Weight Lifting + Breast Augmentation - What is the best placement and profile?

For most recreational, everyday exercise dual plane or half under muscle works well.

For professional body builders, usually recommend gels above the muscle to avoid displacement, animation deformity, etc.

More natural , size would be tailored to your measurements and anatomy.

An exam and consultation with a plastic surgeon is recommended to best discuss your options and expectations.

Dear tatno,

I almost always place implants submuscular. It lowers the rate of capsular contracture significantly. In addition, it looks much more natural because the muscle provides covering over the implant so its not as round on the top. I've also noticed the implants drop less over time when they are protected under the muscle.

Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Placing your implant in a subfascial position will: 1) minimize implant animation with pectoral muscle contraction and 2) give you comparable rates of capsular contracture to submuscular placement. The trade off of submuscular placement, especially in patients with little breast tissue, is the loss of the layer of pectoral muscle in helping camouflage the edges of the implant. The best profile for you would be determined by your breast dimension measurements performed by your plastic surgeon. These breast dimensions will also be your guide to implants which will look proportional and natural on you. Having noted that, I have found a moderate or moderate plus profile gives a natural breast contour in a very wide range of patients. The incision with the lowest rate of early, as well as later, complications is in the inframammary fold. All this should be discussed in detail with your plastic surgeon. Best wishes.

Your question is a very good one and a concern for many people who are heavily involved in fitness. Studies have shown that submuscular implant placement does not affect athletic performance. Given that you have very small breasts and are very thin, I believe the implant should be placed submuscularly. If a very superficial placement is chosen (i.e., above the muscle), over time this could lead to deformities in your chest. In my opinion, subfascial placement is no different from above-the-muscle placement.

When undergoing breast augmentation there are a number of choices which need to be made: saline or silicone? Volume: Larger or smaller? Incision? However, one of the most commonly debated choices is that of implants placement: subglandular/ submammary vs. subpectoral/ submuscular? While many surgeons recommend submuscular placement there are distinct differences to each approach.

Subglandular Augmentation (“overs”):

• Subglandular augmentation means place of the implant underneath the breast tissue but above the pectoralis muscle. Subglandular placement spares the pectoralis muscle which leads to reduced post operative pain/discomfort and no impact on muscle function post augmentation. Recovery is also faster
when compared to subpectoral augmentation.

• Subglandular augmentation can impact mammographic evaluation of the breast. However, as dedicated breast radiography has become more prevalent this has become less of an issue. Fellowship trained radiologists have become familiar with evaluating breasts post augmentation. It is also important to note that implant position does not interfere with visualization of breast tissue via contrast enhanced MRI (the most sensitive and specific study available for breast cancer detection).

• Studies suggest there is an increased risk of capsular contracture when implants are placed in a subglandular space.

• Aesthetically, implants placed superficial to the pectoralis major create a rounded, convex appearing breast profile. This effect is camouflaged, at least initially in larger breasted patients. However, as a woman ages fat atrophies and breast tissue descends. The result is a more noticeable implant specifically in the upper pole. Similarly, patients who have thin coverage superiorly are more likely to be able to perceive the implants and at higher risk of visible rippling.

Subpectoral Augmentation (“unders”):

• Subpectoral augmentation is technically a bit of a misnomer. Traditionally, subpectoral augmentation involves the release of the pecotralis major muscle from its lower attachments. This allows the muscle to “window-shade.” The upper hemisphere of the implant sits underneath the muscle (dual plane). This release contributes much of the discomfort encountered postoperatively by patients.

• Subpectoral implants have a lower rate of capsular contracture.


• Aesthetically, in contrast to submammary implants (which are prominent in the upper pole- especially in thinner patients), the pectoralis muscle both conceals the underlying implant and flattens the upper pole. This flattening effect creates a natural sloping as one proceeds from the upper portion of the implant to the lower portion.

• The most commonly cited drawback to sub-muscular augmentation is the animation deformity associated with contraction of the overlying muscle.

With regards to your specific question, for a professional bodybuilder whose livelihood is dependent upon appearance and performance...I would recommend pre-pectoral placement to preserve strength and avoid animation deformity.

Each approach has both costs and benefits. Patients are unique and so too is each operative plan. A potential augmentation candidate may be better suited for one approach or the other. As always, your board certified plastic surgeon can help guide you in your decision making process.

Due to fact that you are weight lifter it is better to consider placement of implants on top of muscles. We found that subfascial placement provides good, durable correction and early back to lifting. In person consultation with a board certified plastic surgeon with experience with this type of breast augmentation is recommended. Good luck.

Thank you for your question. I have been in practice for over 30 years and breast surgery and in particular, revision breast surgery is a large portion of my practice. Over the years, I have operated on many figure and fitness/body builder women and have found that the submuscular/dual plane breast augmentation is much more superior. In thin patients with low body fat, placing implants on top of the muscle often leads to significant wrinkling and also have a much higher percentage of capsular contracture/hardening. If the implants are placed higher on the chest/breast and are more of a higher profile and more cohesive, the animation deformity is much less. Although it is not perfect, it is much better than placing him on top of the muscle. I hope that helps. Best wishes to you.

builders with the above recommendations and tolerate the occasional "moving" quite well. I recommend an in person consultation with a plastic surgeon to discuss your goals and be measured. After I measure and discuss goals with my patients, we then look at pictures of women (my patients) with similar measurements with different size breast implants. They also get to see what they would look like when the breasts have fully dropped and fluffed and in clothes. You get to see actual results and the surgeon' s experience and not a virtual idea of what can be achieved. Women tell me that this process is very helpful in determining what is right for them. Dr. Ted Eisenberg, Board Certified Plastic Surgeon and Author. RealSelf Distinguished Hall of Fame Inductee. Philadelphia, Pa., USA

Generally speaking, implants are either placed in a subglandular/subfascial plane vs dual plane. When surgeons talk about "under the muscle" placement, they are generally referencing this dual plane placement. What is "best" for patients a combination of starting anatomy and goals. It is very common that women who are highly active (especially with weight lifting) have concerns about dual plane implant placement. However, whether or not you are a good candidate for subglandular/subfascial implant placement has a lot to do with your anatomy- Especially if the goal is a natural look. In very thin patients, with little breast tissue, a subfascial augmentation will result in very obvious borders of the implant with little natural transition from the chest to the breast implant. This may be softened with the addition of fat grafting, however whether this is possible is again anatomy dependent- at 5 ft 95 lbs, it may be quite challenging to find enough fat to use for fat grafting purposes. If this is the case, dual plane will result in a much more natural appearance, however there will be some degree of animation with this. If done properly, this can be kept to a minimum. The best first step is meeting with a well qualified plastic surgeon who can evaluate your anatomy and offer a solution that is tailored to you.
Sean M Fisher, MD Aesthetic Plastic Surgeon Seattle, WA

From your description a conservatively sized silicone implant placed under the muscle should help you achieve your desired look. Once healed you will be able to return to your active lifestyle including lifting weights. The under the muscle placement helps with minimizing capsular contracture occurrence. The inframammary fold is often preferred to give the surgeon the best visualization of the pocket and lower tension on the incision for optimal scar formation. I welcome you to visit us in our Houston office to learn more.