What Is The Best Option For Breast Implant Placement For Someone Who Exercises A Lot?

Should someone who exercises a lot go over or under the muscle? Is there a risk of one or the other to a runner/gym goer? Will they look fake or real?

Doctor Answers 25

Breast Augmentation for bodybuilders

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.
Please take a look at the before and after photos on my website and on websites of other physicians to see the results of implants very active, muscular women with very little breast tissue prior to surgery. please also speak to several women with breast implants who particpate in bodybuilding or figure competitions

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

Breast augmentation for the athletic woman

Quick answer: gel implants on top of the muscle.

Gel implants are soft and natural and are very well tolerated over the muscle.  Your natural breast tissue is over the muscle, contained within your breast skin envelope.  Implant volume should be contained within the same space and not isolated by a layer of muscle.


Implants under the muscle are deformed with muscle activity, leading to an unnatural appearance.

Daniel Greenwald, MD
Tampa Plastic Surgeon
5.0 out of 5 stars 45 reviews

Best Breast Implant Placement Location in Weight Lifters and Active Women

All breast implants suffer from a common failing - They all ripple. To avoid such rippling from being visible and palpable in augmented breasts, surgeons must like as much tissue as they can on top of the implants. This is the prime decider in breast impant choice ( what width breast tissue do we have to fully cover an implant?) and where in the breat do we create a home for or chaen impant?(Under the breast alone or under a combined (dual plane) muscle and breast pocket. 

The vast majority of athletes do not ave argue breast and suffer from a paucity of ft tissue available to cover the implants. Placing breast implants,especially wider / larger ones solely under the breat to avoid an occasional muscle contraction is an error. To prevent an occasional abnormal pectoral is mice contraction these women are condemned to a life long ripplely breast appearance. It would be a far better compromise to put breast implants in a dual layer Coker under both the muscle and skin. The location if done well has less rippling deformities, less risk of scar around the implants (capsular contracture). The majority of Plastic surgeons think this is a good exchange and the best place for a breast implant. 

Peter A. Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Breast Implant placement in Athletic Women

This is a good question and it raises a number of important considerations. In general, athletic individuals have thinner tissues and this puts them at risk for visible rippling particularly in the upper breast. The risk of this is minimized by placing the implant under the muscle (partial submuscular or dual plane approach), however a submuscular implant can be associated with noticeable upward movement of the implant when the muscle contracts (also known as animation or muscle activation deformity). For most people this is not a major concern but it depends on your exercise activity. This activation deformity can also me minimized by preserseving as many of the lower muscle attachments as possible when placing the implant. This is not possible for all women depending on where the muscle is located in relation to their breast tissue.  Most athletic women tend to prefer more modest implant sizes so they aren't impeded in any way by a larger implant. In addition, a smaller implant will thin the tissues less and be less likely to cause visible rippling. If your tissues are already thin, then a Gel implant might be a better option for a softer more natural look. You should review all these issues with your surgeon to be sure you get the result that best fits your active lifestyle. 

Braden C. Stridde, MD
Kirkland Plastic Surgeon
4.8 out of 5 stars 53 reviews

Breast Implant Placement For Someone Who Exercises A Lot

Excellent question. Most athletic women prefer submuscular placement (since they have thinner tissue and are hence at a greater risk of rippling) of gel implants (since they provide a more natural feel). The risk of distortion with submuscular placement is not as great as the risk of rippling. To verify this is the best option for you, you will need to have an in person physical examination and consultation. Consult with 3 - 4 experienced and expert board certified plastic surgeons to explore your options.  

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.4 out of 5 stars 41 reviews

Breast implant placement

Dear patient, Placement depends on the type of implant, silicone or saline. Saline implants are placed under the muscle. Whereas silicone implants can be placed either over or under the muscle. Generally, when you do intense training or bodybuilding, silicone implants would be highly recommended when placed above the muscle. 



Teanoosh Zadeh, MD, FRCSC
Montreal Plastic Surgeon
5.0 out of 5 stars 4 reviews

Over muscle

You will get different answers to this question depending on whom you ask.  I almost always place an implant under the muscle to avoid visible rippling of the implants. This may create some distortion of the implants when you do certain exercises, such as bench pressing, but I think  the trade-off is worthwhile all things considered. It may be worth getting a few opinions from plastic surgeons to help you make  a decision you will be comfortable with.

Ronald J. Edelson, MD
San Diego Plastic Surgeon
5.0 out of 5 stars 27 reviews

Implant position in athletic women

I operate on a lot of athletic women, from distance runners to rock climbers to back country skiiers.   I put about 95% of implants under the muscle.  The technique I use positions the upper part of the implant under the muscle but the lower part is under the gland.  Most athletic women are pretty lean and the extra padding of the muscle makes the breast look and feel more natural.  Also, an under-the-muscle implant makes mammograms easier to do and read. 

The implant and breast shape are changed by contraction of the pec but unless you are on stage in a teeny weeny top and contracting your breasts (as in body building competitions) this should be a little or no consequence.  It does feel a little weird and takes some getting used to.

Under-the-muscle hurts a little bit more in the first few post op days but I think the advantages of under the muscle make the extra discomfort worth it. 

The key for you and all athletic women is not to go too big!   


Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 72 reviews

You won't notice the difference under the muscle

This always an important concept to understand before you get an augmentation.  The pros of going under the muscle if you are an A to small B cup include more coverage of the implant on top and more natural enhancement of your upper cleavage area.  Going on top of the muscle is okay by me if you are already a C cup.

None of my patients have ever complained that they lost strength or mobility in their pectoral muscles after getting implants under the muscle.  It simply does not affect your work-out or your ability to run, even long distances.  I have heard back from hundreds of my patients who are personal trainers, tri-athletes and exercise nuts who feel they haven't given up a thing with their implants under the muscle.

Phillip C. Haeck, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 37 reviews

What Is The Best Option for Breast Implant Placement For Someone Who Exercises A Lot?

Probably the best implant for someone that is very, very active is....small! I think the question of above vs below and activity really comes into play in women doing body building competition and will have the need to flex on stage wearing a bathing suit the size of a band-aid. In those patients, above is suggested. But otherwise, stay a bit on the smaller side so as to end up a small to middle C at most!

John J. Corey, MD
Phoenix Plastic Surgeon
4.6 out of 5 stars 44 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.