Bodybuilder needs redo breast aug that is above muscle (capsular contract). Thick strong pecs. Above or under muscle? (Photo)

Currently implants above muscle. Many doctors advising to keep them above. I am not so much concerned about under the muscle movement of implants. More concerned about how they would look under these pecs everyday life. Pec implants rather than breasts? Little breast tissue but at normal weight they looked great and natural (before contracture). When lean for competing, they look like the pictures below. Bikini covers misshape. That is very low body fat. Now 230cc. Want 330-350. Any recs?

Doctor Answers 5

Augmentation for athletes

Congrats on your hard work! You are in great shape!  Unfortunately, the downside is that the implants become more visible as you lose all your breast fat.  Implants above the muscle are even more visible, worse with saline implants.  And appear even worse if they have capsular contracture.  
I specialize in athletes.  I strongly recommend a partial submuscular augmentation with a silicone gel implant to reduce the visibility of the implant. I believe that it gives the most natural longest lasting result over your lifetime.   I also require that they will not do any weight training of the chest (pectoralis major) when this technique is performed.  With implants, the pectoralis major will contract with more force, pressing the implant down-and-out (implant malposition).  Why you may see some athletes with implants on the side of their chest. Because they keep training chest! This will require a revision surgery to correct the malposition.  If you insist on continuing to do chest training with benchpress, flys, dips, then a subglandular augmentation is what I would offer.  I don't do this to be mean.  It is only to ensure a longer lasting result, with decreased complications.  Female athletes (especially bodybuilding and powerlifters) are at the highest risk for malposition with submuscular augmentation.  
Based on your statements and photos, I think a total capsulectomy (removal of the scar capsule), explantation of the implants, conversion to a partial submuscular plane, with a silicone gel textured round implant would probably a good choice for a long lasting result. An exam would be required for final assessment.  

Please make an in-person consultation with a ABPS board certified PS to evaluate you and discuss your options.

Hope that helps and best wishes!
Dr. Morales
ABPS Board Certified
Houston, Tx

Houston Plastic Surgeon
5.0 out of 5 stars 23 reviews

Dr Kayser

Thank you for your question. I totally agree that keeping the implants above the muscle would be your best choice as this would eliminate the animation deformity that occurs with each muscle contraction if an implant is placed under the muscle. Implant exchange with an anatomical device combined with the placement of fat grafting could certainly improve the contour and due to the texturing of an anatomical implant, this may theoretically also reduce the recurrence risk of capsular contracture. One final option would be to completely remove your breasts and replace them with fat transfer, however, this could be limiting do to your lean body type. Finally, the larger you go, the more visible and palpable irregularities are likely to exist. In any case, I would recommend a consultation with a board certified plastic surgeon who is experienced in all types of breast surgery. The attached photo gallery demonstrates a patient who presented to my practice in a very similar way that you are. I hope this helps and have a wonderful day. Dr. Kayser - Detroit

Melek Kayser, MD
Detroit Plastic Surgeon
4.9 out of 5 stars 31 reviews

Options for breast implants in body builders

Body builders have a special set of trade-offs that need to be carefully considered. If you go under the muscle with a dual plane you are at high risk for animation distortion, but above the muscle with low body fat and good muscle definition looks fake. The split muscle plane was developed specifically for cases like yours, as a variation of the subfascial technique. Consider also using Strattice for better coverage and support especially  when you have capsular contracture. There are several resources on my website and we can give you references from patients in similar situations as yours.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 45 reviews

Body builder capsular contracture

To begin with awesome physique! Couple thoughts here;

Active body builders have strong pectoral muscles and switching to under them may be aggravating for you when your posing down at a competition. The implants can move from the pressure of the chest muscles when they are contracted. It's referred to as animation. 

But...we have a problem of capsular contracture which has made your breasts hard and unattractive. 

My best approach compromise considering all of the above would be removal of most or all of the capsule, implant exchange to new implants (your current implants look like saline and a switch to silicone would be helpful). Finally I would wrap your implants with stratice (a biological mesh made of porcine skin) to help prevent recurrent capsular contracture and put you on an asthma medication preventively for 3 months after surgery.

Its a challenging but fun case. Choose your surgeon wisely here though as you have little room for error with your bodybuilding passion.


David Shifrin, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 149 reviews

Bodybuilder needs redo breast aug that is above muscle (capsular contract). Thick strong pecs. Above or under muscle?

My suggestion: careful selection of plastic surgeon.  All the information in your post considered, I would likely recommend conversion to sub muscular (dual plane) plus/minus use of acellular dermal matrix.  Best wishes.

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.