145lbs goal, best implant placement and size to give cleavage and fullness? (Photos)

Improvement in cleavage has very little to do with whether the implant is above or below the muscle. The most important factor influencing the ability to create greater cleavage is what we call the "inter mammary distance", or gap between the breasts. As you correctly noted, your distance is fairly wide. Fullness in the inner portion of the breast can be improved with fat grafting at the time of implant placement as a composite breast augmentation. If you are concerned about bottoming out, you may also want to consider the addition of an absorbable mesh for additional support.

Dear resinrustics,
breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Dear resinrustics, Thank you for your question. After analyzing your case I can say you're a good candidate for Mommy Makeover (Vaser Liposuction + Tummy Tuck with Muscle repair + Ultrasound guided BBL and Breast augmentatiojnand Lift). I'm sure those procedures will give you an amazing result! Make sure you go on consultation with a board-certified plastic surgeon. Hope this helps and best of lucks. Dr. Luis Mejia.