you! Dr. De La Cruz.   

Implants placed under the muscle or in a dual plane technique are most recommended.  Photographs would be helpful to better answer your question.
After performing hundreds of breast augmentations, I have found that the size of implant best for you is dictated by your chest wall measurements. Once we determine that we can choose the profile based on what you want or need to achieve.  If you are seeking a natural look, then the diameter of the implant should be equal to or, more ideally, smaller than the width of your breast. The breast width is a measurement of how wide your breast is at the base, which should be measured at the level of the nipple. Choosing an implant that is smaller in diameter than your breast width will avoid the "side breast" fullness that is often associated with a more artificial appearance. Other than that, you should choose the implant based on volume, not on the dimensions of the implant. You should choose a board certified plastic surgeon that you trust to help guide you in this decision. Bringing photos as well can help us to finalize, but please understand that these are of other people’s bodies and your results will probably be different.

Silicone will give you fullness at the top (upper pole fullness). Silicone implants come pre-filled with a silicone gel and are the softest implant available. They feel more natural, which makes them a good option for women with less natural breast tissue; but they require a larger incision. It may be more difficult to realize if this type of implant has ruptured, so it is important to monitor them with annual follow-up visits. Additionally, because this implant contains a softer silicone (less cross-linked), if this implant should rupture, it may leak but only into the scar capsule formed. However, the newer silicone in these implants may not leak even when the implant shell is ruptured.

Anatomic gummy bear implants might be a good choice to give you a more natural look. These highly sought after, anatomic implants offer a look that more closely resembles the natural silhouette of a breast, and, therefore, is a very attractive option for individuals seeking a natural-looking, aesthetic primary breast augmentation. Additionally, these implants are an especially excellent option for patients undergoing restorative or corrective breast surgery because they provide more stability, shape, and reduced incidence of capsular contracture. Compared to other types of silicone gel implants, the silicone in the cohesive gel implant is more cross-linked; therefore, should the implant shell “rupture,” it maintains its shape and silicone does not leak.

During your breast augmentation consultation, you should feel the different types of implants available, and try on various implant sizers in front of a mirror to help you to get an idea of how you will look following the surgery. You should also bring pictures of the look you would like to achieve, as well as a favorite top to wear when trying on implant sizers. I also use a 3D imaging system to allow you to try on a variety of shapes and sizes. I prefer this method over adding volume due to implants being under the muscle.

We will also discuss the possibility of needing a lift along with an implant. This will depend on the amount of ptosis (nipple position) as it relates to your breast, inframammary crease and chest wall. Needing a lift or not will also determine where to place the scar for the incision.  In some cases if the breast and nipple is really ptotic (low) it might be best to stage the procedure by performing a lift first and then doing an implant at a second stage. This will also allow you to have a better understanding of the true size and shape of your breast.

The best way to assess and give true advice would be an in-person exam. Please see a board-certified plastic surgeon that specializes in aesthetic and restorative breast surgery.

Best of luck!

Dr. Schwartz

Board Certified Plastic Surgeon 

#RealSelf100Surgeon

#RealSelfCORESurgeon

thank you for your question. 700 cc implants are very large implants. Having them over the muscle will most likely lead to a high risk of  visibility of the implant as well as rippling is the skin. In addition regardless of the pocket please understand that you will most likely need a revision surgery within the next 10 years.

Best wishes!