Under Muscle Breast Augmentation for Tight Pectorals?

I'd like to enhance my breasts and am looking at the options.  I am a fitness competitor and trainer and I worry about the effects of under the muscle implant placement. I have a tendency toward very tight pectorals which has resulted in some issues with my training. I am a full B cup (small C depending on the bra). I would like to go up, maybe a little more than one cup, but less than two. My sister recently got implants and her doctor does not even offer over the muscle procedure. Is this a standard in Breast Augmentation now? It seems like everything I read leans toward under the muscle. Would "unders" be an option for me with my training concerns and chronically tight pectorals?

Doctor Answers 19

Breast Augmentation for Bodybuilders - Professional Athletes, and Fitmess Models

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 

Raleigh-Durham Plastic Surgeon
5.0 out of 5 stars 89 reviews

Breast Augmentation in a Fitness Competitor or Trainer

In general, most of the time I use saline or silicone gel implants below the muscle because they have a tendency to look and feel better and mammograms are easier to perform. However, in patients who are fitness competitors and trainers, I use a subglandular breast augmentation with a silicone gel implant because of the fact that most of these patients are lean, have minimal amount of breast tissue, and don’t want their implants to move during these fitness competitions.

Rod J. Rohrich, MD
Dallas Plastic Surgeon
5.0 out of 5 stars 33 reviews

Consider subfascial implant placement

Your situation is actually common but one that requires special consideration. Traditionally, under the muscle is recommended for better coverage of the implant and more natural contours. However, athletes such as yourself are usually advised to have them over the muscle, because of the tightness of the muscle and the potential for what are called animation deformities (which is distortion of the breast with physical activity). But going over may mean that coverage isn't good because of low body fat. A good compromise is something called subfascial or split subpectoral/subfascial.

I became interested in this technique about 6 years ago specifically for athletic patients.

Richard Baxter, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 38 reviews

Subglandular Should Be Consideration

It’s not unusual for female body builders to be concerned about the appearance of their breasts. For this reason, they often request breast augmentation surgery.
Surgery in this group can be challenging for a variety of reasons. These patients often have large thick pectorals muscles that have the potential to distort the underlying breast implant when they contract. This problem is often accentuated by minimal subcutaneous and breast tissue.
It’s important to realize that each patient is unique and, for this reason, treatment needs to be individualized. In the vast majority of female body builders, submuscular breast augmentation is the treatment of choice but it’s also important to realize that exceptions do exist.
In patients who express concern about implant flattening because of contractions of their pectoralis muscles or patients who are concerned about animation deformities, subglandular placement is definitely a consideration.
Female body builders should consult a board certified plastic surgeon and thoroughly discuss these issues. Based on these discussions, a treatment plan can be formulated that addresses unique anatomic considerations and hopefully, achieve the patient’s aesthetic goals.

Under the muscle vs over the muscle breast augmentation


A breast implant can be placed under the muscle, on top of the muscle under the cover of he muscle (subfascial), or over the muscle under the breast gland.  In general, saline implants should be placed under the muscle.  Some patients with very thick breast tissue may be ok with saline on top of the muscle but in general saline implants should be placed under the muscle.  Silicone implants can be placed under or over the muscle.  Very thin patients and patients that have a lot of breast laxity (ie. after multiple children or massive weight loss) should also go under the muscle with silicone.  Every one else can get silicone either under or over the muscle. The benefits of going on top of the muscle is that the pocket is not determined by the muscle connections, recovery is faster, the breast feel softer, and there is no animation (breast movement with muscle contraction)

All the best,

Dr Repta


Remus Repta, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 133 reviews

VIDEO: Dynamic animation deformity with well defined pectoralis

individuals with well developed pectoralis muscles tend to prefer over the muscle placement which can make the implants more visible. If placed under it is more likely to result in the dynamic animation deformity: see attached video

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 64 reviews

Implants in trainers

Tight or not the implants can go under the pectoralis msucles.  These are usually cut to accomodate the implants along the inferomedial aspect.  But, they might move funny especially in a weight trainer. You may want to consider above the msucle if you have enought soft tissue to cover them.

Steven Wallach, MD
New York Plastic Surgeon
4.0 out of 5 stars 22 reviews

There are trade-offs in implant techniques

In general, body builders and fitness trainers opt for implants over the muscle (subgalndular). When you contract the muscle a lot, it distorts the implants. Placing the implants under the muscle also requires cutting and dissecting muscle that may alter your normal anatomy when you pose.

If you have a significant amount of normal breast tissue (large B/ small C) then you may be able to effectively hide your implants behind your breast tissue making for a very natural result without the problems of rippling and excessive show of the implants that plagues subglandular placement in patients with a paucity of breast tissue. The breast will move more naturally since the implants will be located where the breast gland normally is located rather than under the muscle.

The trade-off is a higher risk of hardening with silicone gel implants compared to under the muscle technique. If the implants get hard, then mammograms are more difficult to obtain. There is also a risk of the silicone gel leaking into the gland itself if the bag ruptures and the leak becomes extra-capsular or migrates outside the capsule. In the end, you have to prioritize your desires and your acceptance of certain risks and side effects.

Robin T.W. Yuan, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 10 reviews

Submuscular implants are usually better

The placement of an implant partially submuscular (under the pec major) has the benefit of better mammograms than above the muscle, less edginess of the implant, less implant palpability, less capsular contracture, and a more natural long term look. Depending on how your surgeon handles the muscle, there can be more or less of an "active breast" deformity under the muscle. This is the main trade-off but usually is outweighed by the above benefits even in body builders and fitness experts. The tightness of your muscle isn't really an issue because it will relax when stretched by the implant.

You can have the implants above the muscle


It is okay to have your implants above the muscle. If they are put under the muscle, the muscle needs to be cut in order to accommodate the implant. However, if you are an athlete, then you may prefer to the have the implant placed above the muscle. Just find a plastic surgeon who is comfortable doing this procedure. Good luck.

David Shafer, MD
New York Plastic Surgeon
5.0 out of 5 stars 69 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.