Can over the muscle implants look natural and still get a great look?

It would be necessary to examine you in person to make specific recommendations.  Most thin patients  should probably have their breast implants placed under the muscle to get adequate soft tissue coverage.  In some patients, the submuscular pocket can experience quite a bit of muscular distortion to the breast shape with arm use, or have a wide cleavage, and may be more prone to implant position asymmetries.  That said, carefully selected patients with a little early ptosis or sag can get a very nice natural shape and cleavage with a sub glandular implant pocket and might be able to avoid having a breast lift for a few years.  Discuss with your doctor and consider getting second opinion from an experienced plastic surgeon.

It's a great question. I strongly prefer under the muscle implants because the muscle provides another layer of camouflage for your implants. The muscle contours the top of the implant to give it a more natural slope and implants under the muscle have a decreased risk of scar tissue forming around the implant (capsular contracture). Although an implant on top of the muscle can be a good choice for some women, for very thin women there is not enough camouflage for the implant to look natural. When considering breast augmentation make sure you find a board certified plastic surgeon who will take the time to answer all of your questions and explain all of your options, so that you can decide if breast augmentation is right for you.

Thank you for your question. Given what you have said, I would say your doctor is absolutely correct. I nearly always place implants below the muscle because it maintains the best natural look as well as maintaining a better blood supply and possibly sensation. The challenge in the upper pole of the breast is avoiding the Half-a-coconut-stuck-on-your-chest-look. This is especially true in thin women who have upper breast atrophy after breast feeding. By placing the implant below the muscle, you add a significant thickness of soft tissue between the implant and skin, so the upper pole looks much more soft and natural. Much of the fake look comes from having an obvious implant under the skin. There are a few down sides to going under the muscle (animation defect and a little longer recovery) but the trade off is far worth it in nearly all patients.  It sounds like you picked an excellent surgeon. Best of luck.

You are in a special group of breast augmentation patients where the pros and cons of over- and under-the-muscle are delicate. Ultimately I give my patient's the choice. But, I have a long discussion with them about the pros and cons. What I offer weight lifters/trainers/body builders who are worried about the under the muscle aspect is (in short): over the muscle shaped (gummy bear) implants. Here are a couple reasons why: 1. over time, under the pec muscle simply looks better at the upper pole of the breast because it camouflages that rounded shelf look that occurs over time if it's over the muscle. Eventually, and if you were in my office I would show you pictures of patients I've revised, the round implant over the muscle just develops a round mellon and fake look. Those patients hate their breasts and I end up revising them who have been implanted by other surgeons. What do I do? I put it under the muscle! Now, with the shaped implants, that round shelf look up top can be decreased with shaped implants. Still not perfect, and under the muscle will ALWAYS be better LONG-TERM, but it is a calculated risk and we are taking steps to get the most longevity out of the over-the-muscle augmentation. 2. Capsular contracture. Over the muscle has bigger capsular contracture rates, and so far, the shaped implants likely have less cap contracture. So, this is another reason I use them over the muscle. To decrease the overall risk of cap con.
Hope this helps!