Overs or Unders? Which is Best for a Person Who Exercises a Lot?

I know there are more complications with overs. However, I have also read that for an active person unders can be susceptible to muscle distortion. I am active. I walk alot and have just got back into running after a hip injury. I do weights, nothing too heavy but I try to keep it at a challenging weight! I am 21, 60kgs and approx 180cm tall. I am currently a 12B thinking about a 12C or D, high profile, smooth, round implants. I dont mind the fake breast look either but not overly fake!

Doctor Answers (14)

Breast Enhancement Surgery

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I think the under the muscle thing is overplayed, if you are super concerned about animation deformities I would downsize your implant and place it above the muscle


New York Plastic Surgeon
5.0 out of 5 stars 36 reviews

Under muscle or over muscle

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I generally recommend under the muscle unless the woman is a high performing athlete who needs every fiber of their pecs to perform at a high level. Most us don't fall into that category.

Raj S. Ambay, MD
Tampa Plastic Surgeon
4.0 out of 5 stars 14 reviews

Breast augmentation under or over the muscle

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The only time I recommend placing the implants over the muscle is for a body builder with little fat/breast coverage, since when they flex their muscles during a competition, it may push the implant up.

For other patients, going under the muscle makes more sense as there is less chance of rippling, palpabiligy, and most importantly less interference with mammography.  Given that 1 out of seven women in this country develop breast cancer, this is, in my opinion, the most important reason.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon
4.5 out of 5 stars 8 reviews

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Over the muscle to prevent distortion but can have other problems

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Thank you for your question. If you are very concerned and would be upset if your implants distorted by being under the muscle, then over the muscle can be an option. However, if you can feel your ribs on your sides, then you are going to be able to feel your implants. Moreover, you will have a much higher chance of rippling, thinning, and implant palpability if you go over the muscle. Plus, it's harder for mammograms, higher chance of capsular contracture. If you have a good bit of your own breast tissue and don't go too big on the implant though, then your own breast can do a good job of covering the implant. Don't go too wide on the implant. High profile implants will really press on your breast tissue and can cause significant thinning over time if you go big.  Ihope this helps.

J. Jason Wendel, MD, FACS
Nashville Plastic Surgeon
5.0 out of 5 stars 33 reviews

Breast Augmentation for Active "Exerciser”

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Thank you for your question. 

Although I understand your concern about muscle movement and/or distortion with breast implants placed under the muscle, I think there are a whole host of benefits of using the dual/plane breast augmentation approach.  For example, implants placed partially under the muscle tend to have fewer problems with rippling / palpability, encapsulation, interference with mammography, etc..  These advantages outweigh the potential for implant movement / distortion that can occur with exercise.

Also, most patients who are very active and/or exercise frequently, do not have significant adipose tissue or breast tissue coverage.  These patients are at higher risk for rippling/palpability of breast implants especially if placed in the sub-glandular position.

I hope this helps.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 710 reviews

Pocket location for implants

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In most patients, I place them in a dual plane ( submuscular pocket).  This is done to provide more soft tissue coverage for patients. I think there is a lower capsular contracture rate, but patient can develop a flexion deformity.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

Implant Position

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There is definitely a lower risk of capsular contracture and less palpability with implants placed subpectorally.  While there can be some distortion of the shape with pectoralis contraction, it is usually minimal and not noticeable in the outfits worn for fitness competitions or in workout attire.  Subglandular positioning can work, but if problems with palpability or capsular contracture occur, they can be harder to deal with in these patients especially if they are thin and have very little breast tissue. 

Donald Griffin, MD
Nashville Plastic Surgeon
4.0 out of 5 stars 12 reviews

Over vs under the muscle

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The placement of the implant with regards to the pectorals major muscle is a consideration in every patient. There are specific concerns that are unique to the patient's anatomy that may tip the scales for the decision in a particular direction. Either approach is technically feasible. The patients anatomy implant shape and size all play a role in the decision.

Jay M. Pensler, MD
Chicago Plastic Surgeon
4.5 out of 5 stars 10 reviews

Best augmentation for those who exercise

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There is nothing wrong with a moderate size subglandular gel implant for those who exercise and wish to avoid the risk of implant shift with muscle action. The submuscular location can avoid a visible edge, and reduce capsular contracture rates, but does not work out for all. If you like the idea of subglandular implants you might have to give up on the high profile bit.

Best of luck, peterejohnsonmd.com

Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 28 reviews

Implants above or below the muscle

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It is straightforward to go either way surgically, but far more patients have them under the muscle becasue they look better, have less scar tissue and give better mammograms than above the muscle implants.  Even in athletes.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
5.0 out of 5 stars 48 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.