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

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.

Your procedures should always be performed by a #PlasticSurgeon who is board-certified and has a great deal of experience specializing in cosmetic #surgery. You will then greatly improve your chances of getting the result you desire, and, without the need for a revision surgery. It is suggested that you look at before and after photos of the surgeons actual patients, and read patient reviews. Gathering all of this information will help you make a well-informed decision. Please be advised that each patient is unique and previous results are not a guarantee for individual outcomes. As with all cosmetic surgery, results will be rewarding if expectations are realistic. With any surgical procedure, there are some risks which your doctor will discuss with you during your consultation.

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.Best!

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.

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