I am considering breast implants but have some concerns with going over or under the muscle. I am a 32A and very lean. I have had two children with no plans to have any more. My concern is that I worry going under the muscle with interfere with my workouts. I have very dense chest muscles from being very active yet because I am so lean and my breast are small I wonder if there is enough tissue to go over the muscle. What should I be thinking about in my case?
Will Going Under the Muscle with Interfere with my Workouts?
Doctor Answers 12
You are ideal for a Textured Anatomic implant above the muscle.
It was people like you that convinced me to do most of my implants on top of the muscle. Before I moved to my present location, a great deal of the people who desired breast augmentation were also very athletic or used their arms a lot. When the implant is put below the muscle, it moves and flattens every time the muscle is contracted (i.e. used). This was upsetting to most. I therefore switched to a sub-glandular implant. Since a smooth implant in this position had a higher incidence of capsular contracture, I switched to a textured implant which reduced the incidence of capsular contracture back to what was found with sub-muscular implants. To further improve the result I switched to an anatomic shaped implant. This generally gives a very natural appearance and seems to be the best compromise for active people like you. Unfortunately, this implant, at the present time, only comes in a saline inflatable form. Silicone textured anatomic implants should be available soon, but no one knows when the FDA will release them. Therefore, I will frequently use a low to moderate profile round textured Silicone implant. This seems to work very well also
Muscle limitation after sub-muscular breast augmentation with implants
There is a very crude rule that essentially states that if you can pinch less than an inch of tissue from the upper portion of the breast than you should strongly consider going under the muscle.
Another aesthetic measure is that if you can see your ribs along the upper portion of your chest, then again, you should consider under the muscle. Why? Well if you don't have enough tissue to hide your ribs, you will not likely have enough tissue to hide your implant (which lies above your ribs).
Generally, if you go under the muscle, you should avoid pectoralis contraction/strengthening exercises to avoid pushing the implants to the outside of your chest. These tradiionally consist of avoiding the bench press, ped deck, butterflies, wide stance push ups. Generally these tend to not be popular with women anyway. You can usually perform all other exercises as long as they do not involve contraction of the pectoralis which will be obvious when it causes movement of the implants
Breast implant surgery is a procedure of trade-offs. You need to discuss each of your concerns and the pros and cons of each variable of the surgery. There is no right answer. Subpectoral implants do not interfer with workouts but can cause the implants to firm up and distort while contracting the pectoralis muscles. That is why they are not done in body builders or athletes who pose. On the other hand, implants on top of the muscle have a higher incidence of hardening and can look too round if there is minimal cover. In either situation,I think you can minimize each disadvantage by chosing a size and style that fits your natural breast and chest anatomy. In general, that means a flatter, smaller implant.
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Breast implants and thin patients
Thin patients with minimal breast tissue and not alot of soft tissue coverage are best to have the implants placed under the muscle. Does it interfere with workouts and strength? The literature does not support that concept. Unless you are a professional weight lifter I wouldn't think twice about lacing them in this pocket unless there were significant contraindications to do so.
Will Going Under the Muscle with Interfere with my Workouts?
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. You may want to consider above if you work out quite a bit. 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!
Breast Implant Placement and Working Out
Sub muscular Breast Augmentation and Workout?
Thank you for the question.
Based on your fitness level I would be very surprised if you have any significant adipose tissue coverage of your rib cage. This is a good problem to have unless you are seeking breast augmentation.
Although breast implants in the sub muscular ( or dual plane) position may experience “distortion” with muscle movement (workout) I still think it is in your best interests (and that of most patients seeking breast augmentation surgery) to have implants placed in the “dual plane” sub muscular position. This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).
The submuscular positioning also tends to interfere with mammography less so than in the sub glandular position. The incidence of breast implant encapsulation (capsular contraction) is also decreased with implants placed in the sub muscular position.
I hope this helps.
Breast implants under muscle will cause visible contraction during workouts
Many patients have breast implants under the muscle and do not complain about movement during workouts. However you will have very visible movement of the implant during chest exercises and this may be disturbing.
Placing the implant under your breast gland is your best option.
However, if you have so little breast tissue that the implant will be visible, another option is total submuscular breast implantation which avoids the risk of the implant slipping out from under the muscle during contraction.
In my experience, textured breast implants are firmer and more palpable that smooth breast implants. Personally in a small breasted woman who wants subglandular breast implants, I use smooth implants.
See before and after photos of breast augmentation.
Think about muscle movement
One of the problems that can occur when the implant is placed under the muscle and the muscle moves is implant displacement. What can happen is the implant is relatively stable in its encapsulated pocket. Because the inferomedial or low sternal part of the muscle is cut the muscle can ride over the implant during pectoralis contraction causing a significant distortion. Long and short of it is if your a work out queen get them over the muscle.
Consider subfascial or split submuscular
You have described the tradeoffs well for lean and athletic women. You need coverage but under the muscle poses problems with distortion of the breast with muscle activity and generally unfavorable appearance; overs look fake because there isn't enough "padding" of your own tissue. The subfascial option or the split muscle technique is often a very good choice for women in your situation.
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.