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