Decided on 600-650cc: should I go with over or under the muscle?

Dear torihes87,
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, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

600-650 cc implants cannot physically fit underneath the muscle. If you want something this large, it will have to be placed in front of the muscle which results in a higher chance of capsular contracture. At size 34, each 100 cc of implant corresponds to 1 cup size change. 300 cc implants would take you up to a DD. You may need a simultaneous lift. The technique I recommend is a mini lift. Using a circumareola incision, your breast tissue is reshaped, elevated higher on the chest wall and more medial to increase your cleavage. At the same time, small implants can be placed totally submuscular.

Best Wishes,

Gary Horndeski, M.D.

Good afternoon,
You're smart to have concerns, and overs is a terrible way to perform breast augmentation- the encapsulation rate is double that of under the muscle, they do not look or feel as good, and they sag more commonly. Also, mammograms are better when implants are under the muscle. textured implants have fallen out of favor because of their association with a weird lymphoma of the breasts called BIA-ALCL. Go under, go smooth.

Thank you for sharing your question and photograph. If uncertain I would advocate seeking out additional consultations in your area as in most cases placement underneath your muscle will help limit the chance of future complications.

The majority of breast augmentation surgeries I perform are under the muscle. This approach allows for coverage for a portion of the implant, lower capsular contracture rates, and some muscle support for the implant. Because of the weight of the implant you are wanting, the extra support may be beneficial.