Breast Augmentation for Body Builders - Above the Muscle?

Thank you for your question.  Your situation represents one of the strongest indications for a subglandular (above the muscle) breast augmentation.  This will avoid issues of animation (moving) of the implants upon flexing of the pectoralis, as well as distortion of the contour of the pec by the implant itself.  Either saline or silicone implants would be a reasonable choice.  My personal preference as a surgeon is toward silicone implants, which produce a bit more of a softer, more natural feel, and have been proven safe and reliable.

Hello! Thank you for your question! Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts. Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years. In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance. Your breast width is the most important measurement. Given your description, i would consider above the muscle and consider a shaped, silicone implant.Things to to consider during your consultation, which your surgeon will discuss with you, include implant type (saline vs silicone), shape/texturing of implant (round vs shaped/textured vs non-textured), implant position (sub pectoral, subglandular, or subfascial), incision (inframammary fold, periareolar, axillary, or TUBA), and size of implant. This can be performed with/out a breast lift, which would serve to obtain symmetry in breast size or nipple position as well as improve shape. Good communication between you and your surgeon of your expectations is warranted - choosing your surgeon wisely is the first step. Discussion of your wishes and having an honest and open dialog of your procedure is mandatory. I have found that photographs brought by the patient is helpful to get a visualization of the appearance you wish for in terms of size, shape, fullness, etc. In addition, your surgeon's pre and postoperative photographs should demonstrate a realistic goal for you. Once this has been accomplished, allow your surgeon to utilize his/her best medical judgment during the procedure to finesse the best possible result for you after preoperative biodimensional planning and fitting the right implant for your breast width. Too large of implants for the woman often destroys the breast pocket and breast shape, thus creating an oft seen uncorrectable problem later. Very slightly less tissue may be visualized with subglandular implants, but not very significant.Implants may be placed either in the subpectoral (beneath muscle) or subglandular/subfascial (above muscle). Both locations are excellent and you can choose either one - your surgeon will discuss the pros and cons of each. In general, while a placement above the muscle is a more natural position for an implant to augment the actual breast, I find that it is not desirable for very petite women or women with a paucity of breast tissue - as the visibility and potential rippling seen/thinning of tissue may give a suboptimal outcome. A subpectoral pocket adds additional coverage of the implant, but causes slightly more and longer postoperative pain/swelling as well as the potential for animation deformity with flexing of the muscles. Today, there is no virtually no difference in rupture rate, capsular contracture rate (slightly higher with subglandular as well as certain incisions), and infection with the positions. As you see, there are a few factors to decide upon for incision, placement, and implant type/size. Consult with a plastic surgeon who should go over each of the options as well as the risks/benefits. Hope that this helps! Best wishes for a wonderful result!

There are significant advantages when breast implants
are placed beneath the pectoralis muscle. For this reason, the vast majority of
breast implants are placed in this location. Under rare circumstances, it’s
appropriate to place breast implants on top of the muscles.

One of these circumstances occurs when breast
augmentation is performed on patients who are body builders. These patients
often have large, thick pectoralis muscles. These muscles flatten the implants
and prevent the implants from having definition. In addition, contraction of
these muscles can cause distortion of the implants. When implants are placed on
top of the muscles these problems are avoided.

It’s important to realize that each patient’s situation
is unique and that decisions regarding implant placement involves a series of
tradeoffs. For body builders, subglanduler placement is definitely a
consideration and should be discussed with your plastic surgeon. Your plastic
surgeon should be able to determine which option is best for you.

In most women in this position, I recommend a silicone implant in either the subglandular or subfascial plane.  Animation is a very significant issue with under the muscle augmentation in bodybuilders.

Best,

If you are a true body builder, your implants should be placed above the muscle and not below the muscle. In these cases, since these patients have very little body fat I recommend silicone implants over saline implants because they will have less chance of rippling. However, I suggest discussing this option with your surgeon. I recommend a Smooth, round silicone gel implant, moderate profile using the base diameter as one of the major decision points for size and shape.

In a competitive bodybuidler with realtively little body fat, the best implant for you would be a high profile cohesive silicone gel implant placed above the muscle.

The disadvantages of this location are the potential visiblility.

The advantage are the avoidance of distortion with muscular contraction.

Any implant can have wrinkling or rippling. However, implants that have a higher profile tend to have less rippling and this may be the preferred shape for you. If the cohesive gel "gummy bear" are available than these have the least likelihood of rippling but will require a proportionately larger incision.

Rachel,

You raise a good question. Since you are athletic, your best choice is to have the implant above the muscle. I think that silicone always looks and feels more natural than saline. Also, another option would be to have the implant placed under the muscle fascia, but above the muscles (sub-fascial placement). This placement allows an extra layer of tissue coverage around the implant, but avoids having to place the implant below the muscle. Not every plastic surgeon does sub-fascial implants, so you may have to search one out in your area.

I hope this is helpful.

I think a silicone implant placed above the muscle would be your best option, and I would recommend a rather modest enhancement in size. The reason is that given your profession you probably have very little if any fat to hide the implant. In this case, the larger the implant, the more artificial the appearance. If you want the most natural look for your particular situation, I would discourage a major change in size (I would recommend a medium C as the maximum size goal in your case).

Breast augmentation in body builders has been a special interest of mine, starting several years ago when a patient with submuscular implants consulted me for a deformity when she flexed her muscles. it is a really tricky trade-off, since women with low body fat need better coverage for the implants, but under the muscle is just not a good option for obvious reasons. Putting them over, on the other hand, often just looks too fake. A compromise is called subfascial, which provides better support for the implants, and I believe improved contour on the upper part where the transition along the edge of the implant is especially important. There are some variations on this procedure so that it can be individualized. It is frequently used in other countries but only a few are doing a lot of it in the U.S.

Generally, I recommend silicone for patients with less of their own natural breast tissue and want subglandular placement, just because rippling is less of a risk.