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

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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 123 reviews

Sub glandular implants

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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

Type of augmentation for a petite athletic woman

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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 133 reviews

Silicone gel implants (above or below the muscle) are preferred over saline implants in petite women.

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Silicone gel implants look and feel more natural than saline implants in small thin women.  A recent study concluded that rippling with gel implants was no more likely above the muscle than below it.  I think your surgeon gave you good advice.  The only obstacle you face preventing a beautiful result is capsular contracture over which your surgeon has little control.  In my experience, about 1 chance in 25 that you will have a significant contracture.

Breast augmentation placement options for petite woman

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It’s hard to say without a photo which placement fits you the best. There are various factors regarding how you want your breasts to look and feel, but if you and your doctor have a good, open line of communication, you shouldn’t need to go back and forth on your decision.

A major factor that effects how breast implants look and feel is whether they're inserted over or under the chest (pectoral) muscle. Traditionally I do a submammary implant, inserting the implants under the breast tissue and over the muscle through an incision in the breast fold. The result is fabulous: perkiness with barely a trace of scar.

If you want the most natural-looking breast you'll need a subpectoral implant, in which the implant is placed under the muscle. This procedure also requires the merest incision - about three centimeters in the crease under the breast or at the edge of the nipple -- and diminishes the incidence of capsular contracture, the formation of hard scar tissue around the implant which occurs in 10 to 30 percent of cases.

Subpectoral implants aren't right for everyone, though. If you have saggy breasts, an implant placed under the muscle won't fill out that empty breast sack, and you'll get what we call the "double bubble" look, where the implant is situated next to your armpit and the breast hangs several inches below it. Instead, you can have a procedure called augmentation mastopexy, in which the implant is placed under the muscle and the skin on the breast is lifted and tightened.

In short, you must know -- realistically -- what you are starting with, as well as what you want to look like when surgery is done. Do you want a natural appearance or a round, perky look? These are some of the factors I weigh with my patients when evaluating what type of procedure to do.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Breast Implants under the muscle for an active woman

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Hi there-

Although when placed under the muscle implants MAY lead to distortion of the breast with exercise, this is only noted when the breasts are exposed (as in a tight tank top), and does not have implications for the longevity of the implants, your health or comfort, and does not affect the beauty of the outcome otherwise...

Further, when placed under the muscle, the appearance (whether during exercise or not) tends to be more natural and the feel of the breasts more soft.

Finally, the implants and your lovely outcome will last longer, and you will experience fewer risks, because of the protective effect the muscle tissue seems to have on the risk of capsular contracture and on the risk of stretching of the skin.

In my opinion and experience (I have multiple professional athletes as patients, and they all have their implants under the muscle), most women would prefer to deal with the minor possibility of some breast distortion with pectoralis contraction than with breasts that look unnatural AT ALL TIMES because the skin has been stretched by an implant on top of the muscle, or because the scar tissue has tightened around the implant.

Under the muscle would be best over the long term

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I believe that you would do best with silicone implants under the muscle. This would reduce the risks of palpability and capsular contracture. I think that you will have a better overall shape with a more natural transition from your upper chest to your breasts.

Later in life, if you need a lift, the procedure is safer as the blood supply to the breasts (which comes in large part from the underlying muscles) has been preserved and shaping of the breasts can be accomplished with less risk of healing problems.

I tell my patients who are very active like you that they may resume all of their activities at 6 weeks except no pectoral work such as pushups and bench press. Which you won't need as your breast contour will be beautiful. Early on you can exercise by walking on a treadmill or riding a stationary bike.

Michael D. Yates, MD
Huntsville Plastic Surgeon

Muscle exercise after breast augmentation and avoiding the "fake look"

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If you are afraid of golf ball boobs, I would recommend moderate to moderate plus profile silicone gel filled prostheses placed under the muscle to soften the appearance of the implants and create a tapered look. This will mean that you will have to limit your exercises to avoid pushing the implants outward. This generallly consists of wide grip bench press, wide push ups, butterflies and the "pec deck"

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Over the muscle breast implants good for very athletic women.

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250 cc's might be a litte large for you, but otherwise your doctor's plan for your breast implants is good. Moderate plus profile, round, smooth walled, cohesive silicone gel implants should feel natural and hardly ever ripple.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Subglandular is the Appropriate Placement

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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. 

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.