I have to preface my remarks by stating that these are merely the recommendations that I provide to my own patients on this issue, and each person has to ask her own surgeon for his or her recommendations regarding exercise. We all have our own techniques for doing this operation, as well as our own experience with postoperative activity. Some surgeons recommend absolutely no resistance training for the pectoralis muscles at all after breast augmentation, while some allow it.I think the main rule of thumb is to understand what has been done during the surgery and what the rationale is for the postoperative recommendations based upon that. When implants are placed under the pectoralis muscles, those muscles are not completely disrupted, and they can still function. There is still quite a bit of functional attachment left along the sternum as well as along the entire upper border by the collarbone. I typically release not only the lower border of the muscle to allow it to be lifted and an implant inserted beneath, but I also release the fibers along the sternum, not completely, so as to prevent symmatia ("uniboob"), but enough to weaken that part of the muscle so that it doesn't push on and distort the implant so much. The problem with allowing too much activity of the muscle on the implant is that over time it can push downward and outward on the implant and theoretically stretch the capsule and force the implant in that direction. In reality, I have seen this happen very infrequently when reasonable activity levels are observed. In addition, I believe that textured implants are more likely to resist this type of force than smooth ones. I tell my patients to go ahead and train their pecs for tone and to maintain balanced strength around the shoulder girdle, but once they have implants in they should no longer train their pecs for hypertrophy, or overdevelopment in both size and strength, like the bodybuilders. Those girls are the one population that I almost always just recommend implants above the muscle. If you need to preserve the full form and function of your muscle, that is the only way to do so. If you decide your priority is to have beautiful breasts with implants under the muscle, there is a small trade-off that has to be made. But, as I said, it's a small trade-off. I don't think it's good to totally avoid pec exercises just because you have implants, especially if you train the other muscles around your shoulders. You need to balance the forces around that joint to avoid problems with the joint function down the line. Having said that, I think a few sets of modest bench press or push-ups per week is just fine for most women with implants. I am also a big fan of dumbbell flyes on a bench, and they don't have to be with heavy weight at all. In fact, lighter weights and allowing a short pause for full stretch at the end of the range of motion when the arms are outstretched is a really good way to keep the pecs elongated, which in turn keeps the capsule supple and prevents the pecs from becoming shortened and contracted. I have many, many patients who are competitive bodybuilders, figure and bikini competitors (some have even posted reviews on my profile here, and you could reach out to them and ask them about their experience with workouts and implants), fitness trainers, yogi's, and other competitive and non-competitive athletes, and I have used these guidelines for years without any issues. But, again, I think it's always best to check with your own surgeon first before introducing any activity or exercise after breast augmentation, as our experiences do differ, and that guides our recommendations. Good luck.
