Breast Augmentation: Q&A

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Under Muscle Breast Augmentation for Tight Pectorals?

I'd like to enhance my breasts and am looking at the options. I am a fitness competitor and trainer and I worry about the effects of under the muscle implant placement. I have a tendency toward very tight pectorals which has resulted in some issues with my training. I am a full B cup (small C depending on the bra). I would like to go up, maybe a little more than one cup, but less than two. My sister recently got implants and her doctor does not even offer over the muscle procedure. Is this a standard in Breast Augmentation now? It seems like everything I read leans toward under the muscle. Would "unders" be an option for me with my training concerns and chronically tight pectorals?

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18 Doctor Answers | Asked by Melinda75 in MA

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Breast Augmentation in a Fitness Competitor or Trainer

In general, most of the time I use saline or silicone gel implants below the muscle because they have a tendency to look and feel better and mammograms are easier to perform. However, in patients who are fitness competitors and trainers, I use a subglandular breast augmentation with a silicone gel implant because of the fact that most of these patients are lean, have minimal amount of breast tissue, and don’t want their implants to move during these fitness competitions. more

Rod J. Rohrich, MD

10 reviews

Dallas Plastic Surgeon

Breast augmentation for bodybuilders

I regularly perform breast augmentation surgery for patients who participate in body building, fitness and figure competitions. While many are initially concerned about sub-pectoral placement and the potential for distortion of the appearance of augmented breasts when the pec major contracts, I am absolutely confident that the aesthetic outcome for these patients will be far superior with implants placed under the muscle. A pre-pectoral implant in a slender patient, especially one with... more

Michael Law, MD

17 reviews

Raleigh-Durham Plastic Surgeon

michaellawmd.com

Consider subfascial implant placement

Your situation is actually common but one that requires special consideration. Traditionally, under the muscle is recommended for better coverage of the implant and more natural contours. However, athletes such as yourself are usually advised to have them over the muscle, because of the tightness of the muscle and the potential for what are called animation deformities (which is distortion of the breast with physical activity). But going over may mean that coverage isn't good because of low... more

Under the muscle vs over the muscle breast augmentation

Hello, A breast implant can be placed under the muscle, on top of the muscle under the cover of he muscle (subfascial), or over the muscle under the breast gland. In general, saline implants should be placed under the muscle. Some patients with very thick breast tissue may be ok with saline on top of the muscle but in general saline implants should be placed under the muscle. Silicone implants can be placed under or over the muscle. Very thin patients and patients... more

VIDEO: Dynamic animation deformity with well defined pectoralis

Individuals with well developed pectoralis muscles tend to prefer over the muscle placement which can make the implants more visible. If placed under it is more likely to result in the dynamic animation deformity: see attached video see video

Otto Joseph Placik, MD

32 reviews

Chicago Plastic Surgeon

Implants in trainers

Tight or not the implants can go under the pectoralis msucles. These are usually cut to accomodate the implants along the inferomedial aspect. But, they might move funny especially in a weight trainer. You may want to consider above the msucle if you have enought soft tissue to cover them.

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

There are trade-offs in implant techniques

In general, body builders and fitness trainers opt for implants over the muscle (subgalndular). When you contract the muscle a lot, it distorts the implants. Placing the implants under the muscle also requires cutting and dissecting muscle that may alter your normal anatomy when you pose. If you have a significant amount of normal breast tissue (large B/ small C) then you may be able to effectively hide your implants behind your breast tissue making for a very natural result without the... more

Robin T.W. Yuan, MD

4 reviews

Beverly Hills Plastic Surgeon

Submuscular implants are usually better

The placement of an implant partially submuscular (under the pec major) has the benefit of better mammograms than above the muscle, less edginess of the implant, less implant palpability, less capsular contracture, and a more natural long term look. Depending on how your surgeon handles the muscle, there can be more or less of an "active breast" deformity under the muscle. This is the main trade-off but usually is outweighed by the above benefits even in body builders and fitness experts.... more

You can have the implants above the muscle

RedGirl122, It is okay to have your implants above the muscle. If they are put under the muscle, the muscle needs to be cut in order to accommodate the implant. However, if you are an athlete, then you may prefer to the have the implant placed above the muscle. Just find a plastic surgeon who is comfortable doing this procedure. Good luck.

Both implant placement are options

The reason most Plastic Surgeons recommend sub-pectoral (beneath the muscle) placement of the implants is: 1 - Long term, there is less incidence of capsular contracture 2 - Better for mammograms 3- More natural slope to the upper pole of the breast, especially long term 4- Less chance of feeling the implant. The main disadvantage for a fitness competitor is when the pectorals are flexing, it can distort the breasts. I have implanted a number of body builders both above and beneath the... more

Implants may get displaced upward when flexing pectorals

First, there is no standard way to do breast augmentation. Under the muscle vs. over the muscle have pros and cons. I prefer under the muscle due to lower capsular contracture rate, the extra padding, and the stronger support (minimizes sagging) of under the muscle vs. over the muscle placement. On the other hand, when you flex your pecs, the implant may "jump" or get displaced upward until you relax the muscle. This is something that you must consider. I don't feel that your... more

Above muscle implant placement probably best for you

Hi there, Because of your very active lifestyle, I would agree with my colleagues that you are probably best served by implant placement on top of your pectoralis.

Firmness maybe, loss of strength no

Dr. Stephen Beals and others performed an excellent study detailing the changes in pectoralis muscle flexibility and strength changes after under the muscle breast augmentation. What they proved was that you clearly have a TEMPORARY decrease in strength and flexibility while recovering from surgery, but tested on machines used by physical therapists for rehabilitating orthopedic patients, they demonstrated a return to full function after recovering and reconditioning was accomplished. ... more

You should not have implants under the muscle.

Jessica, Women like you do poorly with subpectoral implants. I recommend Mentor round smooth-walled Moderate PLUS profile silicone gel implants OVER the muscle. Also don't go too big as this may interfere with your competitiveness.

Consider above the muscle silicone implants

Hello Jessica, Your concerns are very valid. We prefer under the muscle (partial submuscular, dual-plane) placement for the vast majority of our patients, including fitness instructors. However, when a woman's pectoralis muscle is very thick and tight (as in body builders), we have chosen to go above the muscle using silicone implants of a higher profile. I have seen "unnatural" results with both above the muscle and under the muscle approaches, so one approach does not guarantee a... more

Breast implant placement above the muscle

Hello Jessica There are pros and cons for under the muscle implant placement. I personally prefer the over the muscle placement with a gel implant, as it gives the best breast projection. It is the way to go for atheletes and body builders. Under the muscle has benefits for thin patients especially with a saline implant. It is important for them not to have a protective layer so that the implant will not show. Hope that helps!

Submuscular implants have many benefits, some tradeoffs

Jennifer, Submuscular augmentation was started years ago for two main reasons. Intuitively the implant belongs under the gland of the breast and in the best of worlds the implant and breast tissue flow together and feel as one, soft and natural. The problems encountered are capsular contracture, and visibilty of the implant within the breast. Capsular contracture is a tightening of scar tissue around the breast implant causing it to round up and become firm and appear less than pretty... more

Consider above the muscle implant placement

Hi! I would share your concerns regarding submuscular implant placement. Typically, it is not a problem, however with pectoral contraction there is indeed a chance for banding and potential unattractive characteristics. If otherwise possible, above the muscle could be the best choice. Various implant options are available and can be tailored to your physical exam and wishes. Hope this helps!