Under or over the muscle with gummy implants (BA)? (Photo)

Thank you for your question and photograph.  Broadly speaking, breast implants can be placed above or behind your chest muscle (pectoralis).  There is great variability on the answer to your question on this site, so a thorough discussion with your PS is important in choosing the best implant placement for you.  Typically, with an A cup breast, placement of moderate to large implants above the muscle can be problematic: the implant doesn't have as much soft tissue covering in this position which may make the implant more visible over time.  It also has a higher rate of scarring which may be noticeable (capsular contracture), and it will not look as natural as when placed behind the muscle. For these reasons, an implant behind your muscle is probably best.  

You are a perfect candidate for sub muscular dual plane implants!!!!There are many advantages to sub
muscular dual plane placement and very many disadvantages to sub glandular
placement. I would see no indication to do anything but sub muscular.
However, the shape of your breast would require a surgeon that is specifically
experienced in the treatment of ptosis with implants. This can be best
accomplished with the armpit approach. The most sophisticated approach to
breast augmentation is through the armpit with a surgical camera (transaxillary
endoscopic). Using this modern approach the space can be crafted under direct
vision, with virtually no bleeding and no postoperative bruising. Most
importantly, the shape of the breast is meticulously created. The other, older
methods of insertion are technologically less advanced. Both silicone and
saline implants can be placed through the armpit by a surgeon with skill and
experience using this approach. The incision in the crease is the oldest method
of placing the implants and puts a scar directly on the breast.Subglandular
silicone implant placement is the historical approach to this surgery, and was
widely used in the 1960's. The implant edges are more visible, the risk
of rippling is higher, the implant is in contact with the non-sterile breast
tissue so the risk of infection and capsular contracture is higher. The
interface between the breast tissue and the muscle is blurred so the implant
interferes with mammography more than sub muscular placement. The blood
supply surrounding the implant is worse so the risk of capsular contracture is
higher. The support for the implant is less so there is more long term
shape abnormalities and sagging. The look of a sub glandular implant is
much less appealing than a sub muscular implant. The placement of sub glandular
implants makes any subsequent revision surgeries more complicated and less
successful. There are no advantages to sub glandular implant placement.