Breast Augmentation for Body Builders - Above the Muscle?

I'm a competitive bodybuilder and powerlifter and I'm looking to have saline implants placed above the muscle. I'm currently a 34 A and would like to be a 34 full C- small D. Would saline be the right type of implant for my body type?

Doctor Answers 29

Breast Augmentation in Bodybuilders

Rachel, you have asked a very good question, to which there is no perfect answer. While there is always a trade-off in any surgery, the significant factors in body builders are 1) low body fat 2) desire to show good pec shape, size and definition.

Because of these considerations, I usually recommend leaving the Pec alone, and accepting the tradeoffs of being above the muscle in a thin person. Specifically, these are visibility of  the implants and visible rippling of the implants. This is decidedly worse with saline implants, so I would definitely recommend only silicone gel implants. And even these are not without wrinkle potential. In terms of implant visibility, this also depends a lot on the size of the implants. The bigger they are, the more likely they are to be seen and appear un-natural. Submuscular implants in body-builders are problematic because of the weird look when the muscles tighten. If you want pectoral augmentation, then go sub-pectoral. If you want breast augmentation, then go sub-fascial (above the muscle).

Portland Plastic Surgeon
4.5 out of 5 stars 17 reviews

Tradeoffs in Breast Augmentation surgery

For very athletic women, as you are, I recommend implant placement above the muscle, but this results in less tissue for coverage of the implant, and with time, you may develop quite noticeable rippling of the implant beneath the skin and breast tissue.  A better choice for your implant above the muscle would be silicone, which has a lesser tendency for visible rippling. 

Amy M. Sprole, MD
Wichita Plastic Surgeon
5.0 out of 5 stars 6 reviews

Breast Aug for Body Builders

Since you are having the implant placed above the muscle, you may want to consider gel implants since they will have a more natural feel and don't show visible rippling under the skin as much.

Jeffrey W. Hall, MD
Austin Plastic Surgeon
4.5 out of 5 stars 19 reviews

Saline implant on top of muscle?


As a very good rule of thumb, saline implants should be placed under the muscle, especially if there is very little breast tissue/low percentage body fat.  Breast augmentation performed in the subfascial or subglandular plane (on top of the muscle) is ideally performed with a silicone implant and on patients with at least a 2cm pinch test thickness of the breast tissue.

All the best,

Dr Repta

Remus Repta, MD
Scottsdale Plastic Surgeon
4.9 out of 5 stars 166 reviews

No easy answer for augmentation on athletic build

Unfortunately, this is a compromise operation. You will have to accept some of the disadvantages that are naturally a part of the operation and some of those are emphasized by the fact that bodybuilders in general have a very low percentage body fat which makes visibility of the implant much more likely. This is true whether the implant is placed under the muscle or over the muscle. One issue to consider is size. Going too large will not only give a more unnatural appearance it will increase the chance of implant visibility meaning a greater chance of visible rippling and wrinkling. A more conservative size implant will look more natural and that will have less of the chance of visible rippling and wrinkling. A more conservative size implant will also keep you looking in proportion and more athletic. With regard to this issue the silicone implant is preferable because in general it not only feels more natural but it looks more natural because there is less of the chance of rippling and wrinkling compared to saline implants.

The next issue to consider is whether to put the implants under the muscle or over the muscle. There are disadvantages to each of these choices in bodybuilders. Over the muscle or more accurately, sub glandular, results in less soft tissue coverage which could increase the chance of being able to see the implant. This means that rippling will be more visible.

Unfortunately, placing the implant under the muscle increases the chance of movement of the implant with contraction of the pectoralis muscle, which in many cases is undesirable. It can be difficult to predict how much movement of the implant will be present, but in all likelihood, there will be some. So you need to choose which of those problems you want to try to avoid, and which of those problems will be acceptable to you if they are present after the surgery.

I would recommend silicone gel implants and leave up to you whether he would prefer over the muscle, sub glandular or under the muscle, sub muscular given the issues noted above.

Ralph R. Garramone, MD
Fort Myers Plastic Surgeon
4.7 out of 5 stars 62 reviews

Subglandular breast augmentation

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.

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

Breast Augmentation for Body Builders - Above the Muscle?

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!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Consider silicone instead

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. 

Ronald Levine, MD
Toronto Plastic Surgeon
4.6 out of 5 stars 24 reviews

Above the Muscle for Bodybuilders

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.

Richard J. Bruneteau, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 194 reviews

Above the muscle breast augmentation

In my experience competitive body builders generally choose subglandular or subfascial breast augmentation; however, an above the muscle pocket can be associated with a higher risk of wrinkling and capsular contracture. 

In order to minimize the risk of wrinkling when using a pocket above the muscle, the surgeon must carefully choose patients who would be at low risk and use an implant to minimize the risk. Patients need adequate pre-pectoral soft tissue coverage (as determined at the examination) in order to be good candidates for a subglandular or subfascial pocket. Although it may seem otherwise, the pre-pectoral soft tissue coverage can and often is adequate even in bodybuilders. The type of implant impacts the risk of wrinkling. I would recommend a silicone implant with a highly cohesive gel; I would not recommend a saline implant. 

Textured implants are associated with a lower capsular contracture rate particularly when the implant is placed above the muscle. 

So my implant recommendation for an above muscle pocket would be highly cohesive silicone gel with a textured shell. 

If you were to decide that the risks of an above the muscle pocket are too great to accept then you would consider the pros and cons of a dual plane (under the muscle pocket). Implant animation is associated with the dual plane pocket - the implant can move high up on the chest wall when the pectorals muscle is flexed. Also there is some loss of pectoralis major function. This loss is insignificant in all but high performance athletes - you may well be in this group. 

Consult with a board certified plastic surgeon with significant experiance in aeshtetic breast surgery. I would suggest you visit with a surgeon who is comfortable using pockets above and below the muscle as well as being well versed in using the different implants available currently. The link below will take you to a page on my website that lists the pros and cons of the various options in breast augmentation. 

Michael B. Tantillo, MD
Boston Plastic Surgeon
4.7 out of 5 stars 29 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.