Best Type of Breast Augmentation for Petite and Athletic Woman?

Hi, I am 5'1" tall, I weigh 115lbs. I am very healthy and active. I currently wear a 32 A bra. I have two children (breastfed). An average week for me consists of running 5x, gymnastics 1x, yoga 1x and strength training 1-2x. My doctor has suggested that with my lifestyle, I should get gel Breast Implants in the subglandular placement with 250cc. After reading everywhere, many doctors say that with such a small frame, the implant will be noticeable and I will have rippling. But my doctor says I cannot work out hard with submuscular? HELP! Afraid of golf ball boobs!

Doctor Answers 33

Breast Augmentation for Active Women

I regularly perform breast augmentation surgery for patients who participate in body building, fitness and figure competitions. While many are initially concerned about sub-pectoral placement and the potential for distortion of the appearance of augmented breasts when the pec major contracts, I am absolutely confident that the aesthetic outcome for these patients will be far superior with implants placed under the muscle.
A pre-pectoral implant in a slender patient, especially one with well-developed muscles, looks just as you imagine it would: like a foreign object, not like a natural-appearing breast. The muscle does not have to contract for a pre-pectoral implant to look unnatural in this group of patients - it looks unnatural every minute of the day.
Achieving the ideal aesthetic position for a sub-pectoral implant requires release of part of the inferior origin of the muscle from the chest wall. I perform the minimal release of the origin of the pec major that is required to get the implant in an ideal position vertically, but also weaken the origin in the area where muscle contraction tends to displace an implant. As a result the vast majority of patients have little to no distortion of their breast appearance when the pec major muscles are tensed. Patients also do not experience any loss of function, strength or range of motion from release of this very limited part of the pec major origin. Many patients have indicated that their natural (but augmented) breast appearance has provided a significant advantage for them in competitions.

Raleigh-Durham Plastic Surgeon
4.8 out of 5 stars 118 reviews

Sub glandular implants

As usual, there is more than one way to do a proceedure. I have been doing implants for over 30 years and have put them over the muscle and under the muscle. I find that silicone implants look great under the breast( over the muscle) if you are athletic and exercise, under the muscle can deform the breast when you exercise or use your pecs. You only get tennis ball breasts if you develope capsule contractures. There is no right or wrong answer -- but I am usually right.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.2 out of 5 stars 12 reviews

Subglandular is the Appropriate Placement

Thank you for your question. Your surgeon knows the details of your case, so I would recommend following his advice. In my opinion, if you are very active, the subglandular placement is the appropriate placement. Submuscular placement is not good for very athletic, muscular patients. Rippling of the implants is more a function of saline versus silicone implants than of implant size: saline implants have a higher risk of rippling or wrinkles. 250cc is not too big an implant, and you won't have "golf ball" breasts as long as an implant of the appropriate footprint on the chest wall is selected. Breast implants are made in various height and width footprints to accommodate different body frame sizes.

Good luck, and for more information about other choices to be made before undergoing breast augmentation, take a look at the Guide to Breast Augmentation on my website from the web reference below. I discuss common patient questions I receive, silicone versus saline implants, round versus anatomically shaped implants, smooth versus texturized implants, implant manufacturer, implant insertion incision location, implant location inside the breast, and more. 

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 18 reviews

Subglandular vs submuscular

Thank you for this question.  Deciding to put the implant above or below the muscle has advantages and disadvantages.  Women who have very little breast tissue are not good candidates for subglandular implants.  Even with the silicone implants, the implant wrinkling will be visible and distracting to you, in or out of clothes.  Silicone implants do have the least some wrinkling, though the least as compared to the older saline implants.  If the patient has some breast tissue and uses a very small implant there might be enough breast tissue to cover the wrinkling.  These issues should be discussed during the consultation.  Situations where the patient is thin and has minimal breast tissue I feel the Silicone or Ideal Implant (structured saline implant) is the best choice in the submuscular space.  The wrinkling will be covered by the muscle over the top of the breast and the cleavage area of the breast.  The muscle activity can be minimized by the technique the Plastic Surgeon uses during the surgery.

For athletic patient's I recommend no working out for 6-8 weeks.  The tissues have to heal to minimize risks including bleeding, infection, wound breaking open and the long term risk of capsule contracture.  After that period of time you should have minimal restrictions and can resume working out.  During the  consultation all of these issues should be discussed.  I wish you the best, good luck and enjoy your new look.

David M. Creech, MD
Chandler Plastic Surgeon
5.0 out of 5 stars 8 reviews

Type of augmentation for a petite athletic woman

ConsideringThe advantages of a submuscular placement of a breast implant are significant. Implants placed underneath the muscle have more soft tissue coverage and therefore have a more natural appearance and less likelihood of the borders of the implant being obvious. Submuscular placement also has less chance of capsular contracture and mammography is more accurate. One of the disadvantages is temporary "flattening" of the breast when the muscle is flexed. I routinely place implants in the subpectoral position in patients who engage in bodybuilding and fitness competitions. When discussed preoperatively patients except this flattening as a trade off for a more predictable and trouble-free long-term outcome. If consideration is given to placement of the implant above the muscle it is important that the patient have sufficient soft tissue coverage between the skin and the implant. Its important to have at least a 2 cm pinch test in the upper portion of the breast. This is determined by the surgeon pinching the tissue in the upper portion of the breast to make sure there is at least 2 cm between the thumb and index finger.

John J. Edney, MD
Omaha Plastic Surgeon
4.8 out of 5 stars 112 reviews

Breast Augmmentation for Petite Athletic Woman

As with most if not all questions that are specific to a particular patient and situation, no one can give you an informed answer over the internet. To provide a meaningful answer to you would require a face to face discussion as well as a physical examination. Having said that, your question does raise some common questions.

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 is not always related to BMI - there are petite patients who have adequate soft tissue coverage for a pre-pectoral pocket. Then one would choose an implant that is associated with a low risk of wrinlking which is to say a highly cohesive silicone gel implant; the more form stable the less the wrinkling. The link below will take you to a case of a patient who weighs 102 pounds and had a subglandular breast augmentation with a HSC+ gel implant. 

On the other hand dual plane placement (under the muscle) is not associated with a limitation of physical activities or a significant performance drop off (with the likely exception of high performance athletes). Some patients do not like or want the "implant animation" that can be associated with a dual plane pocket but it is not physically limiting.

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.

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

Breast Augmentation in Thin Athletic Women

This is a very good question. There are a variety of breast augmentation options from the type of implant to use and where to place them.

Breast augmentation with a silicone implant has become the most common in the United States because it gives patients a much more natural appearance and feel than patients can achieve with saline implants.

There are several ways to perform the augmentation, as the implant can be placed through the nipple, axilla or at the bottom of the breast.

In the United States the vast majority of breast augmentations are performed over the muscle. However there are certain situations where the implant is placed over the muscle. The benefits of placing the implant below the muscle:
  • 1.More natural feel
  • 2.More natural appearance
  • 3.Less visibility of the implant
  • 4.Placing the implant below the muscle also decrease the chance that the patient will form scar tissue around the implant.

Patients that have their implant placed under the muscle can resume all of their normal activity once they have completely healed. I have many patients who athletes that have had a breast augmentation under the muscle and been very happy without any issues.

It is important to see your board certified plastic surgeon to help guide you to an implant that will give you an aesthetically pleasing breast.

Johnny Franco, MD, FACS
Austin Plastic Surgeon
4.9 out of 5 stars 107 reviews


I think that sub muscular implants via the armpit incision (transaxillary endoscopic) will work very well for you.  There is no reason to place the implants on top of the muscle based on your physical activity.

Gary Lawton, MD, FACS
San Antonio Plastic Surgeon
4.9 out of 5 stars 133 reviews

Best Type of Breast Augmentation for Petite and Athletic Woman?

The majority of patients who undergo the breast augmentation procedure will be able to return to full activity without restriction, over the long-term. You may find the attached link, dedicated to patients "in competition” helpful to you. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,460 reviews

Submuscular, Silicone Cohesive Gel Breast Implants For Athletic Woman

Breast implants are usually placed underneath the muscles to ensure natural-looking results. But if you have to flex your muscles on stage as a bodybuilder, you may consider sub-glandular implants.

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 175 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.