Breast asymmetry correction with implants - over or under? (Photo)

Going behind the muscle will give the best upper breast fullness and decrease the risk of the implant edge showing. However, you will have muscle animation. Most women do not loose strength, but it is possible. I prefer smooth round implants behind the muscle for a great look and the least long term risks.

I would recommend a subglandular augmentation with a smooth round silicone gel implant. Based on the pictures you have enough gland over top of your chest wall to support the implant underneath and keep it from being too visible. Additionally being that you are very active and have an athletic build, a subglandular pocket will decrease your risk for implant displacement.

In general, you have several options to achieve symmetry given your pictures. Your right breast is not only larger, but has more pseudoptosis (skin below the nipple) as well as a slight ptosis (low nipple). In my opinion, your best bet for true symmetry would be a staged procedure in which you underwent a subglandular or subfascial augmentation followed by a lift at a later time. Anatomic implants in the subfascial plane can look excellent, however can also lead to malposition. To decrease the risk of malposition, there are other cohesive smooth round implants that can give you a similar and reliable result. You could opt for a single stage subglandular augmentation mastopexy procedure on the right side, but the risk of asymmetry and revision surgery is slightly higher.