Is there a size limit to under the muscle implants? 34AA, Athletic, 5'8', 70kg, no kids (Photos)

It is very difficult to determine the best lift you will need (recommended based on your photos) or the exact size and shape implant you will require to best match your ideal breast image without an examination by a board certified plastic surgeon. Not just any board certified plastic surgeon, but one with many years of frequently performing breast augmentation surgery including different approaches, techniques and implant choices. This is because several measurements not to mention your breast characteristics are needed to determine the optimal implant size to obtain your goals. Without knowing these dimensions it would be difficult to make this determination. For example, the existing base width of your breast will determine, in many cases, the maximal volume per implant profile that you can accommodate. To illustrate; a 100 cc difference may make a significant difference with a narrow base width breast, but much less of a difference if you have a wide chest wall and wide breast “foot print”. Therefore, just because your friend may have a great result with let’s say a 300 cc implant to make her go from a “A” cup to a “C” cup size does not mean that you will have the same result with the same size implant. The same process goes for just filling in the upper part of your breast without becoming much larger. Further simply placing implants in a bra to determine the size best for you is not always accurate as the bra often distorts the size, is dependent on the pressure the bra places plus the implant is outside your breast and not under it among other variables. Computer software morphing programs that automatically determine the best implant size can be helpful in some but not all cases (e.g. doesn’t work well in my experience with existing implants, sagging or asymmetric breasts). Using “want to be” photos however are useful if simply provided to the surgeon as I will further explain in the link below including silicone vs saline implants

If you are 22 or older, I would recommend extra high profile or higher filled gels. That would allow a larger cc size for your small frame measurements.An exam and consultation with a plastic surgeon who performs these procedures is recommended to confirm you are a candidate as well as discuss your options and expectations.

Anatomically, there are indeed limits on maximum implant size, though we have all seen women and surgeons who push the limits of what most would consider appropriate or proportionate. Most ABPS-certified plastic surgeons with extensive experience in breast augmentation will be able to give you good advice, and you have done well to consider three different recommendations. I'm OK with big, but in women with your anatomy, "as big as reasonably possible" would be my recommendation.

Based on your goals, I agree that HP implants will be required to achieve the size you wish. However, because you have very little of your own breast tissue or fat with which to "cover" your implants, I believe saline is a poor recommendation. Not only can they leak and deflate, but rippling is more likely, giving two avoidable reasons for re-operation. Submuscular is definitely recommended, but will not suffice to allow saline as a "best recommendation" IMHO. 

I'd see a few more surgeons in consultation--saline implants were "fine" when the FDA mandated their use between 1991 and 2006. Over 85% of plastic surgeons now recommend and use cohesive silicone implants, especially with anatomy such as yours, making the 3 surgeons you have seen thus far in the definite and distinct minority.

Also, you do not have "tubular" breasts--they are simply small with widely-spaced nipple/areola complexes. You are a perfectly fine candidate for breast augmentation. For more information, please read my Comprehensive Guide to Breast Augmentation by clicking on the web reference link below. Best wishes! Dr. Tholen

Hello and thank you for your question. You are a great candidate
for a breast augmentation.  The size, profile, and shape 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.  
Best wishes and good luck.
Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Based on your pictures, it does appear that your own tissues will be the limiting factor in the size of the implant.  A HP implant will provide the projection for improving the shape, but the size is really based more on measurements.  I would caution on the use of saline implants though.  When you are thin and have little breast tissue of your own, there is a higher chance of rippling issues with a saline device.  I hope this helps.