Is It Better for an Implant to Go over or Under in a Tubular Breast?

Tubular breasts are a difficult problem. You can see by the varied recommendations of some of the finest surgeons below that there is no consensus on how to treat them.
In general , we have several theories about tubular breasts.
1. The lower pole of the breast is tight. We must respect that and not try for too large of an implant. Excessive scoring of the breast can kill the nipple or make it insensate. I have personally seen cases where this happened.
2. I prefer under the muscle augmentations with a conservative size, preferably in the dual plane technique.
3. Every effort should be made to correct the asymmetry as much as possible, usually with silicone implants to avoid the inherent differences between saline and natural breast tissue.
4. Lifts are almost always necessary to achieve relative nipple symmetry and reduce drooping.
5. Patients must be realistic. Their breasts will not be perfect with so many changes being made to the breast at once. Revisional surgeries are common once everything settles down, and an implanted breast ages differently than one with a smaller or no implant, so the breasts will become different over time.
These cases are the graduate course, not Breast Aug 101. You should have the distinct feeling that your prospective surgeon has a concrete plan, has considered all the elements, and is safe.

Hi there-
Because the benefits of placing the implants under your muscle are so compelling, I would recommend this position for you, despite the tubular shape.
Given the tubular shape and your asymmetry, a dual plane technique would be best.