Over and under the muscle - high profile or mod+? (Photo)

First let's look at your present situation, before jumping to implant size.1. Your breasts are ptotic and an implant alone will not provide much lift, no matter what size or position2. You are young and haven't had children yet. The expectation is that , sometime in the future, you will have kids and the breast shape and size will change further3. You want to minimize scarring now, and maximize resultThe trap is to rely on large implants to do too many things at once. The breast augmentation procedure itself has been said to have as hight as 40% complication rate and most of these problems are due to implant size (too large) and malposition.You should go on several consultation visits with surgeons with at least 25 years of experience to get the best information. The decision you make now will affect you over the rest of your lift.Hope this helps,Leland Deane MD FACS

Any advice you receive without a full consultation and examination must be considered incomplete, but putting a 600 cc implant under muscle will be damaging to the muscle and create significant movement artefact.  You have enough breast tissue to put implant over muscle.  Nipple or areolar incisions have many disadvantages, and you would be best served by an infra-mammary approach.  The implant profile could only be recommended following a bio-dimensional assessment in office.

Hello and thank you for your question. There are several advantages
and disadvantages to over vs under the muscle.  Under the muscle has the
advantage of lower capsular contracture rates, less risk of rippling, and
better visualization with future mammograms.  Most patients say that under
the muscle also has a more natural look and feel.  The size, shape,
and profile of the implant is based on your desired breast
size/shape, your chest wall measurements, and soft tissue quality. 
This decision should be based on a detailed discussion with
equal input from both you and your surgeon.  This entire surgery can be performed with a
small incision technique.  Make sure you specifically look at before
and after pictures of real patients who have had this surgery performed by your
surgeon and evaluate their results.   The
most important aspect is to find a surgeon you are comfortable with. I
recommend that you seek consultation with a qualified board-certified plastic
surgeon who can evaluate you in person.
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Hello Based on the limited photo you have submitted you may be rather a candidate for s breastlift .Getting such a large implant placed above the muscle through an areolar incision may lead to long term unsatisfactory results with higher chance of need for future revisions.Best for you to do a few more consultations.Thank you 

Thank you for your question. based on your pictures, I would suggest you consider a breast lift with implants. If you just have a breast augmentation, you will end up with fuller breasts but with the nipple facing downwards and an overall poor breast shape. If you do decide to have a breast lift as well, I would suggest using moderate profile implants. Again, from what I can see, you appear to have enough breast tissue to allow the implant to be placed over the muscle.

Thank you for this question. Going under the muscle has resulted in consistently superior results with lower capsular contracture rates and better long term outcome in Europe and the US. The bigger issue is your sagging breasts and this level of sagging makes you less ideal for breast augmentation and a better candidate for a breast lift with implants. However, you may not want a breast lift, but hopefully your plastic surgeon told you that breast implants only in the face of a need for a breast lift does not result in a good longterm outcome, but carries a higher risk of revision surgery into a breast lift anyway. Going above the muscle is the “last resort”  operation for saggy patients not wanting to do the lift. I believe you need to have at least two more consultations with board certified plastic surgeons and get second opinionas on what needs to be done for the best outcome. 
Best wishes! Dr. Aldo

Thank you for your questions. The scientific studies clearly show that placing breast implants thru an incision at the lower breast fold and placing the implants in a "partial submuscular pocket" provides a much lower risk of developing firm capsular contractures when compared to implant placement thru the areola and on top of muscle. Also, based on your photos it appears you may be best served with breast lifts in conjunction with implant placement.The implant size and style cannot be accurately determined without actually obtaining breast and chest measurements.

Choosing the right implants for you requires an exam in person. It does look like you  might need some sort of lift as well.

Hello. Thank you for your inquiry.
You may be an excellent candidate for breast augmentation surgery.
It is important to have an in-person assessment regarding your concerns as it is difficult to determine virtually.
There are many different factors that go into choosing a breast implant size which will correspond with your body dimensions while concurrently achieving your aesthetic results. Some of these factors are: Implant size (CC's), Implant profile (Low, Moderate, High), Placement of the implant (Subglandular vs. Dual Plane) etc. We utilize smooth round cohesive silicone gel 'gummy bear' implants for the best results.
During a consultation your aesthetic goals are heard and taken into account with the measurements of your breasts and the integrity of your tissue, as well as level of ptosis (sag). From here we collectively can find your 'perfect fit'. You are able to try out sizers and different implants in our office such that you can get an idea of what size you would be post-operation. We also offer Crisalix 3D plastic surgery virtual simulator during our in-person and virtual consultations to preview potential results. After your consultation, you will receive your very own implant sizers to take home with you (at a small cost) whether or not you decide to go forward with your procedure.
I usually recommend that my patients stop smoking, take vitamin C daily, and avoid aspirin/ibuprofen and vitamin E 3 weeks prior to surgery. I specialize in the 24-hour Recovery method which minimizes trauma to the breast and decreases pain post-operatively.
We encourage you to look at our website and Instagram (drkaraplasticsurgery) for lots of before and after pictures!
Please note that this response does not substitute patient-doctor relationship. We welcome any and all patients seeking advice to come in for a complimentary consultation available for limited time only.
During the COVID-19, we are offering complimentary online consultations as well as in-office consultation with social distancing and masks. Procedure done in-hospital private surgical facility while taking covid-19 precautions. We utilize UV-light to clean the air of viruses and bacteria during our consultations and surgery.
We invite you to come in to discuss your options more thoroughly. Please send us an email at info@drkaraplasticsurgery.com with the subject line: "Attention Meagan" and we will be happy to coordinate your appointment!

M.Kara,MD,FRCSC (27+ years experience) - Specializing in 24 hour recovery/ out to dinner breast augmentation in-hospital private surgical facility for your added safety and peace of mind