Can I switch from under the muscle silicone implants to over the muscle? I have 275cc implants and have started bodybuilding.

Question

I got under the muscle 275cc Mentors silicone implants back in 2011 and now I've begun preparing for a fitness/bikini competition so I've lost 10 pounds and some breast tissue. My breast size has gone from a 36C which is what I wanted down to a 34C (I was a 34A). I'm concerned because with the chest workouts I'm doing, my implants have moved somewhat to the side and I can feel the implant bubbling a tiny bit a bit under the muscle now. I want to get back to the 36C I originally wanted.

Richard Baxter, MD · Answer

There are several options to consider but no single perfect solution for fitness competitors. Your options include under to over with subglandular placement, or subfascial placement which may add a little bit better coverage but not much. Another option is the split muscle, which minimizes animation problems but retains muscle coverage over the upper part of the implants. The larger the implants, the more likely you will have an unnatural appearance over the muscle so size and profile choice are important. A higher fill ratio implant such as Allergan Inspira might help reduce rippling.

Eugene Kim, MD · Answer

You can change planes from under the muscle to over the muscle,
especially if you are having a lot of problems with animation deformities every
time you flex your chest.The one thing
you need to consider, especially in fitness competitors, is if you are very
lean and do not have much breast tissue you may see a lot more rippling of the
implant when placed over the muscle.It
is best to follow-up with your Plastic Surgeon for more specific questions.

Nana N. Mizuguchi, MD, FACS · Answer

You will have to consider tradeoffs when you switch from under the muscle to over the muscle. Keeping the implant under the muscle will protect you from implant visibility but you may have implant animation or movement.  Going above the muscle is the opposite.  Depending on how serious you are about body building, I would discuss these risks/benefits with your surgeon.In my practice, most fitness/bikini competitors keep their implants under the muscle.Best Wishes,Nana Mizuguchi

Bradley A. Hubbard, MD · Answer

Thank you for your question. Women in the fitness/physique competitions have many issues specific to them:1. When becoming "lean" these women will lose a fair amount of breast tissue and usually need to increase implant size. Also, to be proportional to their muscle mass sometimes their overall cup size needs to be increased.2. When lean implant visibility and wrinkling become an important issue. Because of this, I would not encourage you to change implant position above the muscle. 3. Because of increased pec use and strength the implant will migrate down and out. To prevent this you could place a biologic mesh support, use a textured implant, or just accept the fact that you might need a revision more often than other women to tighten the outside of the implant pocket. 4. During workouts and competition, animation of the implant can be a problem. You could move the implant above the muscle at the cost of less natural shape and increased visibility or you could switch to a form-stable or gummy bear implant. I attached a link of a recent patient that had to increase size due to issues you described and stayed under the muscle for reasons described above. Best of luck!

Robert Najera, MD · Answer

Thank you for your questions. This a difficult question and does not have a "correct" answer. Although I agree with some of the responses that keeping the implants in the sub pectoral position is the better option to minimize wrinkling of the implants seen in the upper pole. A split muscle technique or adequate dual plane release may help minimize animations deformities. Perhaps a pocket revision with mesh reinforcement may eliminate the implants moving to the side. Good luck.

John Y.S. Kim, MD, FACS · Answer

You need to consider the risks and benefits of this.  If the animation deformity bothers you so much that you are willing to trade off the potential downsides to having a thinner soft tissue envelope over the implant (more rippling, palpability, contour irregularities), then that is an option.  Your PS can assess the degree of coverage you currently have.  There are also ways to mask some of the rippling with potentially fat grafting or ADM as well but these would be more complex procedures with their attendant risks as well.

Ciro Adamo, PhD, MD · Answer

It is technically possible to change the pocket of the implants and place them above the muscle. In practice, this is rarely done, as it tends to increase the visibility of the implants and the risk of rippling. With body builders, it is a fine balance and a very personal choice. Highly cohesive silicone implants can be placed in subglandular pockets, but it is important to be conservative about their size. As for going back to 36C from the current 34C, it must be noted that 36 is the measure of the band (your chest right under the breasts) and that is not generally affected by a breast enlargement. The reason why you went from 36 to 34 is probably your weight loss.

Scott L. Replogle, MD (retired) · Answer

I would agree with Dr. Baxter. A dual-plane release of the pectoralis muscle out of the lower pole of the breast should solve or minimize the animation problems but retain the padding and protection of the implant over the medial side and upper pole. This is the best overall solution for breast implants in body builders.

Can I switch from under the muscle silicone implants to over the muscle? I have 275cc implants and have started bodybuilding.

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