Can I go back to weightlifting/powerlifting with sub-muscular implants? What placement should I have?

Question

I've returned to weightlifting/powerlifting in the last yeat and have gained significant strength and muscle mass (165lb/5'4). I do a lot of bench press - pushups etc. Can I return to lifting fine in the future (3+months recovery). I've heard both sides from women who have implants saying absolutely yes and some who say no way. Any advice on pocket placement/profile? Ideally I would like under muscle, around 400cc, moderate "gummy" (he recommended a periaereola incision and I'm ok with that)

William Bruno, MD · Answer

There are numerous advantages to placing breast implants under the pectoral muscle. However your return to heavy weight lifting may take up to three months with this procedure. If you were to place the implants subglandular (on top of the muscle) you would return to working out much sooner but have higher risk of capsular contracture and difficulty with breast feeding and mammogram interpretation- compared to under the muscle. I hope this information helps you.Best wishes,Dr.Bruno

Luis A. Mejia, MD · Answer

hello thank you for your question and provided information as well;..based in your question its difficulted evaluate your case if the question dont have a picture, its recommended to get a consultation in personal with a plastic surgeon.

Gregory A. Buford, MD, FACS · Answer

Great question!I will have to politely disagree with the last person and say that a study at the Cleveland Clinic Foundation actually looked at pectoralis strength both before and after sub muscular placement and found that there was NOT a decrease in overall strength.  However, that study also did not look at powerlifters or professional athletes and so there might be a bit of a bias there.  That being said, I work with a large number of IFBB pro's and professional athletes and have been involved in the competitions myself.  In my experience, you should be able to go back to full capacity at least by 3 months.  I hope that helps and wish you the very best!Warmest regards,-Gregory A Buford MD FACS PCEOBoard Certified Plastic Surgeon and Author

Daniel Barrett, MD · Answer

Dear kcammie,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.Breast implant type and sizing selection is a complicated process and requires a detailed consultation that includes a discussion of your goals, a detailed examination, and a lengthy discussion. But the decision will always start and end with the patient. When it comes to sizing, we have all of our patients find 3 photos of their desired breast size. We ask for naked breast photos because clothing can obscure the true size (push up bras). Next, we consult with patients and go over the photos and take detailed breast measurements during a physical exam. Next, we using a sizing algorithm to determine a range of implants that will work based on the exam and the measurements.Lastly, during the operation, we use silicone sizers in the operating room to see how the size actually looks in the breast. We sit the patient up in the operating room, while asleep of course, and compare the sizer result with their desired look photos. If it is too small, we start the process over with a slightly larger implant. We don't stop until we get the perfect match.Of all of my breast augmentation patients, every one of them has been happy with their size due to this detailed and meticulous process. You don't want to invest time and money into a result that is either too big or too small.You should discuss your concerns with a board-certified plastic surgeon and make sure that your surgeon understands your goals.Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Keith Hodge, MD · Answer

I would suggest placing the implants above the muscle. This will avoid the possibility of having an animation deformity when flexing or working out. This will also avoid the potential of the pocket becoming larger from the repeated flexion of the pectoralis muscle. Good luck!

Ted Eisenberg, DO, FACOS, FAACS · Answer

All of my over 6000 patients have received implants behind the muscle and are able to return to full workouts. I have a couple triple crown body builders who had no problem returning to their competitions.Dr. Ted Eisenberg, Board Certified Plastic Surgeon and AuthorRealSelf Distinguished Hall of Fame Inductee

Kenneth Hughes, MD · Answer

As a bodybuilder and as an athlete who has bench pressed 600 lbs, I probably have a different view on this question.   If your goal is to become the strongest you can become, there is NO doubt that there will be a decrement in strength with submuscular augmentation.  If you have enough tissue above the muscle to camouflage the implant, then go above the muscle.  If you have very little tissue or diet down at certain times, you should consider submuscular implants with the understanding that there will be a small decrease in strength and that there may be a small chance to laterally displace the implants.  I have put submuscular implants in women who have bench pressed almost 300 lbs without ill effect, but it is always better for the patient to be fully informed. In uneventful healing, I will allow my patients to return to lifting weights in about 6 weeks following surgery.

Christine Blaine, MD, FACS · Answer

Thank you for your question.  Submuscular placed implants will not prevent you from partaking in weight lifting and/or muscle/body building activities, but some patients will elect for subglandular placed implants instead so as to avoid the higher risk for animation deformities that can occur with submuscular implants.  There is not necessarily a singular rule to help body builders decide on implant placement.  It’s a matter of patient preference, consideration of a patients anatomy and lifestyle, and a detailed consultation and preoperative assessment with your board certified plastic surgeon.As far as implant type (size, type, and profile) is concerned, the best implant for you will depend on your anatomy, cosmetic goals and quality of soft tissue coverage.  I generally recommend placing implants through an inframammary incision, as opposed to the areolar incision, to decrease the risk of developing a capsular contracture.  I hope that this helps!

Tom J. Pousti, MD · Answer

Thank you for the question. 
 There are pros and cons to the placement of breast implants in the “sub muscular” position versus the "sub glandular position”.   I think it is in the best interests of most patients (including athletes) 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)  that can be seen with breast implants placed in the sub muscular position.  
My best advice: select your plastic surgeon carefully. Make sure that he/she has significant experience achieving the types of outcomes you will be pleased with. Then, communicate your goals carefully, as  well. Working together you will come up with a good plan to achieve your goals.

Ronald V. DeMars, MD (Retired) · Answer

I inform all my patients they need to avoid any strenuous weight lifting exercises for 8 weeks after the surgery. At that time the capsule is usually strong enough to maintain good position of the implant. But I also warn them there are a certain number of patients that make such soft capsules that they will eventually push the implants into the armpits and need corrective surgery. You can preemt the issue by placing ADM support internally but that adds quite a bit to the cost of the surgery. These are choices only you can make. And of course you can just avoid chest exercises. Many of my patients do that as there is no need for a large defined pec when you have the nice roundness of the breast.

Can I go back to weightlifting/powerlifting with sub-muscular implants? What placement should I have?

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