Uplift with under the muscle 265cc implants. Crossfit concern - should I reconsider the implants?

Question

I have had my consultation with my surgeon and he has recommended an uplift with an implant but under the muscle, as if he goes over he says I may get sagging breasts again. I'm really concerned as I do crossfit 5 days a week which involves a lot of overhead movements. Should I reconsider my implants? So worried.

Andac Aykan, MD · Answer

Hi, great question to ask.
You do not need to avoid implants because of CrossFit, but you should expect an adjustment period. Under muscle placement is commonly recommended with a lift to reduce future sagging and give better long term support. With a size like 265cc, most patients return to full training without issues once healed. That is the important part.
You will need a proper recovery period (usually 6 to 8 weeks before heavy overhead lifting). After that, most athletes resume CrossFit comfortably. And you will be able to as well. Some tightness or awareness in the chest during pressing movements can happen early on but usually improves over time.
If avoiding any chest muscle involvement is a top priority, over the muscle is an option, but it does carry a higher risk of recurrent sagging in lifted breasts. This is a trade-off to discuss clearly with your surgeon.
&mdash; Andaç Aykan, MD, Assoc. Prof.

Daniel Barrett, MD · Answer

Dear Diligent242326,

it is hard to tell for sure without an examination. Generally speaking, you can get breast implants even if you do crossfit often. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Richard Baxter, MD · Answer

In general, over muscle placement is the most reliable way to avoid issues like animation deformity and muscle weakening from under muscle placement, especially with dual plane. My preferred way for over muscle is subfascial, which adds a little  it of support. It may not be ideal if your body fat is extremely low, but should definitely be considered.

Jacob Carlson, MD · Answer

I would strongly recommend having that conversation with your plastic surgeon, as your concerns are certainly valid. The vast majority of the breast augmentations that I do are 'under the muscle.' For patients who are very active (e.g. bodybuilders, CrossFitters), I think it's worth considering going 'above the muscle' for a couple of reasons.
Anecdotally, patients who have had implants put 'under the muscle' have told me that they feel like they have about 90-90% of the strength of their pectoralis muscle after they are all healed, compared to before surgery. For the average patient or for someone who works out sparingly, losing 5-10% of their pectoralis muscle strength may be inconsequential. For those patients who are very active, that 5-10% loss of strength may be a big deal.
Another thing to consider with patients who use their chest muscles a lot is the possibility of developing "animation deformity." When the pectoralis major muscle contracts, it can cause the implant to move in position, which results in a visible distortion of the breast. This can happen in any patient where the implant is 'under the muscle,' but it might be even more noticeable in patients with more robust pectoralis major muscles. If the implant is 'above the muscle,' contraction of the pectoralis major muscle shouldn't change the position of the implant as significantly.
There are good arguments in favor of placing implants in either position, so I would encourage you to talk with your plastic surgeon to make sure that you're comfortable with the route you choose.

Ted Eisenberg, DO, FACOS, FAACS · Answer

In my experience lift with implants under the muscle has not affected physical abilities. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Donovan Rosas, MD · Answer

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach. Subglandular Augmentation (“overs”): • Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster when compared to subpectoral augmentation. • Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection). • Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space. • Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling. Subpectoral Augmentation (“unders”): • Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients. • Subpectoral implants have a lower rate of capsular contracture. • Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion. • The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle. Each approach has both costs and benefits. With regards to your specific question, submuscular/dual plane augmentation does impact pec muscle function. There is a real but minimal loss of strength post operatively. Most don't notice the diminished strength. Physically active individuals can return to exercise at 4 weeks but they may notes some losses in strength. However, one must decide if the improvement aesthetically is worth the sacrifice in strength.

Camille Cash, MD · Answer

Once you are fully healed from surgery you will be able to resume your current activities including crossfit.  This is regardless of if you get implants or if they are placed above or below the muscle.  I advise my patients they can resume strenuous activities after six weeks with normal healing.  It is important that you slowly and gradually build back up to your previous activity level.

Uplift with under the muscle 265cc implants. Crossfit concern - should I reconsider the implants?

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