Every woman’s body is different and because of that the only person that can talk with you about the size and implant placement of your implants is your surgeon.
I prefer to place breast implants under the muscle as I believe it achieves a more natural look, less interference with mammography and minimizes the appearance of rippling.
Talk with your surgeon in length about your desired results and voice your opinions and concerns. (Joseph G. Bauer, MD, FACS, Alpharetta Plastic Surgeon)
Silicone gel implants (above or below the muscle) are preferred over saline implants in petite women.
Silicone gel implants look and feel more natural than saline implants in small thin women. A recent study concluded that rippling with gel implants was no more likely above the muscle than below it.
I think your surgeon gave you good advice. The only obstacle you face preventing a beautiful result is capsular contracture over which your surgeon has little control.
In my experience, about 1 chance in 25 that you will have a significant contracture. (Vincent N. Zubowicz, MD, Atlanta Plastic Surgeon)
Pocket location for implants
In a very thin woman without a lot of breast tissue, I prefer to place implants under the muscle or what some call through a biplanar approach. This gives more soft tissue coverage in the upper pole. (Steven Wallach, MD, Manhattan Plastic Surgeon)
Breast Implants under the muscle for an active woman
Although when placed under the muscle implants MAY lead to distortion of the breast with exercise, this is only noted when the breasts are exposed (as in a tight tank top), and does not have implications for the longevity of the implants, your health or comfort, and does not affect the beauty of the outcome otherwise. Further, when placed under the muscle, the appearance (whether during exercise or not) tends to be more natural and the feel of the breasts more soft. Finally, the implants and your lovely outcome will last longer, and you will experience fewer risks, because of the protective effect the muscle tissue seems to have on the risk of capsular contracture and on the risk of stretching of the skin.
In my opinion and experience (I have multiple professional athletes as patients, and they all have their implants under the muscle), most women would prefer to deal with the minor possibility of some breast distortion with pectoralis contraction than with breasts that look unnatural AT ALL TIMES because the skin has been stretched by an implant on top of the muscle, or because the scar tissue has tightened around the implant. (Armando Soto, MD, FACS, Orlando Plastic Surgeon)
Under the muscle would be best over the long term
I believe that you would do best with silicone implants under the muscle. This would reduce the risks of palpability and capsular contracture. I think that you will have a better overall shape with a more natural transition from your upper chest to your breasts. Later in life, if you need a lift, the procedure is safer as the blood supply to the breasts (which comes in large part from the underlying muscles) has been preserved and shaping of the breasts can be accomplished with less risk of healing problems.
I tell my patients who are very active like you that they may resume all of their activities at 6 weeks except no pectoral work such as pushups and bench press. Which you won’t need as your breast contour will be beautiful. Early on you can exercise by walking on a treadmill or riding a stationary bike. (Michael D. Yates, MD, Huntsville Plastic Surgeon)
Muscle exercise after breast augmentation and avoiding the “fake look”
If you are afraid of golf ball boobs, I would recommend moderate to moderate plus profile silicone gel filled prostheses placed under the muscle to soften the appearance of the implants and create a tapered look. This will mean that you will have to limit your exercises to avoid pushing the implants outward. This generallly consists of wide grip bench press, wide push ups, butterflies and the “pec deck” (Otto Joseph Placik, MD, Chicago Plastic Surgeon)
Fore! Keep exercising after under the muscle implants
Your surgeon’s plan for gel filled implants placed under the muscle is a very reasonable one and the most likely to give you a natural appearance. I don’t know what “cannot work out hard” means, but the only patients that I recommend against submuscular implant placement in are body builders and professional athletes. Anyone less will never notice any functional change in their pectoral muscles. As noted, you may see some implant movement when exercising the pectorals after submuscular augmentation. Good luck! (Kenneth R. Francis, MD, FACS, Manhattan Plastic Surgeon)