Should I have my implants placed over the muscle so I can continue with frequent push ups and pull ups?

There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:

Subglandular implant benefits:

A shorter recovery time.
Less discomfort initially.
No distortion of the breast when the pectoralis muscle flexes.
Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
Easier surgical procedure.
Larger implants can be placed.

 Subglandular implant disadvantages:

The implant may be more visible.
More visible rippling, especially in patients with a small amount of natural breast tissue.
Generally, saline implants do not produce a good result in front of the muscle.
Higher incidence of capsular contraction.
“Bottoming out” in some patients.
Some radiologists have more problems reading a mammogram with an implant in front of the muscle.

 Submuscular implant benefits:

Usually results in a better appearance for naturally small breasted women
Less tendency for seeing ripples of the implant.
A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
Lower rate of capsular contraction.
Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.

Submuscular implant disadvantages:

Recovery usually takes a little longer and is more uncomfortable initially.
There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
It is harder to achieve cleavage in women who have widely spaced breasts.
The implants often ride higher on the chest.

Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.

The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach and desired outcome..

Keep in mind, that following the advice from a surgeon on this or any other website who proposes to tell you what to do based on two dimensional photos without examining you, physically feeling the tissue, assessing your desired outcome, taking a full medical history, and discussing the pros and cons of each operative procedure may not be in your best interest. I would suggest you find a plastic surgeon certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS) that you trust and are comfortable with. You should discuss your concerns with that surgeon in person.  

Robert Singer, MD  FACS

La Jolla, California

 

Thank you for your question. It is not uncommon for very active women, including competitive body builders, to want to avoid negatively impacting on the function or strength of their pectoral muscles. As you may well know, placing the implant under the muscle helps conceal the edge of the implant, particularly in the upper pole, thus helping the appearance be more natural, and making the implants less obvious. The other advantage of placement under the muscle includes a reduced risk of capsular contracture (unwanted tightening and firmness surrounding the implant) and better breast visualization with future mammograms. The advantage of placement above the muscle is that the muscle remains totally undisturbed, but you are risking implant visibility or palpability, including rippling. If, however, you have an adequate amount of breast and subcutaneous tissue, placement above the muscle may be a good option for you. Please consult with an experienced board certified plastic surgeon who can advise you specifically as to which option and treatment plan would be best for you after evaluating you in person. Best of luck to you.