I have tuberous breasts. Would you place an implant over or under the muscle? (photos)

Tuberous breasts are defined by two main characteristics:  1. a tight constricting "band" encircling the base of the breast and causing it to be narrowed and 2. an enlarged areola.  You have both of these characteristics.  I do NOT think that you necessarily  have any asymmetry.  I think it may look that way simply by the way your picture is taken.  In my hands, I would suggest a peri-areolar (aka, donut or Benelli) mastopexy to keep your areolae from expanding further after breast augmentation.  This would also help elevate your areolae slightly.  The constricting bands could also be addressed through this approach.  Finally, I would put your implants under your chest muscle.  I feel like the long term results would be better with submuscular placement as you appear to have minimal breast tissue coverage.  Also, submuscular placement would decrease your risk of capsular contracture.

I
recommend a new technique called Breast Augmentation with Mini Ultimate Breast
Lift™.Using only a circumareola
incision it is possible to reshape your breast tissue creating upper pole
fullness, elevate them higher on the chest wall and more medial to increase
your cleavage.Through the same
incision, implants can be placed.Aligning the areola, breast tissue and implant over the bony prominence
of the chest wall maximizes anterior projection with a minimal size
implant.Small round textured silicone
gel implants placed retro-pectoral look and feel more natural, are more stable,
less likely to ripple or have complications needing revision.Implant profile is irrelevant in the
retro-pectoral position since the muscle compresses it.A tissue expander is only necessary if you
want large implants otherwise a small implant can be done simultaneously.Best Wishes,Gary Horndeski, M.D.

I prefer the implant under the muscle in most cases.  Your left breast would require a lift to make it look right, so I would actually lift both breasts with the lollipop lift and put implants under the muscle.

    Either is acceptable, and a good result can be generated with either approach.  I usually place the implants under the muscle.Kenneth Hughes, MDLos Angeles, CA

Your breasts are significantly asymmetric. The left is more tuberous than the right-- I would approach your condition with a infra-areolar incision on the right with a high profile  Silicone gel over the muscle. On the left-- I would use a Supra-areolar incision with a crescent lift to achieve symmetry of the nipple with the right side. Simultaneously on the left- I would reduce the tuberosity from  the inside. And place the high profile implant-once again over the muscle.