Recommendations, please: above/below muscle, size, style, shape of implants? (Photo)

You appear to be a good candidate for breast augmentation . A silicone implant placed beneath the muscle can give you more upper pole fullness while maintaining a natural look and feel. Depending on your surgical goals, you may consider a lift as well. I've included a video on implant selection that I hope you find helpful.

Dear muphinn,
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. Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.
Daniel Barrett, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Although your nipples are in a good position, your breasts have sagged and will need to be lifted again. Implants can be added behind the muscle for better upper breast fullness and support the weight of the implant. Do notice that your natural breast bases sit somewhat low on your chest and the bases cannot be moved. I would meet with a board certified plastic surgeon, be measured and examined, and try on a variety of sizes to see what you like. I do not recommend going large for you will just sag again from the weight. As we age, our tissue holds weight less well and things sag.