40, 66kg, 165cc, 430-500cc, under or over the muscle? (Photo)

Thank you for your question. A large portion of my practice is dedicated to breast revision surgery. I have been in practice over 28 years. I have some perspective for you. No one wants a lift! Your anatomy dictates the procedure that is needed, and you definitely need a lift. I have seen your scenario to many times over the years in which the idea is: "placing a larger implant over the muscle to fill up the skin envelope so that you do not have to have a lift". In theory, that would work if we lived on Mars. I have a whole gallery online titled " term complications associated with implants placed on top of the muscle". Please look at that. What I see is people who are already drooping place an implant which adds more weight and more drooping. That being said, you should be able to have an excellent result with an implant placed under the muscle and a lollipop lift. Best wishes to you.

Dear Resourceful388991,
I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Unfortunately, you don't seem to have a lot of breast tissue to hide the implant, which means that by placing the implants over the muscle, they will be more visible and palpable (unless that is something that you want). Also, implants over the muscle have been shown to be associated with higher rupture and capsular contracture rates in the long term. Moreover, the larger the implant, more sagging will happen and quicker. I think placing a slightly smaller implant (ie 385-415cc) under the muscle with a small lift will give you a better and longer lasting result.

I would go toward the lower end of your size range. I prefer implants under the muscle. Some surgeons think that going above the muscle gives the effect of a lift. Going with larger implants may cause your breasts to sag sooner. As far as the lift is concerned you appear borderline I can understand your desire to avoid the scars involved in a lift.

After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size and style breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon's experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what size and style breast implant is right for them. Mildly Sagging Breasts: If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. That’s because as the implant fills out the top of the breast, it also fills out the bottom, making it look as if the nipple has moved higher. It hasn’t. You can always get a lift later if you feel you are not perky enough when fully settled and healed. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Implants over the muscle can reinflate the breasts better than under the muscle (or dual plane which is half under). Especially with larger implants. Breasts tend to look more natural.

This can avoid the need for a formal breast lift with its extra scars. Over the muscle has slightly higher risk of capsule and bottoming out, but may be a good option in your case.

Further discussion with your/a plastic surgeon

You have lost a lot of volume and now your breast is deflated and second degree saggy.
You are an absolute candidate for a Breast lift, you, as any person on the world, are not getting any younger and your breast will only become saggier in just a couple of years.
If you get a 500 Cc implant you will become a saggy, very obvious almost subcutaneous implant, Large D.
I consider based on your small frame a Beautiful rejuvenated Full C would look awesome. To achieve that it will be mandatory a Circumvertical (lollipop) breast lift and an implant under the muscle using a 350-375 Cc implant.
Be encouraged!!
Dr. Cárdenas

Regardless of where implants are placed, you seem to need a breast lift. Considering that you have a relatively small amount of breast tissue to cover a large implant, partial placement underneath the muscle would be my choice. Hope this helps.

Based on the description of your goals and your photo, placing the implants under the muscle should be considered. The weight of the implants can lead to a need for a lift whether they are under or over the muscle. Better to have it done now and enjoy the results. As for size of the implants, many surgeons have sample implants available that you can "try on" to give you an idea of how you may look after surgery. With either of the mentioned volumes you will go up multiple cup sizes.

In you, I would suggest placing the implants behind the muscle for better upper breast fullness, avoiding seeing the implant edge, avoid the round ball look, and better support of the weight of the implant. I also would not go with 500 cc's in you for that is too large and heavy for your frame and tissue. That size will thin and stretch your own tissue and will not support the weight of such heavy implants. Do the lift if needed now as well.