Hello and thank you for your question. . Based on your photographs, the best shape and contour could be achieved with an implant and a breast lift. 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. 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