Board certified PS suggested textured silicone OVER the muscle implants. I am a little worried. Any suggestion?

I have a deflated but no sagging 32B goal is 350cc implants. My torso is very small width and height (11 and 14 are some numbers he measured) . There is not much space from nipple to under the breast (6cm I think he said) so he suggested ultra high profile also. I am a bodybuilder and have quite a serious bit of pectoral muscle he said this is why he suggested over. Everything I read warns don't go over the muscle. Is textured ultra high over the muscle an ok option?

Doctor Answers 10

Breast Augmentation in a Body Builder...

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Great question -- many female body-builders get breast implants and have similar questions...

Your question involves two issues -- implant position and implant type.

First, lets talk about the position of the implant...  Being a body-builder does not preclude you from getting a sub-muscular implant -- many do so with minimal changes in overall "pec" strength, and enjoy the appearance of their sub-muscular breast augmentation.   What you do have to watch out for is an "animation effect" where the implant is displaced by the (very well-developed) muscle, but this can be minimized or prevented with careful surgical technique which your plastic surgeon should discuss with you. 

Another point about implant position is the possible negative effects of "going above the muscle".  Since body-builders have low body fat, and subsequently little breast tissue, an above-the-muscle placement can make the implant appear very prominent... I've known body-builders who have placed breast implants above the pec (and underneath the thin breast tissue and skin layer), so as to not interfere with overall muscle strength, but have been unhappy with the prominent appearance of the implant.

Secondly, lets focus on implant type.  Both round and anatomic (aka tear-drop or contoured) implants can be effective.  But there are differences in terms of how they "fill your breast" and the technique involved in placing them.  The cliffs notes version is that anatomic implants tend to provide less upper pole fulness (and subsequently less of an "augmented look") but have to be carefully placed because if they rotate, then the breast will look significantly distorted.  For this reason, anatomic implants are textured to reduce the risk of this rotation.   However, often times they are thicker and more palpable, especially if a fold develops in the implant.  Be sure to "sample" multiple implant types especially anatomic implants, if you are leaning in this direction.  Those who choose anatomic implants tend to prefer the subtle lower pole fullness look of this implant without the upper pole "augmented" look of a round implant.  However, many prefer the latter and want to appear like they have full breasts.  It's up to you.  I would definitely go over this in detail with your plastic surgeon and show multiple photographs, or utilize imaging software, or sizers to make sure you are both on the same page in terms of post-operative goals.  During the examination, the skin stretch of your breast tissue in addition to the dimensions will allow your plastic surgeon to assess whether a a Hi-Profile implant would be suitable for you.

Hope this helps.

Good luck.

Dr Markarian

Over the Muscle Implants

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Jennydancer26, every surgeon has a preference for placements of implants.  Most of us take into consideration a woman's goals, body type, breast shape, tissue quality, etc.  Yes there are pros and cons to each.  There is no "right" answer.  I'm sure he chose the over the muscle because you are a body builder.  I would probably do the same, however, I might change my mind after examining you. 

Again, there is no right answer.  Don't get carried away reading what this patient or that patient says.  Women get so much misinformation from "people".  Go for another consult if you wish with another Board Certified Plastic Surgeon, however, you might get several opinions from different surgeons.  We are going to suggest what would give you the results you want based on our experience.  It is possible to get the same results via different approaches. 

Hope this helps. 

Position of breast implants.

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There are positives and negatives to both above and below the muscle, however most implants are placed under the muscle to hide the implant under as much tissue as possible.  Done properly, a submuscular implant should not interfere with body building.  The new form stable anatomic implants can help keep the shape of the breast and may be an option for you.  A face to face examination would be necessary to provide you with the best recommendations.

Ove the muscle

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Textured implants over the muscle are an option, as smooth implants in this plane are more prone to contracture.
This plane helps remove the strong pectoralis muscle from the equation. The main disadvantage is potential implant visibility. With some of the new highly cohesive implants, maintenance of shape and decreased implant visibility are advantages.
I am not aware of a textured UHP implant. This is also an issue when the distance from the nipple to crease is short and an appropriate diameter implant is crucial or extreme upper pole fill wil result in an unnatural appearance.
good luck!

Sam M. Sukkar, MD
Houston Plastic Surgeon
4.6 out of 5 stars 40 reviews

Board certified PS suggested textured silicone OVER the muscle implants. I am a little worried. Any suggestion?

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Thank you for your question.

First, if a submuscular placement of the breast implant is properly done movement of the implant is minimal and should not interfere with body building. I have many professional body builders who have implants under the muscle.

Second, in a thin fit person with little breast tissue, placing implants under the breast creates a significant risk of the implant being visible because of lack of coverage of the implant.

Third, shaped breast implants are textured. The textured wall is much thicker than the smooth round implant wall. Thus the textured implant will feel firmer and may be more visible. If a fold develops it is very noticeable.

Ultra High profile implants are very narrow and artificial looking due to the high projection. At 6 cm you have plenty of space to fill the lower pole of your breast and yours is in the normal range.

I would get a second opinion, the online Smart Beauty Guide is a good place to start. Trust your gut feelings-I share the concern that you expressed.

Please read the following link on shaped anatomic breast implants. Also scroll down the blog section to read about breast implant porofiles and another blog about textured breast implants.


Over or under in bodybuilder

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I think implants for thin patients are best under the muscle, but body builders can be different.  The release of the muscle along the inferior pole usually does not affect strength to any significant degree.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Breast Augmentation and Bodybuilding

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Submuscular breast augmentation typically doesn't affect upper extremity strength to the point where it is an issue.  However, bodybuilders are one of the few types of patients who warrant additional consideration.  With competitive athletes sometimes even a minimal "disadvantage" in muscle function can be significant when every little bit counts.  Furthermore, the "animation deformity" that comes from having implants placed underneath the muscle may be more dramatic in patients who have well developed pectoral muscles.
Bodybuilders also tend to have a minimum amount of subcutaneous fat.  Therefore they are also a patient population in whom teardrop shaped implants might be worth considering.  The teardrop shape helps to smooth the transition onto the upper pole of the implant thereby minimizing the tendency for an obviously augmented look.

Over the muscle in a bodybuilder

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I don't think you should be too alarmed by the suggestion that your implants go in front of the muscle. About half of all breast augmentations I perform have the implants in a subglandular, pre-pectoral plane and they can give very natural results. However, I assume you have a very low body fat and would therefore I have my doubts about how natural a pre-pectoral implant will look. The thickness of your muscle can certainly make this decision quite difficult and I think you need to talk through the pros and cons with your plastic surgeon in detail. 

Textured silicone over the muscle

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Body builders are patients that you typically want to go over the muscle as the muscle is too strong to tolerate being stretched by the implant. Silicone is more natural over saline so a better choice. As for the type of implant look on line at mod plus implants and high profile implants and look at results and choose what looks better for you. I prefer non textured but each surgeon has their preferences. 

Rick Rosen, MD
Norwalk Plastic Surgeon
4.8 out of 5 stars 28 reviews

Board certified PS suggested textured silicone OVER the muscle implants. I am a little worried. Any suggestion?

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Thank you for the question.
There are pros and cons to the placement of breast implants and the “sub muscular” position versus the "sub glandular position”.    I will try to outline some of the differences here;  you may find the attached link helpful as well.
I think it is in the best interests of most patients seeking breast augmentation surgery to have implants placed in the “dual plane” or sub muscular position.  This positioning allows for more complete coverage of the breast implants leading to generally more natural feel/look  of the implants in the long-term. This position will also decrease the potential for rippling and/or palpability  of the implants (which may increase with time, weight loss, and/or post-pregnancy changes).

The submuscular positioning  also tends to interfere with mammography less so than breast implants in the sub glandular position. The incidence of breast implant encapsulation (capsular  contraction)  is also decreased with implants placed in the sub muscular position.

On the other hand,  sub glandular breast implant positioning does not have the potential downside of “animation deformity” ( movement/ distortion of the breast implants  seen with flexion of the  pectoralis major muscle)  they can be seen with breast implants placed in these sub muscular position.  

You may find the attached link,  dedicated to athletic patients and breast surgery, helpful to you as you consider options. Best wishes with your decision-making and for an oucome that you will be very pleased with. Make sure that you consider the longer-term outcome ( for example changes in body/breast with time/age) as you make your decisions.

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.