Size, technique and shape - is 300cc over the muscle right for me? (Photo)

Thank you for your question and photos. An examination in person would be required to properly evaluate you but from your photos you appear to have very pretty and symmetrical breasts. Based on those alone I would carefully consider why it is that you are seeking a breast augmentation . An experienced board certified plastic surgeon should be able to advise you, but please use photos of “favorites” to communicate your wishes, as opposed to words such as “natural” or “not too big”, which can be misinterpreted. Best of luck to you.

Dear Khloe14109,
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

That is a great question. Every patient has a different preference in terms of size and how big they want to be. For example, some people prefer to have a subtle and natural result, whereas others prefer to have an "augmented" look where it is obvious breast implants are in place. Sometimes, patients want to have implants that are too big for their frame.
In order to determine the best size, certain measurements help guide surgeons pick the best implant for patients. Based on the limited photographs, however, it seems as though 300cc would appropriate, depending on what size you ultimately want to be.
Going on top of the muscle depends on how much breast tissue is present over the muscle. This is determined by examining the breast by a "pinch test" (literally pinch the skin on the breasts) to feel how much tissue is present. This makes sure the implant will not be too obvious and show rippling (creases in the implant itself that shows on the skin). Sometimes, a firmer (or more cohesive) implant can be used if the implant is going to be placed above the muscle to prevent the risk of rippling. The implant your surgeon used is a more cohesive type of implant, and your surgeon said you have enough tissue above your muscle, making the technique choice acceptable.
One of the risks of going above the muscle is that there is a higher rate of capsular contracture. This is when scar tissue surrounding the breast tissue causes pain and firmness in your breasts. The rate of capsular contracture is lower when implants are placed under the muscle.
One of the benefits of going above the muscle is that there is no animation deformity (movement of the breast implant with movement/flexion of your chest (pectoralis major) muscles).
Going above or below the muscle depends on each individual patient's characteristics and skin quality, which can only be assessed in person. The most important thing is to have an informed discussion with your surgeon who will help you make the right decision.