Breast augmentation and lift - have my breasts dropped too much? Will I need a revision? (Photos)

I am so sorry to hear you have concerns about your aesthetic result. From your description, it sounds like you had some amount of skin stretch after surgery. It may or may not be due to the position in relation to the muscle. Your best option at this point (assumptions being made since you didn't post any current photos) is for a revisional surgery include some type of mesh to create an internal support bra for longer-lasting results. I utlize both synthetic absorbable mesh (galaform or durasorb) or a biologic mesh (strattice) based on the amount of support that is necessary. I highly seeking out a board-certified plastic surgeon that has extensive experience in revisional breast surgeries since revisions can be a challenge. Best of luck in achieving your aesthetic goals!

When performing an Augmentation with a breast lift (Mastopexy), there is a concern with dual-plane submuscular placement of the implant, as the Pectoralis Major muscle, due to muscular tonicity, can inferiorly displace the implant, creating a 'bottomed out' appearance. This 'bottoming out' can result in cephalad autorotation of the nipple areolar complex to an undesired higher position.

Breast lift is a temporary correction of sagging, and the normal aging process, gravity, activity, and most importantly the quality of your tissues will determine how quickly you re-sag. Patients who have a lot of excess skin or have lost a lot of weight are the most challenging for me and about 20% of them, have dropped too low by 2 years in my opinion (sometimes my patients think this is OK or don't notice, but I do).

It looks like you had a good surgery with the surgeon providing plenty of fullness at the top and good nipple placement. The pec muscle, if anything, pushes the implants down and out because the pec muscle never completely covers the implant (its anatomically impossible in normal situations). That said, no data supports that going "under" saves women from early re-sagging.

It would take true "before and after" photos or an exam to figure out what may have caused early sagging in your case.

Based on your written questions and only two post of photos, one immediately postop, and one in clothing in action in a pool very hard to offer an accurate response. You need to post how your breast look now in a frontal view. Or do a virtual consultation. But for informational purposes breast augmentation under the muscle is never 100% under the muscle. That’s a mistake to think that Your doctor sounds like he offered you the correct procedure and at times breast tissue and your own personal tissue do not hold in position, therefore due to your elastic tissue laxity genetically or otherwise you get a reoccurrence sag again best of virtual consult with a revision whether exchange of implant to a larger size use of an internal mesh or re-lifting fees could range from $10,000-$25,000. Again, best of virtual consult with.

To make an assessment we need pictures. In your paragraph what you look like in the operating moment probably isn't sufficient to understand what your breasts are like now.
Breast augmentation when done in conjunction with a breast lift it's almost universally done under the muscle. This is considered a standard approach for a number of reasons including safety.
I combined breast augmentation and lift has a fairly High revision rate. You may want to consider getting a few second opinions from other plastic surgeons in your community.
For second opinion consultations come prepared bringing with you it completes set of proper before and after pictures and a copy of your operative report. These are part of your medical record that you can request from your current provider's office.
Not going fully under the muscle doesn't make much sense. The pectoralis muscle is usually transected in order to make room for the implant under the muscle. Plastic surgeons will vary on what level they transect the muscle parent and usually they implant is either above or below though some plastic surgeons prefer a dual plane which generally implies that the muscle is divided a bit higher up.
Good luck,Mats Hagstrom MD