Saline rupture - can I go over the muscle with silicone 500cc & look natural?

Your biggest problem is your excess hanging skin. You will need a lift and the technique I recommend is The Bellesoma Method. This will reshape your breast tissue creating upper pole fullness without implants, elevate them higher on the chest wall and more medial to increase your cleavage. Vertical scars are avoided, nipple sensation (in 95%) and the ability to breast feed are maintained. Later, fat transfers or small implants can be placed if additional volume is desired.

Best Wishes,

Gary Horndeski, M.D.

Although the more cohesive implants can look natural in front of the muscle, it is less likely with larger implants and little breast tissue. It would be helpful to know what size your implants were before deflation and whether you liked that size.

There is absolutely no good reason to make a new implant pocket over the muscle. You don't state your reason, but if you think it will allow you to avoid a very much needed breast lift, you are very wrong. If you don't get a breast lift your breasts will look terrible regardless of where the implant is sitting.

I see no reason to go over the muscle. You don’t say why you want over the muscle. There’s nothing to be gained

Dear SunShine Baker,
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

You need a lift and place the implants behind the breast. Measurements are needed to be sure, but I do not recommend going with such large and heavy implants of 500 cc's. I doubt your tissue will support that weight.

With little tissue, going above the muscle will probably look worse than staying under. Also as your pockets are already there, there is less recovery. Unless your pockets are very asymmetrical or have bad scar tissue, staying under is better.