Will Going Under the Muscle with Interfere with my Workouts?

Question

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?

Otto Joseph Placik, MD · Answer

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

Lewis Albert Andres, MD · Answer

Hello! Thank you for your question!  Breast augmentation is a procedure often sought by women to increase size, add upper pole fullness and projection along with improve shape and symmetry of her breasts.  Women who have the breast augmentation done report increased self-confidence, self-esteem, and more comfortable with her body. In fact, it has been the most popular procedure in plastic surgery in the US for the past few years.  In general, implant size does not correlate with cup size. The cup size itself will vary from manufacturer to manufacturer as well as who is doing the actual measurements. Thus, cup size or implant size is never a reliable indicator for your breast size. I typically encourage my patients not to communicate her desires in cup size but more on the actual look and appearance.  Your breast width is the most important measurement.  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!

Richard Baxter, MD · Answer

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.

Scott C. Sattler, MD, FACS · Answer

Without the benefit of seeing your photos- you described yourself as thin and active. I'd say the safest place for your breast implants would be behind your pectoral muscles. For a variety of reasons, implants seem to perform better and last longer in the sub-pectoral position. In addition, your long-term 'look' after augmentation will likely be better.
There are varying opinions on this issue- which I'm sure you'll hear about. If you are fit and have tight pectoral muscles, it will take some time for the pectoral muscle to relax with the implant beneath them. Consequently, your implants will sit fairly 'high' on your chest wall for a few weeks. The pecs gradually relax and thin, and the implants settle into a better position.
I recommend to patients that do pectoral muscle exercises (bench press, push ups, flys) to curtail these movements from their exercise regimens. These movements tighten the pectoral muscles and can displace the implants out to the sides, which may be noticeable while you are performing the movement. You may also find that you are weaker when doing these types of exercises.
There is no reason why you should not be able to do other types of weight-lifting exercises with your arms, and do aerobic exercise, after your augmentation. I tell patients to wait 6 weeks after augmentation before starting to lift weights again. You can begin walking, treadmill and elliptical machines as soon as you are ready after your augmentation.

Kris M. Reddy, MD, FACS · Answer

There will be advantages and disadvantages with each breast implant placement. In person consultation and examination are advisable. Consult with 3 board certified plastic surgeons, and choose the one that best fits your needs and objectives.

Tom J. Pousti, MD · Answer

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 &ldquo;distortion&rdquo; 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 &ldquo;dual plane&rdquo; 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.

Christopher L. Hess, MD · Answer

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.

Steven Wallach, MD · Answer

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.

Robin T.W. Yuan, MD · Answer

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.

Brooke R. Seckel, MD, FACS (retired) · Answer

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.

Will Going Under the Muscle with Interfere with my Workouts?

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