Saggy empty breasts, should I get implants above the muscle or below the muscle? (Photo)

Every surgeon has his or her own personal preference when performing breast implants with breast lift. My personal preference is to put the implants under the muscle when performing a lift. Lifting and tightening the breast and getting it to a higher level usually prevents a double bubble sign. As far as size goes, the size chosen depends on your size goals and breast width measurements, so you could go with a range of sizes. Make sure you view many before and after pictures of your surgeon's work to make sure you admire the  results obtained with his or her approach. A breast lift without implants would look great!

It is hard to tell from the pictures you supplied, but it looks like you need a lift. The only reason to place implants is to go larger. If you want to go bigger, implants and a lift would work well. My personal preference is to place the implants under the muscle always, because the result is more natural. However, implants under the muscle move whenever the muscle is flexed. For most people that is not an issue. Double bubble is extremely rare, and would not be a reason to avoid the sub-muscular implant placement.

Thank you for the question. Based on your of photographs, I think that you have a good plan: breast augmentation/lifting surgery is indicated. I do not think that you will be pleased with results of breast augmentation surgery alone.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 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.  Although mild "deformity" may be seen for most patients undergoing sub muscular breast augmentation surgery, the vast majority of patients who have breast implants in the sub muscular (dual plane)  position do not express concerns about significant deformity.   Best wishes with your upcoming surgery.

Your photos are not in standard form so it is not easy to determine the degree of ptosis of your breasts. It looks like you can go either above or below the muscle. My preference would be below the muscle with a breast lift. It has been my experience that implants below the muscle do better than those above, and always look more natural when below the muscle. I would not be concerned about "double bubble" with your anatomy. You should be close to your ideal weight before any procedure.

You could get a lift with or without implants.  Implants add volume and breast lift re - shapes the breast for a pleasing cosmetic result.  I agree with your surgeon.  If you are getting implants putting them on top of the muscle would be a good choice.